J Korean Soc Radiol.  2014 Apr;70(4):251-254. 10.3348/jksr.2014.70.4.251.

Extramedullary Plasmacytoma from Bronchus Mimicking Lung Cancer: A Case Report

• Kim KS
• Hahn S
• Kim YJ
• Lkhagvadorj S

• KMID: 2041934
• DOI: http://doi.org/10.3348/jksr.2014.70.4.251

Abstract

Extramedullary plasmacytoma originating from the bronchus is a very rare condition, and the radiological diagnostic criteria for this disease are not well established due to its rarity. It often appears as a tumor with smooth margins and very rarely invades the surrounding structures. A computed tomography scan and a positron emission tomography/computed tomography scan were performed on a 71-year-old male patient who was admitted for hemoptysis. A solid mass with irregular margins infiltrating the surrounding vasculature and mediastinum was observed, and a presumptive diagnosis of lung cancer was made. However, bronchoscopy with transbronchial biopsy and immunohistochemical staining confirmed the diagnosis of extramedullary plasmacytoma. We herein present a rare case of extramedullary plasmacytoma which mimiked lung cancer.

MeSH Terms

Aged
Biopsy
Bronchi*
Bronchoscopy
Diagnosis
Electrons
Hemoptysis
Humans
Lung Neoplasms*
Lung*
Male
Mediastinum
Plasmacytoma*

Figure

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  Fig. 1 Chest posterior anterior view shows atelectasis of right middle and lower lobes.

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  Fig. 2 Chest CT scan. A. Axial image shows 5.8 × 4.8 cm heterogenous enhancing mass obstructing right bronchus intermedius and invading mediastinum. B. Coronal image shows narrowing of right main bronchus by this mass and atelectasis of right middle and lower lobes.

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  Fig. 3 Positron emission tomography CT scan. A. Axial fusion image shows increased fluorodeoxyglucose (FDG) uptakes (maximal standardized uptake value 6.9) in this mass. B. Torso maximum intensity projection image shows increased FDG uptakes in this mass and mediastinal lymph nodes.

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  Fig. 4 Bronchoscopy shows protruding round-shape mass in right main bronchus with bloody oozing.

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  Fig. 5 Microscopic images of tumor tissue sampled by bronchoscopy. A. The tumor composed of sheets of closely packed plasma cells which are characterized by an eccentric nucleus and basophilic cytoplasm. The plasma cells destroy the lung parenchyma and scattered fibrous bands course through the neoplasm (H&E, × 400). B. Immunohistochemically, the tumor cells show diffuse reactivity with monoclonal λ-light chain of the cytoplasm (IHC × 400). C. Immunohistochemically, the tumor cells show negative reaction with κ-light chain (IHC × 400). Note.-IHC = immunohistochemistry

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  Fig. 6 Follow-up chest CT axial image after 3 months shows decreased size change of this mass and partially opened bronchus intermedius.

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