Primary plasma cell leukemia (pPCL) is an uncommon disease. IgM multiple myeloma (MM) is an infrequent subtype that accounts for less than 1 percent of MM cases. IgM pPCL is quite rare with only a few cases published to date. We describe a case of a patient with IgM pPCL who initially presented with hyperviscosity syndrome requiring urgent plasma exchange. His bone marrow biopsy demonstrated t(11;14). He progressed on proteasome inhibitors, immunomodulating agents, and other chemotherapy medications but later achieved very good partial response (VGPR) to venetoclax and dexamethasone. Given the poor prognosis of pPCL, further studies using venetoclax alone or in combination with other novel agents as first-line treatment options are warranted particularly in patients with t(11;14).

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Bladder adenocarcinoma is an uncommon type of bladder cancer. Signet ring cell pathology is a rare subtype of bladder adenocarcinoma. Global incidence rates of signet ring cell adenocarcinoma of the bladder have not been established. Management of signet cell bladder cancer is challenging as it is aggressive in behavior with frequent relapse despite chemotherapy. Here we present a case of stage IV signet cell bladder cancer with retroperitoneal fibrosis treated with FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) regimen with a complete durable response.