Hepatic Plasmacytosis as a Manifestation of Relapse in Multiple Myeloma Treated With Thalidomide

Abstract

Thalidomide and its analogs have been extensively studied in patients with multiple myeloma. We present the case of a 58-year-old female patient with immunoglobulin GA-kappa multiple myeloma who was receiving thalidomide after failing an autologous transplant. She presented with profound asthenia and several space-occupying hepatic lesions, one of which was shown by a CT-guided percutaneous biopsy to be plasmacytoma. The patient then received bortezomib and had a transient response. Because thalidomide may also increase the expression of cytoadhesion molecules in myeloma cells and in the bone marrow microenvironment, it is possible that some patients with multiple myeloma who relapse on thalidomide may present with extramedullary plasmacytomas, as seen in this case. Therefore, whenever symptoms arise in patients with multiple myeloma who are receiving thalidomide, extramedullary plasmacytomas should be considered.

Extramedullary plasmacytoma, a report of five cases diagnosed by FNAC

“…All the three cases who presented with metastasis in our case series were on treatment with thalidomide. Extramedullary relapse in spite of good medullary and serological response in patients with MM on treatment with thalidomide has been reported by other authors as well 16,17 . The evidence so far suggests that the mechanism of action and effectiveness of thalidomide might depend on the site of the tumour cells.…”

“…The evidence so far suggests that the mechanism of action and effectiveness of thalidomide might depend on the site of the tumour cells. It is proposed that thalidomide possibly increases the expression of cytoadhesion molecules in myeloma cells and in the bone marrow microenvironment, thus predisposing to EMP 17 …”

Imaging Features of Extramedullary, Relapsed, and Refractory Multiple Myeloma involving the Liver Across Treatment With Cyclophosphamide, Lenalidomide, Bortezomib, and Dexamethasone

“…4 Clinically, this can manifest as extrahepatic biliary obstruction, ascites, nonobstructive jaundice, and hepatomegaly, but is more often asymptomatic. [6][7][8][9][10] On CT, focal hepatic lesions usually appear as a solid, noncalcified mass with less enhancement. 5,11 At MRI, they appear as mildly hyperintense on T2WI and hypointense on TWI, with either uniform moderate 7 to minimal enhancement 11 on postcontrast images.…”

“…6 Several case reports have described especially poor prognosis with nodular hepatic EMD. [6][7][8][9][10] There are no established guidelines regarding treatment options for EMD in MM. Therapeutic options consist of systemic treatment (eg, chemotherapy combined with novel targeted agents), radiation, surgical resection, or a combination of all three.…”

Pancreatitis aguda y lesiones ocupantes de espacio hepáticas en paciente trasplantado de médula ósea por mieloma múltiple

“…La localización hepática aparece con una incidencia del 30 al 50% en series post mórtem. Fundamentalmente se produce como infiltración difusa de predominio sinusoidal; la afectación en forma de nódulos es menos frecuente [2][3][4][5] .…”