Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands

Waal, Esther G. M. de; Leene, Marnix J.; Veeger, Nic J. G. M.; Vos, Hanneke J.; Ong, Francisca; Smit, Wilma G.J.M.; Hovenga, Sjoerd; Hoogendoorn, Mels; Hogenes, Marieke C.H.; Beijert, Max; Diepstra, Arjan; Vellenga, Edo

doi:10.1111/bjh.14291

Cited by 63 publications

(48 citation statements)

References 18 publications

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“…Additionally, another potential application of MET-PET might be considered in patients with (assumed) solitary plasmacytoma. Given the fact that a substantial proportion of patients develop MM within 2 years after radiotherapy of the solitary lesion 28 , MET-PET performed at the initial presentation could contribute to detection of additional viable myeloma lesions and therefore, identify a patient subgroup benefitting from systemic therapy. Future research will clarify the role of MET-PET in this setting.…”

Section: Discussionmentioning

confidence: 99%

¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

Lapa¹,

Velloso²,

Lückerath³

et al. 2017

Theranostics

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11C-methionine (MET) has recently emerged as an accurate marker of tumor burden and disease activity in patients with multiple myeloma (MM). This dual-center study aimed at further corroboration of the superiority of MET as positron emission tomography (PET) tracer for staging and re-staging MM, as compared to 18F-2`-deoxy-2`-fluoro-D-glucose (FDG).78 patients with a history of solitary plasmacytoma (n=4), smoldering MM (SMM, n=5), and symptomatic MM (n=69) underwent both MET- and FDG-PET/computed tomography (CT) at the University Centers of Würzburg, Germany and Navarra, Spain. Scans were compared on a patient and on a lesion basis. Inter-reader agreement was also evaluated. In 2 patients, tumor biopsies for verification of discordant imaging results were available.MET-PET detected focal lesions (FL) in 59/78 subjects (75.6%), whereas FDG-PET/CT showed lesions in only 47 patients (60.3%; p<0.01), accordingly disease activity would have been missed in 12 patients. Directed biopsies of discordant results confirmed MET-PET/CT results in both cases.MET depicted more FL in 44 patients (56.4%; p<0.01), whereas in two patients (2/78), FDG proved superior. In the remainder (41.0%, 32/78), both tracers yielded comparable results. Inter-reader agreement for MET was higher than for FDG (κ = 0.82 vs κ = 0.72).This study demonstrates higher sensitivity of MET in comparison to standard FDG to detect intra- and extramedullary MM including histologic evidence of FDG-negative, viable disease exclusively detectable by MET-PET/CT. MET holds the potential to replace FDG as functional imaging standard for staging and re-staging of MM.

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Section: Discussionmentioning

confidence: 99%

¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

Lapa¹,

Velloso²,

Lückerath³

et al. 2017

Theranostics

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“…In the SEP patients, the plasmacytoma was most frequently located in the oropharynx or nasopharynx (65%). 18 …”

Section: Incidence Signs and Symptoms And Diagnostic Criteriamentioning

confidence: 99%

Solitary Plasmacytoma

Grammatico¹,

Scalzulli²,

Petrucci³

2017

Mediterr J Hematol Infect Dis

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Solitary plasmacytoma is a rare disease characterized by a localized proliferation of neoplastic monoclonal plasma cells, without evidence of systemic disease. It can be subdivided into solitary bone plasmacytoma if the lesion originates in bone, or solitary extramedullary plasmacytoma if the lesion involves a soft tissue. The incidence of solitary bone plasmacytoma is higher than solitary extramedullary plasmacytoma. Also, the prognosis is different: even if both forms respond well to treatment, overall survival and progression-free survival of solitary bone plasmacytoma are poorer than solitary extramedullary plasmacytoma due to its higher rate of evolution in multiple myeloma. However, the recent advances in the diagnosis of multiple myeloma can better refine also the diagnosis of plasmacytoma. Flow cytometry studies and molecular analysis may reveal clonal plasma cells in the bone marrow; magnetic resonance imaging or 18 Fluorodeoxyglucose positron emission tomography could better define osteolytic bone lesions. A more explicit exclusion of possible occult systemic involvement can avoid cases of misdiagnosed multiple myeloma patients, which were previously considered solitary plasmacytoma and less treated, with an unavoidable poor prognosis.Due to the rarity of the disease, there is no uniform consensus about prognostic factors and treatment. Radiotherapy is the treatment of choice; however, some authors debate about the radiotherapy dose and the relationship with the response rate. Moreover, the role of surgery and chemotherapy is still under debate. Nevertheless, we must consider that the majority of studies include a small number of patients and analyze the efficacy of conventional chemotherapy; few cases are reported concerning the efficacy of novel agents.

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“…Prognosis with SEP is good with reported overall survival rates ranging from 40 to 85% (13). It is unknown if tumor location affects the prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…It is unknown if tumor location affects the prognosis. Approximately 10 to 15% of patients with SEP ultimately develop multiple myeloma (13). Patients should be followed for development of local recurrence or plasmacytomas of other sites (10).…”

Section: Discussionmentioning

confidence: 99%

Solitary Extramedullary Plasmacytoma of the Thyroid Gland Following Head and Neck External Beam Radiotherapy

Clark

Tharmalingam

Manduch

et al. 2018

AACE Clinical Case Reports

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Objective: We report a case of a solitary plasmacytoma of the thyroid gland that was diagnosed 17 years after external beam radiotherapy for treatment of tonsillar squamous cell carcinoma in a patient on long-term immunosuppression. Although radiation exposure has been reported to be associated with solitary bone plasmacytoma, this is the first case report of an association with external beam radiotherapy and long-term immunosuppression with plasmacytoma of the thyroid. Methods: A 54-year-old man presented to the outpatient endocrinology clinic with a 2-year history of a fluctuating but progressively enlarging tender goiter. Past medical history included tonsillar squamous cell carcinoma treated with surgical resection and head and neck external beam radiotherapy 17 years previously, external beam radiotherapy for metastatic squamous cell carcinoma to jugular digastric lymph node, and long-term immunosuppression for liver transplant. Results: Fine-needle aspiration biopsy revealed numerous plasmacytoid cells. Core biopsy revealed clonal plasma cell proliferation. Computed tomography of the neck, chest, abdomen, and pelvis showed no evidence of lymphadenopathy, splenomegaly, bony lytic lesions, or other abnormalities to suggest underlying systemic lymphoma or multiple myeloma. A bone marrow aspirate and biopsy showed no evidence of a plasma cell neoplasm or B cell lymphoma. A total thyroidectomy was performed and pathology revealed diffuse plasma cell proliferation consistent with a plasmacytoma. The lesion appeared to be restricted to the thyroid gland. Conclusion: Plasmacytoma of the thyroid should be considered in the differential diagnosis of an enlarging thyroid mass in patients with previous exposure to head and neck external beam radiotherapy.

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Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands

Cited by 63 publications

References 18 publications

¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

Solitary Plasmacytoma

Solitary Extramedullary Plasmacytoma of the Thyroid Gland Following Head and Neck External Beam Radiotherapy

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Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands

Cited by 63 publications

References 18 publications

11C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

11C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

Solitary Plasmacytoma

Solitary Extramedullary Plasmacytoma of the Thyroid Gland Following Head and Neck External Beam Radiotherapy

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¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions

¹¹C-Methionine-PET in Multiple Myeloma: A Combined Study from Two Different Institutions