Bilateral Synchronous Testicular Plasmacytoma as Extramedullary Relapse in High-Risk Multiple Myeloma Patient

Case Report

Ann Hematol Oncol. 2015;2(4): 1032.

Bilateral Synchronous Testicular Plasmacytoma as Extramedullary Relapse in High-Risk Multiple Myeloma Patient

Gonzalez de la Calle V1, Alonso S1, Del Carmen S2, Dávila J1, Antúnez P2, Gomez Veiga F3, Lopez- Godino O1, Puig N1, Gutiérrez N1, Lopez-Corral L1, Ocio EM1, Caballero MD1 and Mateos MV1*

1Hematology Department, University Hospital of Salamanca-IBSAL, Spain

2Pathology Department, University Hospital of Salamanca-IBSAL, Spain

3Urology Department, University Hospital of Salamanca- IBSAL, Spain

*Corresponding author: Mateos MV, Hematology Department, University Hospital of Salamanca, Paseo de San Vicente 88-182, 37007, Spain

Received: December 19, 2014; Accepted: March 16, 2015; Published: March 18, 2015


Testicular Plasmacytoma is a very rare neoplasm, even more bilateral and synchronous forms. We report a young multiple myeloma patient, with a high risk disease early relapsing after autologous stem cell transplantation presenting bilateral and synchronous testicular plasmacytoma. In this case, implementation of PET/CT pre-allogeneic stem cell transplantation allows detecting an early and asymptomatic testicular relapse. After combination of orchidectomy, radiotherapy, chemotherapy and allogeneic stem cell transplantation, the patient is currently disease-free and alive.

Keywords: Testicular Plasmacytoma; Extramedullary disease; Multiple myeloma

Case Presentation

A 43 year-old man with no significant medical history, in September 2011, anaemia (Hb: 8.8 g/dl) and hyperproteinemia (13.6 g/dL), were detected both in a medical check-up. The patient was asymptomatic and physical examination was unremarkable, 1.75 m tall, with a BMI of 23 kg/m2. Serum protein electrophoresis and immunofixation assay demonstrated the presence of Ig G-κ monoclonal protein (7.87 g/dL). The required work-up confirmed the diagnosis of Multiple Myeloma (MM) Ig G-Kappa, ISS-2. Anaemia was the only end-organ damage sign. Bone marrow aspiration showed 70% infiltration by Plasma Cells (PC), all of them aberrant. FISH analysis showed t (4;14) and del gen RB (13q14).

Induction therapy with chemotherapy VBCMP (vincristine, BCNU, cyclophosphamide, melphalan, and prednisone) was initiated, but in the absence of response, VTD [1] (bortezomibthalidomide- dexamethasone) was administered. After five VTD cycles, Very Good Partial Response (VGPR) was achieved followed by tandem Autologous Stem Cell Transplantation (ASCT) with Mel 200 and BuMel as conditioning regimens due to the presence of highrisk features. The M-protein remained persistent (0.24 g/dL) on day 100 after second ASCT. The patient received 4 VRD consolidation cycles (bortezomib-lenalidomide-dexamethasone) achieving Immunophenotypic complete response, followed by prednisone/ interferon as maintenance.

Eleven months from second ASCT, biochemical relapse was detected. Considering that we were dealing a young MM patient early relapsing after ASCT and with high risk features, together with the availability of an HLA-identical sibling donor, we planned to give one cycle of VRD to maintain the disease under control and to immediately proceed to allogeneic Stem Cell Transplantation (allo-SCT) with reduced-intensity conditioning. Although the patient remained asymptomatic with negative examination findings, a symmetrical 18F-Fluoro-2-Deoxyglucose (FDG) uptake in the testes was identified on the PET/CT (Figure 1) performed as part of the standard work-up prior allo-SCT. Several hypoechoic nodules with hypervascularity were identified by ultrasound scan (Figure 2) and fine-needle aspiration showed infiltration by plasma cells. Immunohistochemical analysis revealed positivity for CD138 with restriction for Kappa light chain, and flow cytometry analysis confirmed also the presence of aberrant plasma cells (90%). Serum M-protein was 0.15 mg/dL, with no evidence of plasma cells in peripheral blood or spinal fluid. Bone marrow aspirate showed only 2% of plasma cells, most of them (85%) aberrant by flow cytometry and identical to those identified in the testicular biopsy (Figure 3). Therefore, an asymptomatic bilateral and synchronous testicular extramedullary relapse was diagnosed.