The association between plasmacytomas and multiple myeloma (MM) is well-described, and in about one third of the cases of plasmacytoma the additional study will lead to the diagnosis of MM. The finding of plasmacytomas in the genital tract is extremely rare, with sparse cases described in the literature, and these cases pose a challenge regarding the optimal guidance and treatment. This paper describes a case of uterine extramedullary plasmacytoma in a 79-year-old woman with complaints of postmenopausal abnormal uterine bleeding. The complementary study led to the diagnosis of uterine plasmacytoma and, subsequently, of MM. Despite the unfavorable outcome of this case, we consider pertinent to report it because it constitutes a differential diagnosis to be taken into account in the approach of pelvic masses. Palavras-chave► plasmocitoma ► mieloma múltiplo ResumoA associação entre plasmocitomas e mieloma múltiplo (MM) encontra-se bem demonstrada, e em cerca de um terço dos casos de plasmocitoma o estudo adicional conduzirá ao diagnóstico de MM. O achado de plasmocitomas no trato genital é extremamente raro, havendo um número muito limitado de casos descritos na literatura, o que dificulta concluir sobre a melhor forma de orientação e tratamento destes casos. O presente trabalho descreve um caso de plasmocitoma extramedular uterino em mulher de 79 anos estudada por queixas de hemorragia uterina anômala pós-menopáusica. O estudo complementar levou ao diagnóstico de plasmocitoma uterino e, posteriormente, de MM. Apesar do desfecho desfavorável do caso, consideramos pertinente o seu relato por se tratar de um diagnóstico diferencial a levar em consideração na abordagem de massas pélvicas.
DESCRIPTIONA Caucasian woman aged 35 years, with no relevant personal history or history of drug abuse and an uneventful pregnancy, presented in the emergency room (ER) at 34 weeks of gestation, with preterm premature rupture of membranes. On physical examination, she had elevated blood pressure and bilateral peripheral oedema. An extensive blood panel was performed, providing the diagnosis of pre-eclampsia. Four hours after admission, she had a vaginal delivery and, 36 hours later, discharged herself against medical advice. A few hours later, she returned to the ER, reporting of severe thoracic pain of sudden onset, sweating and nausea. Her vitals were within normal range, and peripheral pulses were present and symmetrical.Suspecting a pulmonary embolism, a thoracic CT was performed (figures 1-3), showing 'extensive dissection of the ascending aorta, extending from the aortic root to the origin of the celiac artery. No aneurism is observed'. The patient was transferred to our referral cardiothoracic surgery department, and submitted to an emergency replacement of the aortic root by a tubular prosthesis. The postoperative period was uneventful.Acute aortic dissection is a rare and lifethreatening condition, which can be presented in different forms and mimic other medical conditions.1 Despite its rareness, nearly half of the cases in young women occur during pregnancy, most commonly in the third trimester and peripartum. Since it requires a high level of clinical suspicion, and has an extremely high mortality rate if left untreated, this condition poses an enormous challenge, that obstetricians rarely encounter. Contributors TE admitted the patient initially. TE, AC and LC all followed the patient during the hospital stay. TE wrote the initial article, which was then revised by FF.Competing interests None declared. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed.
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