J Korean Soc Radiol.  2014 Jul;71(1):49-53. 10.3348/jksr.2014.71.1.49.

A Case of Multiple Myeloma with Extramedullary Plasmacytoma Involving the Testis and Pleura at the Time of Initial Diagnosis

• Shin M
• Chong S
• Moon YT
• Lee TJ

• KMID: 1709021
• DOI: http://doi.org/10.3348/jksr.2014.71.1.49

Abstract

Extramedullary plasmacytoma (EMP) is defined as extra-osseous proliferation of neoplastic plasma cells in multiple myeloma (MM). A 55-year-old man presented with painless swelling of his left testis. Chest imaging showed plaque-like pleural thickening in the right hemithorax, and bone imaging revealed multiple sites of bony involvement. Left orchiectomy and pleural biopsy were performed and the histologic assessment revealed a diagnosis of EMP. Although testes and pleura are rarely involved in MM, the possibility of testicular or pleural EMP should be considered when a patient with MM presents with testicular swelling or a chest imaging abnormality.

MeSH Terms

Biopsy
Diagnosis*
Humans
Middle Aged
Multiple Myeloma*
Orchiectomy
Plasma Cells
Plasmacytoma*
Pleura*
Testis*
Thorax

Figure

• 

  Fig. 1 A 55-year-old man who presented with painless swelling of the left testis. Gray-scale (A) and color Doppler (B) images of testis ultrasonography shows heterogeneous echogenicity with multiple, ill-defined, hypoechoic foci and hypervascularity in the left testis.

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  Fig. 2 Chest CT scan shows plaque-like pleural thickening in the right lower posterior hemithorax (arrows).

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  Fig. 3 A 55-year-old man who underwent left orchiectomy. A. Photograph of surgical specimen obtained from left orchiectomy shows no definite nodular or mass-like lesion in testis. B. Photomicrograph of surgical specimen obtained from left orchiectomy shows relatively uniform plasma cells with eccentrically located nuclei and the residual seminiferous tubules separated by heavy infiltrates of plasma cells (H&E, × 400). C, D. Immunohistochemical stains of surgical specimen obtained from left orchiectomy show positive reaction for cytoplasmic lambda light chain in plasma cells (× 400) (C), and negative reaction for kappa light chain in plasma cells (× 400) (D).

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  Fig. 4 Photomicrograph of biopsy specimen obtained from pleural excision shows plasma cells infiltrating the pleura (H&E, × 400).

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