Subcutaneous Plasmacytoma Metastasis Precipitated by Tunneled Central Venous Catheter Insertion

Abstract

Extramedullary plasmacytomas are tumors of monoclonal plasma cells arising within soft tissue that uncommonly occur in multiple myeloma patients. While sporadic development of these tumors at cutaneous trauma sites, including venous catheter access sites, has been reported, interventional radiologists seldom encounter this disease. Herein, we describe a case of metastatic subcutaneous plasmacytoma precipitated by tunneled central venous catheter insertion in a male patient undergoing stem cell therapy for treatment of multiple myeloma. In addition, we review the identification, diagnostic pitfalls, pathogenesis, and treatment of this rare entity.

Diagnosis of Subcutaneous Metastatic Deposits by Fine Needle Aspiration

“…In our 25 patients there was a patient with multiple myeloma, presented with cutaneous extramedullary plasmacytoma in the axillary area. This event has been rarely reported [17]. According to our experience, FNAC is a very accurate and rapid method for this diagnosis, but to the best of our knowledge this method has not been previously reported in multiple myeloma.…”

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

“…MM occurring in tissues other than bone and bone marrow are called extramedullary plasmacytoma 7 8 9 10 . It can also be defined as aggregates of plasma cells showing monoclonality occurring within soft tissue.…”

“…It can also be defined as aggregates of plasma cells showing monoclonality occurring within soft tissue. About 7% of patients diagnosed with MM have extramedullary plasmacytoma at the time of diagnosis, and about additional 6%~7% of MM patients can have extramedullary plasmacytoma over the course of disease 7 . Cutaneous plasmacytoplasma can occur from hematogenous spread or infiltration of plasma cells from adjacent structures such as bones.…”

“…Metastasis of tumor at surgical sites can occur by different mechanisms. It may be due to etiologic factors of local surgical site such as direct wound contamination and manipulation of tumor cells and systemic condition of the patient such as alteration in immune response 7 13 . A theory has been proposed to explain the immunologic process of plasmacytoma metastasis at wound sites after chemotherapy regimen.…”

Rapidly enlarging cutaneous nodules on a full-thickness skin graft following an excision of a squamous cell carcinoma – a diagnostic clue for multiple myeloma

“…Yet, malignant tumours arising in scar tissue are a well-documented phenomenon, common examples include Marjolin’s ulcers and tumour seeding from biopsy tract sites [ 8 ]. Cutaneous plasmacytomas have been reported, in known MM patients, to occur at surgical incision sites after insertion of a central venous catheter [ 9 ]. It is speculated that plasma cells expressing cytokine receptor CXCR4 interact with the inflammatory cascade released due to tissue injury, facilitating the migration of myeloma cell into the skin.…”