Disseminated plasma cell myeloma presenting as massive pleural effusion

Babu, Kanahasubramanian Anand; Sundararajan, L; Pandurangan, Prabu; Parameswaran, Ashok

doi:10.3402/ecrj.v2.27028

Cited by 3 publications

(10 citation statements)

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“…Diagnostic criteria to confirm the myelomatous etiology of pleural effusion include the detection of atypical plasma cells in pleural fluid cytology, demonstration of the monoclonal protein in pleural fluid electrophoresis (identical to serum protein electrophoresis), and histologic confirmation with pleural biopsy [6]. Our patient, however, did not fit the diagnostic criteria for plasma cell neoplasm as serum/urine protein electrophoresis, BM examination was negative and no evidence of plasmacytomas elsewhere was found.…”

Section: Discussionmentioning

confidence: 68%

“…Cardiac failure due to amyloidosis has been the most common cause for effusion in patients with PCM. A rarer mechanism occurring in less than 1% of the patients is the infiltration of pleural fluid by malignant plasma cells or direct infiltration of the pleural fluid from adjacent tissues leading to malignant MPE [6].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that it is rare for patients with PCM to present initially with MPE [ 5 ]. Diagnostic criteria to confirm the myelomatous etiology are the detection of atypical plasma cells in pleural fluid cytology, demonstration of the monoclonal protein in pleural fluid electrophoresis, which is equivalent to serum protein electrophoresis, and finally histologic confirmation with biopsy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Transient Pleural Fluid Infiltration by Clonal Plasma Cells Associated with Pulmonary Tuberculosis

et al. 2020

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Pleural effusion is a rare presentation of plasma cell myeloma, occurring in around 6% of patients during the course of their disease, most commonly as a consequence of a concurrent disease process like heart failure secondary to amyloid deposition. Direct infiltration of the pleural fluid by malignant cells leading to myelomatous pleural effusion is a rare mechanism occurring in less than 1% of patients with plasma cell myeloma, and it is associated with a worse prognosis. There are few case reports of myelomatous pleural effusion as an initial presentation of multiple myeloma. Pleural fluid infiltration by monoclonal plasma cells in the absence of an underlying plasma cell myeloma was not reported before in the literature. Tuberculosis is a known cause of polyclonal gammaglobulinemia, however few case reports described the coexistence of monoclonal gammopathy of undetermined significance and tuberculosis. Here we present an interesting case of pleural fluid infiltration by an abnormal looking clonal plasma cells associated with active pulmonary tuberculosis and parapneumonic effusion in a patient with a background of acute myeloid leukemia. Interestingly, the clonal plasma cell proliferation was confined to the pleural fluid without any evidence of an underlying plasma cell neoplasms (including monoclonal gammopathy of undetermined significance and plasmacytomas). Since our patient had an underlying meyloid neoplasm, we though about the possibility of secondary malignancy. However, in almost all patients with coexisting

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transient Pleural Fluid Infiltration by Clonal Plasma Cells Associated with Pulmonary Tuberculosis

et al. 2020

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“…It was postulated that MPE usually develops during the treatment course of MM and is associated with an extremely poor prognosis, with a median reported survival of fewer than 4 months [ 8 ]. MPE represents clinical progression of the disease in itself and is associated with less mature population of plasma cells [ 9 ]. Furthermore, it was noted to coincide with other morbid complications such as diffuse bone loss [ 10 ] and pulmonary embolism [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…MPE represents clinical progression of the disease in itself and is associated with less mature population of plasma cells [ 9 ]. Furthermore, it was noted to coincide with other morbid complications such as diffuse bone loss [ 10 ] and pulmonary embolism [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Pleural effusion in 11:14 translocation q1 multiple myeloma in the setting of proteasome inhibitor presents therapeutic complexity

Ghannam

Bryan

Kuross

et al. 2018

memo

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SummaryBackgroundPrimary malignant pleural effusion has been reported in about 134 cases of multiple myeloma (MM). Associated pleural effusions in cases of MM portend a poor prognosis and identifying them is highly relevant. Reported is the case of a man diagnosed with MM who developed primary myelomatous pleural effusion in the setting of multiple relapses and subsequent mortality within 2 months of the pleural effusion diagnosis.PresentationA 61-year-old African American man was diagnosed with MM in 2011. He received induction therapy of lenalidomide and dexamethasone and an autologous stem cell transplant in 2012. Over the next 5 years, the patient went through alternating periods of remission and relapse that were treated with two rounds of thoracic spine radiation therapy and chemotherapeutic agents. In September 2017, the patient presented with worsening dyspnea and was found to have pleural effusion. Fluid analysis showed plasma cell dyscrasia. Fluid drainage was performed, then the patient was discharged after 1 week which was followed by rapid re-accumulation of fluid and rehospitalization about 10 days after discharge. The patient passed away a few weeks after the second admission.ConclusionPleural effusion carries a differential diagnosis which may include malignancy but is commonly thought to be less specific to multiple myeloma but should still remain in the differential diagnosis. To our knowledge, this is the first case of myelomatous pleural effusion (MPE) that was reported after multiple relapses of MM. MPE is a very rare complication of MM, and its presence is a strong indicator of imminent mortality and need for comfort care in case of multiple relapses. End-stage pleural effusion in MM in the setting of proteasome inhibitor adds more therapeutic and diagnostic challenges.

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Reactive Plasmacytosis in Effusions - Not A Rare Occurrence

Naik,

Kulkarni,

Khedkar

2023

Int J Health Sci Res

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Introduction: Effusions with plasma cells are uncommon. In such effusions reactive plasma cells need to be differentiated from malignant ones. In the literature we came across a single case of plasmacytic effusion in the absence of underlying malignancy. Material and methods: A retrospective analysis of the ascitic and pleural fluid samples received for routine analysis, from Jan 2021 to Dec 2022 was done. Result: Five cases were incidentally detected to have reactive plasmacytosis in effusions, three in pleural fluid and two in ascitic fluid. Number of plasma cells varied between 2% to 30%. In all these cases thorough clinical details were obtained and relevant investigations were studied. All the cases had ailments related to hepatobiliary system. None of these cases had any features of lymphoma or plasma cell neoplasm. In all the cases plasma cells had a reactive morphology. In one of the cases the reason for reactive plasmacytosis was viral hepatitis, in another case it was suspected to be tuberculosis. In two cases some intercurrent infection could be the cause for reactive plasmacytosis in effusion. However, in one case the patient passed away before proper investigations could be made. Discussion: The mechanism for reactive plasmacytosis is not documented yet. Further studies in this regard are needed as the entity is not rare. In our study the incidence was 0.36% (5 cases out of a total of 1397 cases). Key words: Effusions, plasma cells, reactive

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Disseminated plasma cell myeloma presenting as massive pleural effusion

Cited by 3 publications

References 4 publications

Transient Pleural Fluid Infiltration by Clonal Plasma Cells Associated with Pulmonary Tuberculosis

Transient Pleural Fluid Infiltration by Clonal Plasma Cells Associated with Pulmonary Tuberculosis

Pleural effusion in 11:14 translocation q1 multiple myeloma in the setting of proteasome inhibitor presents therapeutic complexity

Reactive Plasmacytosis in Effusions - Not A Rare Occurrence

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