Pleural myelomatous involvement in multiple myeloma: five cases

Abstract

Pleural myelomatous involvement in multiple myeloma (MM) is rare, occurring in less than 1% of cases. We retrospectively studied five cases of patients with MM who developed myelomatous pleural effusions. Three men and 2 women with a mean age of 61 years presented with myelomatous pleural effusion. The pleural fluid electrophoresis revealed a peak of IgG in three cases, of IgA in one case, and of lambda light chains in one case, which were identical to that in the sera of the patients. Detection of typical plasma cells in pleural fluid cytology was contributive, and histologic confirmation by pleural biopsy was positive in four cases. Treatment consisted of chemotherapy. The clinical outcome was initially good, but relapses occurred in all cases early and were complicated by fatal infections. Myelomatous pleural effusion is a rare affection. It is usually a late complication associated with poor prognosis.

Myelomatous ascites and pleural effusion in relapsed multiple myeloma

“…Her clinical presentation was typical with worsening bone pain and classic fatigue but in about 5 months of treatment initiation, new respiratory symptoms led to the diagnosis of myelomatous pleural effusion based on a chest X‐ray, thoracentesis, and a pleural biopsy. 16 …”

Plasma cell infiltration of skin and pleural fluid: A case report on an unusual presentation of myeloma

“…Affected patients are usually resistant to treatment and often relapse in spite of receiving appropriate chemotherapy [9] . The patients may show no respiratory symptoms or may have symptoms like dull chest pain, dyspnea, dry cough which are generally seen in pleural effusion [10] . It has been observed that the disease has worse prognosis if the patients have myelomatous pleural effusion [11] .…”

Myelomatous Ascites and Pleural Effusion in Relapsed Multiple Myeloma

“…Her clinical presentation was typical with worsening bone pain and classic fatigue but in about five months of treatment initiation, new respiratory symptoms led to the diagnosis of myelomatous pleural effusion based on a chest X-ray, thoracentesis, and a pleural biopsy. [16] To help rule out secondary causes of effusion in MM such as infections, secondary tumors, renal or heart failure, ascitic fluid can be examined to calculate the serum ascites albumin gradient (SAAG) ratio, pleural fluid for pleural fluid/serum lactate dehydrogenase (LDH) ratio, adenosine deaminase (ADA) and glucose levels, and both for cell counts and cultures. [13] [17] Imaging modalities like skeletal survey, PET-CT scan and MRI are also commonly used to corroborate a diagnosis of MM bone disease and extra-medullary MM.…”