We report a case of primary multiple cutaneous plasmacytomas. without underlying multiple myeloma, treated with intralesional tumour necrosis factor-a (TNF-a). A marked reduction in tumour size, with no signiHcant adverse effects, suggests that intralesiona! TNF-a is an eflective treatment for non-solid malignant tumours. Extramedullary plasmacytoma. especially involving the skin as a primary site, has rarely been reported in the Hnglish literature. We describe the ninth reported case of tnultiple cutaneous plasmacytomas without underlying multiple myeloma. Intralesional tumour necrosis factor-s (TNF-al was used to treat this disease and Its anti-tumour effect quantitatively evaluated by comparing the tumour size and histological change before and after treatment.Case report A 7()-year-old woman presented in January 1989 with a 2-month history of painless subcutaneous nodules predominantly on the left arm. There was no relevant past or family history.On physical examination, nodules of sizes varying from U) to 60 mm in diameter were present. 11 on the extensor aspect of the left arm ( Fig. 11. two on the dorsum of the left foot, and two on the face. These subcutaneous nodules were well-demarcated, firm and movable over the underlying tissues. The surface of the nodules was skin-coloured or slightly erythematous. There was no bone tenderness or lymphadenopathy. I'hysical examination was otherwise normal. Results of a full blood count and serum biochemistry were within normal limits. Bence Jones protein was not detected in the tirine. The serum levels of imnuuioglobtiHns were: IgG (1960 mg/dl), IgA (128 mg/dl) and IgM (lOO mg/ dl). X-rays of the skull, spine and extremities revealed mild osteoporosis, but were otherwise normal. A bonemarrow-biopsy specimen showed slight hypocellularity, but there were no abnormal cells.A biopsy specimen taken from a nodule on the left arm Correspondence: Professor H.Ogawa,
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