Plasmocytoma of Lymph Nodes: A Rare Extramedullary Involvement of Multiple Myeloma

Case Report

Austin J Clin Case Rep. 2019; 6(4): 1156.

Plasmocytoma of Lymph Nodes: A Rare Extramedullary Involvement of Multiple Myeloma

Naoufal AS1*, Abdelkhalak MA1, Naoual EL1, Jihane SM1, Amal CH1, Fadoua ME1, Mohamed JI1, Jamal FA1, Mohamed Amine ES2 and Mohamed OU2

¹Department of Internal Medicine, Mohamed V Military Hospital, Faculty of Medical Sciences, University Mohammed V Rabat, Morocco

²Department of Histopathology, Mohamed V Military Hospital, Faculty of Medical Sciences, University Mohammed V Rabat, Morocco

*Corresponding author: Naoufal AS, Department of Internal Medicine, Mohamed V Military Hospital, Faculty of Medical Sciences, University Mohammed V Rabat, Morocco

Received: September 10, 2019; Accepted: October 17, 2019; Published: October 24, 2019

Abstract

Multiple myeloma is a disseminated malignant disease in which a clone of transformed plasma cells proliferates in the bone marrow, disrupting its normal functions and invading the adjacent bone. However, in rare cases, patients can develop extramedullary disease.

The involvement of lymph nodes is a rare condition that illustrates the diagnostic challenge that practitioner could face sometimes in their daily routine.

Here, we report a case of a 66-year-old female patient who was admitted to our hospital for further examination of chronic fever and palor. A computed tomography (CT) revealed retroperitoneal and mesenteric lymph node enlargement. Biopsies of the cervical lymph node showed a plasma cell infiltrate positive for, CD138, kappa light chain.

Multiple myeloma with lymph nodes extramedullary localization was diagnosed.

Our case demonstrates a rare presentation of extramedullary involvement of multiple myeloma, which it could have been misdiagnosed with lymphoid malignancy.

Keywords: Multiple myeloma; Extramedullary; Computed tomography (CT); Lymph node

Background

Multiple myeloma (MM) is characterized by a proliferation of malignant plasma cells with strong dependence on the bone marrow (BM) microenvironment [1]. Although it usually is confined to the bone marrow and surrounding bones, some patients develop extramedullary disease (EMD) in the form of soft tissue plasmacytomas [2]. EMD involves commonly the upper respiratory tract, the gastrointestinal tracts, skin, and lung [3,4] and in rare cases lymph nodes (less than 1% of all EMD) [5]. Here, we present the case of a patient with EMD involving the cervical thoracic, and the abdominal lymph nodes at the time of MM diagnosis.

Case Presentation

A 66-year-old woman who initially presented with arthralgia and fever reported to have been appearing over the previous two months. The patient had neither any remarkable past medical history, nor a family history relevant to such a complaint.

On physical examination, palpable left subclavicular and axillary lymph nodes with hepatomegaly and splenomegaly were noted.

Cervical, thoracic and Abdominal computed tomography showed submandibular, axillary, mediastinal and abdominal lymphadenopathy (the largest lymph node was 23mm in diameter) (Figure 1).

Citation: Naoufal AS, Abdelkhalak MA, Naoual EL, Jihane SM, Amal CH, Fadoua ME, et al. Plasmocytoma of Lymph Nodes: A Rare Extramedullary Involvement of Multiple Myeloma. Austin J Clin Case Rep. 2019; 6(4): 1156.