Retroperitoneal laparoscopic management of a solitary extramedullary plasmacytoma associated with human immunodeficiency virus infection: A case report

Abstract

Abstract. Extramedullary plasmacytoma (EMP) is a rare malignant tumor that is characterized by a malignant plasma cell neoplasm. Such neoplasms in human immunodeficiency virus (HIV)-infected patients are extremely rare. To the best of our knowledge, the present study describes the first case of a solitary adrenal EMP in a patient with HIV. A 35-year-old male who had been diagnosed with HIV 3 months previously presented with a 2-week history of intermittent right flank pain. Abdominal computed tomography revealed a soft-tissue density mass in the right adrenal gland area. The patient subsequently underwent a retroperitoneal laparoscopic adrenalectomy. Post-operative pathological diagnosis revealed a solitary EMP. Although the patient refused to undergo post-operative radiotherapy and chemotherapy, no recurrence was detected after 2 years of follow-up. The present case illustrates the fact that this rare type of solitary EMP associated with acquired immune deficiency syndrome (AIDS) can occur in the adrenal glands, and that retroperitoneal laparoscopic resection of the tumor may be a good method to manage this condition. In addition, although rare, solitary EMP should be considered in the differential diagnosis of an adrenal mass in HIV-infected patients.

Gastrointestinal manifestations of extramedullary plasmacytoma: a narrative review and illustrative case reports

“…Intra-abdominal extramedullary plasmacytoma usually has an indolent life course and manifests by mass effect on surrounding viscera. This can present as abdominal pain, 2,3 intestinal obstruction 4,5 or hydronephrosis. 6 Intraluminal disease can also present with symptoms mimicking other common gastrointestinal malignancies, such as microcytic anaemia, melaena, 7 haematochezia, 8 intussusception, 9 localised perforation 10 or tenesmus.…”

Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation

“…Such neoplasms in this group of patients are extremely rare [9]. In addition, this tumor shows a different clinical behavior among HIV patients: occurrence in a younger age group, with a shorter latency period, with often extramedullary involvement and in a more aggressive clinical course, with a poor prognosis due to the poor immunity of the patient [9, 11–14]. Indeed, the mean of age of EMP is 60 years in noninfected patients [2], but in HIV-positive patients the mean age is 33 years [15].…”

“…EMP has been treated with surgical excision, radiotherapy, chemotherapy, or combined surgery and radiotherapy [9]. EMP is a highly radiosensitive lesion; however, no firmly dose-response relationship has been established due to small patient series and low local failure rates [6].…”

“…Plasma cell tumors are extremely rare in this group of patients [9] and it has been found that these patients are younger and they present a greater tendency to develop solitary extramedullary plasmacytoma with atypical clinical evolution and greater aggressiveness of the neoplastic process [10]. It has a shorter latency period and often has extramedullary involvement with unusual clinical presentation [11–13].…”

A Giant Solitary Adrenal Plasmacytoma in a Patient with HIV: A Rare Case Report and Review of the Literature

“…Ahmed et al [13] reported bilateral regression of the adrenal tumors with calcification and fibrosis after two consecutive autologous hematopoietic stem cell transplantation. Cao et al [14] reported the first case of extramedullary plasmacytoma involving the adrenal gland in an HIV-positive 35-year-old male patient. Of the six cases that have reported follow-up data on adrenal EMP, the follow-up ranging was from 12 to 72 months, with no recurrences.…”