A rare extramedullary involvement in myeloma: lung parenchyma and association with unfavorable chromosomal abnormalities

Abstract

Although pulmonary complications developing secondary to lung infections and involvement in ribs occur frequently in multiple myeloma (MM), involvement of the lung parenchyma is quite rare. In clinical studies, the involvement of lung parenchyma has been found to be associated with unfavorable prognosis. Here, a MM case in whom involvement of lung parenchyma was accompanied by unfavorable prognostic cytogenetic markers is presented. A 62-year-old male presented with complaint of cough, and heterogeneous hypodense mass was detected in thorax computerized tomography. The patient underwent bronchoscopic biopsy. Pathological examination revealed diffuse plasma cell infiltration staining with kappa immunohistochemically. In bone marrow biopsy, plasma cell infiltration was observed. In conventional cytogenetic examination, hypodiploidy was established. In cytogenetic examination carried out with fluorescence in situ hybridization, deletion (13q) was determined. In conclusion, in patients diagnosed with MM and presenting with pulmonary mass lesion, lung involvement associated with plasma cell infiltration should also be considered in the differential diagnosis. As overall survival is low in these cases, more aggressive treatment approaches such as high-dose treatment should be immediately considered. (Turk J Hematol 2010; 27: 109-12) Key words: Myeloma, pulmonary involvement, prognostication, cytogenetics, molecular genetics, del(13q), hypodiploidy Received: May 7, 2008 Accepted: January 7 2009 ÖzetMultipl miyelomda (MM) akciğer enfeksiyonları ve göğüs kafesi kemiklerinde tutuluma bağlı gelişen pulmoner komplikasyonlar sıkça görülmesine karşın, akciğer parankim tutulumu oldukça nadirdir. Yapılan klinik çalışmalarda akciğer parankim tutulumunun kötü prognoz ile ilişkisi bulunmuştur. Burada akciğer parankim tutulumuna olumsuz prognostik sitogenetik belirleyicilerin eşlik ettiği bir MM olgusu sunulmaktadır.