Primary pulmonary plasmacytoma presenting with rare IgG lambda monoclonal gammopathy

BMJ Case Rep. 2019 Mar 6;12(3):e227514. doi: 10.1136/bcr-2018-227514.

Abstract

Extramedullaryplasmacytoma (EMP) represents a peculiar and typically progressive malignancy that can originate outside the bone marrow. Primary pulmonary plasmacytoma (PPP) is a rare subset of EMP, confined to the lung. A 55-year-old man, diabetic, non-smoker presented to our clinic with a right chest wall swelling. A routine chest radiograph showed a well-circumscribed opacity in the right upper lung zone. A CT of the chest revealed a large right upper lobe mass with extensive local infiltration. Biopsy and immunohistochemical evaluation led to a diagnosis of PPP. Screening for multiple myeloma was negative. Serum immunofixation showed an IgG lambda monoclonal gammopathy, found in a minority of PPP patients. In view of disease extent, treatment with chemotherapy and radiotherapy was initiated. The patient is currently in out patient follow-up and has shown a favourable response to the treatment with a considerable decrease in serum IgG levels.

Keywords: lung cancer (oncology); malignant and benign haematology.

Publication types

  • Case Reports

MeSH terms

  • Aftercare
  • Chemoradiotherapy / methods
  • Humans
  • Immunoglobulin G / blood
  • Lung / diagnostic imaging
  • Lung / pathology
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / immunology
  • Lung Neoplasms / pathology*
  • Male
  • Middle Aged
  • Multiple Myeloma / diagnosis
  • Neoplasms, Plasma Cell / diagnosis
  • Neoplasms, Plasma Cell / immunology
  • Neoplasms, Plasma Cell / pathology*
  • Paraproteinemias / blood
  • Paraproteinemias / immunology
  • Paraproteinemias / pathology*
  • Plasmacytoma / drug therapy
  • Plasmacytoma / metabolism
  • Plasmacytoma / pathology*
  • Plasmacytoma / radiotherapy
  • Rare Diseases
  • Treatment Outcome

Substances

  • Immunoglobulin G