J Korean Soc Radiol.  2010 Apr;62(4):365-368. 10.3348/jksr.2010.62.4.365.

A Case of Mediastinal Extramedullary Plasmacytoma Associated with Multiple Myeloma

• Min JH
• Kim TS
• Ko YH
• Kim KH

• KMID: 1460070
• DOI: http://doi.org/10.3348/jksr.2010.62.4.365

Abstract

Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 x 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

MeSH Terms

Humans
Lymphoma
Male
Mediastinum
Middle Aged
Multiple Myeloma
Neoplasms, Glandular and Epithelial
Plasmacytoma
Pleura
Pleural Effusion
Skull
Spine
Thymus Neoplasms
Tomography, X-Ray Computed
Neoplasms, Glandular and Epithelial
Thymus Neoplasms

Figure

• 

  Fig. 1 A 45-year-old male patient with multiple myeloma associated with an extramedullary plasmacytoma in the anterior mediastinum. A. Spinal MRI shows a soft tissue mass (arrowheads) involving the T12 vertebral body on the gadolinium-enhanced T1-weighted sagittal image. Note the compression of the adjacent spinal cord by the epidural mass. B. The posteroanterior chest radiograph shows bilateral mediastinal widening, which is suggestive of a large mediastinal mass. C. The postcontrast CT scan reveals an 11 × 4.5 cm-sized, anterior mediastinal mass that shows mild contrast enhancement. Additionally, several small pleural nodules (arrows) with small bilateral pleural effusions are also noted. D. Photomicrograph of the biopsy specimen obtained from the anterior mediastinal mass shows neoplastic myeloma cells, and this represents an extramedullary plasmacytoma. (H & E stain, ×200) (Inset: The tumor cells are strongly positive for lambda light chains on immunohistochemical staining). E. The gadolinium-enhanced T1-weighted coronal image of brain MRI reveals a slightly heterogeneous, enhancing calvarial plasmacytoma with intra- and extracranial extensions (arrows).

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