Diverse Roentgenographic Manifestations of the Rare Pulmonary Involvement in Myeloma

doi:10.1378/chest.102.3.946

Chest

Volume 102, Issue 3, September 1992, Pages 946-948

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Roentgenographic manifestations of two cases of pulmonary involvement with myeloma were presented. One showed a nodular mass lesion extending from an extramedullary mediastinal plasmacytoma into the lung parenchyma while the other showed diffuse reticulonodular infiltrate by myeloma cells in association with alveolar septal amyloidosis. These two cases demonstrate the extreme variability of pulmonary involvement by myeloma, which can mimic a solitary tumor or an inflammatory infiltrate.

Section snippets

Case 1

A 74-year-old previously healthy man developed some wheezing and vague chest discomfort for about ten days and had a routine chest roentgenogram taken that showed a well-demarcated opacity in the right infrahilar region encroaching on and circumferentially enveloping the right middle and lower lobe bronchi (Fig 1). Findings from the review of his systems were otherwise essentially unremarkable. A bronchoscopy revealed that the right main-stem bronchus appeared to be involved by a mass lesion.

Discussion

Pulmonary involvement in myeloma is so rare that no attention has been paid to such occurrence in several large series.2, 8 Kintzer et al⁹ found that 46 percent of patients in a series of 958 cases had thoracic involvement by myeloma. Most of them showed bone involvement or pulmonary infiltrate secondary to an infectious process. Only 11 patients developed extramedullary plasmacytoma in the thorax, and four patients had pulmonary infiltrate suggestive of myeloma cell infiltrate (only one

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A case of Multiple Myeloma with lung plasmacytoma
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Multiple Myeloma (MM) is a malignant proliferation of the plasma cells mainly affecting bone marrow. Most common sites of extramedullary dissemination reported in the literature are skin, liver, kidneys and central nervous system. Multiple Myeloma is rarely associated with lung plasmacytoma. In fact; dissemination of MM in lung is relatively uncommon being described in only 5% of cases and therefore the diagnosis of this entity can be misleading to most clinicians. We report a rare case of lung plasmacytoma with MM in a 65-year-old, smoker, male who presented with shortness of breath and a heterogeneous mass involving the lower left lobe visualized on CT scan. Careful integration of the clinical manifestations with the radiological and pathological data from CT-guided transparietal lung biopsy and bone marrow biopsy led to the diagnosis of Multiple Myeloma with lung plasmacytoma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among pulmonologists, in order to provide more timely diagnosis.
Lymphoproliferative lung disorders: A radiologic-pathologic overview. part ii: Neoplastic disorders
2013, Seminars in Ultrasound, CT and MRI
Citation Excerpt :
On CT, extramedullary metastatic deposits in the chest may rarely manifest as lung nodules, hilar and mediastinal lymphadenopathy, ground-glass opacities, interlobular septal thickening, or air-space consolidation, similar to pulmonary lymphoma.65,66 The parenchymal pulmonary abnormalities of patients with MM are usually related to alveolar septal amyloidosis, plasma cell infiltration, accumulation of alveolar paraproteins, and metastatic calcification of the alveolar walls and blood vessels.67 Marmor et al.68 reported SDRA associated with MM secondary to neoplastic plasma cells infiltration.
Lymphoproliferative pulmonary neoplasms can occur as primary pulmonary lymphomas or because of secondary pulmonary involvement. Neoplastic disorders may be difficult to differentiate from reactive pulmonary lymphoproliferative disorders, and immunohistochemical evaluation is often required to differentiate the 2 types of lesions.
Neoplastic lymphoproliferative disorders are monoclonal lesions. Most affected patients present with systemic complaints, and imaging findings typically include nodules, masses, and lymphadenopathy.
Primary pulmonary lymphomas are rare and account for less than 4% of the lymphomas that arise in extranodal sites. Secondary pulmonary lymphomas can affect the lung via hematogenous dissemination or by secondary involvement from tumor in adjacent or contiguous sites. Neoplastic lymphoproliferative lesions also include leukemia and plasma cell neoplasms. Posttransplantation lymphoproliferative disorders constitute a special type of lymphoid proliferation occurring in the setting of the chronic immunosuppression required for solid organ and bone marrow transplantation.
A rare cause of superior vena cava syndrome: Extramedullary plasmocytoma
2011, Revue de Pneumologie Clinique
Nous rapportons l’observation d’un homme de 79 ans pour lequel les investigations d’un syndrome cave supérieur ont abouti à la mise en évidence d’un plasmocytome extramédullaire. Parmi les modes d’expression des néoplasies plasmocytaires, le plasmocytome extramédullaire (PEM) est celui le moins fréquemment rencontré. La localisation médiastinale des PEM est rare et le caractère compressif de celle-ci exceptionnel. Autre particularité de notre observation, le PEM était associé à un authentique myélome multiple à chaînes légères kappa.
We report the case of a 79-year-old man for whom investigations of superior vena cava syndrome have revealed extramedullary plasmocytoma. Extramedullary plasmocytoma (EMP) is the less frequent form of plasma cell neoplasms. The mediastinal location of EMP is rare, and its compressive nature is exceptional. Another particular feature we observed is that the EMP was associated with an authentic kappa light chain multiple myeloma.
Lambda light chain multiple myeloma presenting as pleural mass
2011, Respiratory Medicine CME
Citation Excerpt :
Sites such as lymph node, thyroid, intestinal tract, ovary, kidney, and skin were reported to be involved by myeloma cells by Hellwig.10,11 Intrathoracic involvement in multiple myeloma is very rare.12,13 Myeloma cells may involve lung parenchyma in form of lung mass14,15 or pulmonary nodules.16
Light chain multiple myeloma occurs in 20% of multiple myeloma cases. Extramedullary dissemination of multiple myeloma is rare and involvement of pleura by it is even more rare. A 40 years old female patient presented with complains of recurrent vomiting for last 2 months and cough with expectoration for last 1 week. Chest X-Ray (PA view) showed a rounded homogenous opacity in mid zone of left lung field. CECT (thorax) showed pleura based soft tissue density mass lesions overlying apicoposterior segment of left upper lobe and lingular lobe with lytic destruction of underlying 2nd rib. Ultrasound scan of abdomen was normal. CT guided FNAC from soft tissue mass lesion of left side revealed atypical plasma cells, some of them were binucleate and few appear pleomorphic. Bone marrow aspiration showed 20% atypical plasma cells. Serum protein electrophoresis revealed a thin discrete band in gamma globulin region, while serum immunofixation electrophoresis showed presence of lambda light chain band only, with absence of kappa band, IgG band, IgM band and IgA band. Patient was diagnosed as a case of lambda light chain multiple myeloma with extramedullary dissemination to pleura presenting as pleural mass.
Lung involvement in lymphoid and lympho-plasmocytic proliferations (except lymphomas)
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Les manifestations pulmonaires non-infectieuses observées au cours des hémopathies lymphoplasmocytaires autres que les lymphomes sont mal connues et ont rarement fait l’objet de publications dédiées.
Le but de ce travail est donc de faire le point, à travers une revue de la littérature, sur les différentes manifestations pulmonaires spécifiques décrites au cours de ces hémopathies. Seront ainsi abordées la leucémie aiguë lymphoblastique, la leucémie lymphoïde chronique et la leucémie à tricholeucocytes, ainsi que les proliférations plasmocytaires telles que le myélome, le syndrome de POEMS et la maladie de Waldenström.
Les atteintes pulmonaires associées aux hémopathies lymphoïdes sont variées et leur caractérisation doit faire envisager des techniques diagnostiques parfois invasives.
The non infectious pulmonary manifestations occurring in lymphoplasmocytic proliferations others than lymphomas are poorly understood and have rarely been the object of dedicated publications.
The purpose of this work is to review the literature of the various specific lung manifestations occurring during these malignant haematological diseases. We will also consider acute lymphoblastic leukaemia, chronic lymphocytic leukaemia and hairy cell leukaemia, as well as malignant plasmocytic disorders such as myeloma, POEMS syndrome and Waldenström's macroglobulinaemia.
During the course of lymphoplasmocytic diseases, lung manifestations are variable and sometimes require invasive techniques for definitive diagnosis.
Atypical manifestations of multiple myeloma: Radiological appearance
2006, European Journal of Radiology
Diagnostic procedures performed on patients with multiple myeloma typically reveal lytic bone lesions, osteopenia or osteoporosis, bone marrow infiltration by plasma cells as well as overproduction of immunoglobulin or light chains in the serum or urine. Skeletal manifestations are extremely variable and the unusual forms have been described extensively. Extramedullary plasma-cell tumours (plasmocytoma) are found in about 5% of newly diagnosed patients with multiple myelomas. In this paper we present eight patients with atypical forms of multiple myeloma.

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Chest

Selected ReportsDiverse Roentgenographic Manifestations of the Rare Pulmonary Involvement in Myeloma

Section snippets

Case 1

Discussion

Dis Chest

Am J Med

Dis Chest

Am J Med

Chest

Chest

Multiple myeloma: diagnosis and management in a series of 57 cases

Ann Intern Med

Myelomatosis with extensive pulmonary involvement

Thorax

Pulmonary plasmacytoma

Am Rev Respir Dis

Selected Reports
Diverse Roentgenographic Manifestations of the Rare Pulmonary Involvement in Myeloma