Relapsed multiple myeloma manifesting as extramedullary plasmacytoma of the breast: Imaging findings

Urano, Misugi; Denewar, Fatmaelzahraa Abdelfattah; Okabe, Ryo; Komatsu, Hirokazu; Wanifuchi‐Endo, Yumi; Toyama, Tatsuya; Shibamoto, Yuta

doi:10.1016/j.radcr.2019.02.018

Cited by 9 publications

(11 citation statements)

References 9 publications

(17 reference statements)

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“…However, there are few reports about the CT findings of breast plasmacytoma. 20 Previous studies on other body parts have indicated that the imaging features of MM were nonspecific, 19 most extramedullary plasmacytomas were generally demonstrated as well-defined soft-tissue mass with homogeneous enhancement on CT examination, which was consistent with the breast mass in our patient.…”

supporting

confidence: 80%

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A Rare Case of Extramedullary Multiple Myeloma Presenting as Masses on the Breast and Chest Wall Complicated with Sjogren’s Syndrome

Yuan¹,

Lei²,

Gu³

et al. 2021

IJGM

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Multiple myeloma (MM) in the breast has been rarely documented. However, there are no reports on concurrent masses of chest wall soft tissue and breast as the primary symptoms for MM. Herein, we report a case of a 68-year-old woman presented with masses in her right breast and chest wall for 1 month. She recalled having xerophthalmia and xerostomia for 2 years without taking any test to search for the cause of these symptoms. Ultrasonography (US) and computed tomography (CT) examination revealed masses in the right breast and chest wall. Both lesions of the breast and chest wall were confirmed to be plasma cell tumors by ultrasound-guided puncture biopsy and MM was confirmed by bone marrow examination. Meanwhile, Sjogren's syndrome (SS) was diagnosed by the positive expression of antibodies against antinuclear, Ro/SSA and La/ SSB. After three courses of chemotherapy for MM, the symptoms of SS were significantly alleviated and the masses in the chest wall and breast disappeared.

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supporting

confidence: 80%

“…18 In addition, microcalcification was extremely rare in MM. 19 There are various posterior features, and the most common feature is posterior acoustic enhancement, followed by no posterior acoustic transmission, while posterior acoustic shadowing is very rare. In our patient, both the breast and chest wall masses showed posterior enhancement.…”

mentioning

confidence: 99%

A Rare Case of Extramedullary Multiple Myeloma Presenting as Masses on the Breast and Chest Wall Complicated with Sjogren’s Syndrome

Yuan¹,

Lei²,

Gu³

et al. 2021

IJGM

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“…Because mammography, US, and MRI findings may not be diagnostic, the differential diagnosis for primary carcinoma, other lymphoproliferative diseases, and even benign masses depends on histopathological evaluation [4]. Breast MM/plasmacytoma treatment depends on the systemic extent of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…MM can affect extraosseous sites as solitary lesions (extramedullary plasmacytoma) or as a presentation of MM relapse in less than 5% of cases. Moreover, MM in the breast has been rarely documented [2–4]; the first case of MM in the breast was reported in 1925 [4]. Since then, only 20 other patients with breast involvement have been documented in the literature till date [5].…”

Section: Introductionmentioning

confidence: 99%

Multiple Myeloma Breast Involvement: A Case Report

Ali

Nasir

Marzouk

2019

Case Reports in Radiology

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Multiple Myeloma involving the breast is very rare and the diagnosis is challenging because the clinical and radiological features of breast multiple myeloma are indistinguishable to other forms of breast disease whether primary or metastatic. In this article the authors report a case presented with breast masses, which were found to be extra osseous Multiple Myeloma. The patient was managed for multiple spinal lesions that were primarily thought to be metastasis from primary breast cancer.

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“…Breast involvement is rare, with approximately 63 cases reported worldwide between 1928 to 2009 [2]. The study authors found an additional 20 published reports in the literature between 2009 to 2019, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], with two retrospective institutional reviews [15,16]. Additionally, Surov et al conducted a comprehensive review of prior case reports and patients at their institution between 1997-2009, finding that 15% of breast plasmacytomas were primary lesions while 85% involved multiple myeloma [23].…”

Section: Etiology and Demographicsmentioning

confidence: 99%

Extramedullary Plasmacytoma of the breast in a patient with Multiple Myeloma

Vong¹,

Navarro²,

Darrow³

et al. 2020

Radiology Case

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Extramedullary plasmacytoma of the breast is rare. It is important to recognize the imaging findings and include it as a differential consideration in multiple myeloma patients with a breast mass. A 74-year-old woman undergoing chemotherapy for relapsed multiple myeloma presented with a palpable mass in her right breast. A screening mammogram four months prior was unremarkable. She underwent a diagnostic right mammogram which showed two well-circumscribed hyperdense masses. An ultrasound of the right breast showed mixed echogenic masses with indistinct margins and increased vascularity. Ultrasound guided biopsy confirmed the presence of an extramedullary plasmacytoma. A follow-up whole body PET/CT demonstrated an FDG-avid right breast mass with extensive osseous metastases. CASE REPORTA 74-year-old woman undergoing chemotherapy for relapsing multiple myeloma (subtype IgG Lambda) presented to her medical oncologist with a new palpable right breast lump. A screening mammogram four months prior was interpreted as normal and given a BI-RADS Category 1 (negative) final assessment (Figure 1). Kappa free light chains were significantly decreased at 0.17 mg/dL (normal 0.33 -1.94 mg/dL) and Lambda free light chains were significantly elevated at 197 mg/dL (normal 0.57 -2.63 mg/dL). Clinically, the patient had persistent whole-body aches, oral bleeding, and bone pain. The patient was then referred to the breast imaging service for further work-up. She underwent a diagnostic right mammogram which showed two well-circumscribed hyperdense massesthere were no suspicious calcifications, nipple retraction, skin thickening, or areas of architectural distortion (Figure 2). A same-day ultrasound demonstrated two mixed echogenic masses with ill-defined margins and increased vascularity (Figure 3). Primary differential considerations included plasmacytoma and primary breast cancer. Hematoma was initially considered as the patient was on anticoagulation for deep venous thrombosis prophylaxis. However, given the presence of vascularity, it was deemed unlikely. An infectious etiology (i.e., breast abscess) was also considered given the rapid increase in size over four months. This was thought to be unlikely with no clinical signs of infection and central rather than peripheral vascularity. A microscopic examination of an ultrasound guided biopsy yielded plasma cell neoplasm (Figure 5). A follow-up PET/CT

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Relapsed multiple myeloma manifesting as extramedullary plasmacytoma of the breast: Imaging findings

Cited by 9 publications

References 9 publications

A Rare Case of Extramedullary Multiple Myeloma Presenting as Masses on the Breast and Chest Wall Complicated with Sjogren’s Syndrome

A Rare Case of Extramedullary Multiple Myeloma Presenting as Masses on the Breast and Chest Wall Complicated with Sjogren’s Syndrome

Multiple Myeloma Breast Involvement: A Case Report

Extramedullary Plasmacytoma of the breast in a patient with Multiple Myeloma

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