DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200274

Myelomatous pleural effusion as an initial presenting sign in a case of multiple myeloma

Dinesh Chandra Sharma, Deepanjali Sharma

Abstract


Multiple Myeloma (MM) is a neoplastic disease which mainly affects bone marrow but rarely may infiltrate extramedullary tissues as well. Myelomatous pleural effusions (MPE) develop due to extension of plasmacytoid cell lesions of thoracic bones into pleural tissue and directly presenting as an initial sign in a case of MM is exceedingly rare. It indicates poor prognosis, resistance to treatment and more chance of relapse in spite of aggressive chemo-radiotherapy. The effusions of serous cavities in MM generally develop as a late complication of the disease like heart failure, renal failure, pneumonia and amyloidosis. We are reporting a rare case of IgG subtype myelomatous pleural effusion demonstrating abundance of plasmacytoid cells in pleural fluid. Bone marrow smear examination favoured the diagnosis of multiple myeloma with the presence of predominant population of plasma cells with high cellularity. There were also presence of a heterogenous myelomatous mass lesion in the right infratemporal fossae, multiple erosive lesions in ribs, vertebral bodies, skull and pelvic bones. Pleural fluid and serum protein electrophoresis demonstrated the presence of gamma monoclonal protein peaks confirming the diagnosis.


Keywords


Effusion, Myeloma, Plasmacytoma, Pleural

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References


Natori K, Izumi H, Nagase D, Fujimoto Y, Ishihara S, Kato M, et al. IgD myeloma indicated by plasma cells in the peripheral blood and massive pleural effusion. Ann Hematol. 2008 Jul 1;87(7):587-9.

Kamble R, Wilson CS, Fassas A, Desikan R, Siegel DS, Tricot G, et al. Malignant pleural effusion of multiple myeloma: prognostic factors and outcome. Leukem Lymp. 2005 Aug 1;46(8):1137-42.

Chang H, Chou WC, Lee SY, Huang JY, Hung YH. Myelomatous pleural effusion in a patient with plasmablastic myeloma: a case report. Diagn Cytopathol. 2009 Mar;37(3):205-7.

Sasser RL, Yam LT, Li CY. Myeloma with involvement of the serous cavities. Cytologic and immunochemical diagnosis and literature review. Acta Cytol. 1990;34(4):479-85.

Rodriguez JN, Pereira A, Martínez JC, Conde J, Pujol E. Pleural effusion in multiple myeloma. Chest. 1994 Feb 1;105(2):622-4.

Meoli A, Willsie S, Fiorella R. Myelomatous pleural effusion. Southern Med J. 1997 Jan;90(1):65-8.

Agrawal R, Kumar P. Multiple myeloma presenting as bilateral malignant pleural effusion. J Case Reports. 2012 Sep 9;2(2):48-50.

Kintzer JS, Rosenow EC, Kyle RA. Thoracic and pulmonary abnormalities in multiple myeloma: a review of 958 cases. Arch Inter Medi. 1978 May 1;138(5):727-30.

Landgren O, Kyle RA, Rajkumar SV. From myeloma precursor disease to multiple myeloma: new diagnostic concepts and opportunities for early intervention. Clini Cancer Res. 2011 Mar 15;17(6):1243-52.

Oudart JB, Maquart FX, Semouma O, Lauer M, Arthuis-Demoulin P, Ramont L. Pleural effusion in a patient with multiple myeloma. Clini Chem. 2012 Apr 1;58(4):672-4.

Kapadia SB. Multiple myeloma: a clinicopathologic study of 62 consecutively autopsied cases. Medicine. 1980 Sep;59(5):380-92.

Safa AM, Van Ordstrand HS. Pleural effusion due to multiple myeloma. Chest. 1973 Aug 1;64(2):246-8.

Ghoshal AG, Sarkar S, Majumder A, Chakrabarti S. Unilateral massive pleural effusion: a presentation of unsuspected multiple myeloma. Ind J Hematol Blood Transfus. 2010 Jun 1;26(2):62-4.