Extramedullary Plasmacytoma Involving the Heart: A Case Report and Focused Literature Review

Guan, Xuan; Jalil, Anum; Khanal, Kishor; Liu, Baoqiong; Jain, Akriti G

doi:10.7759/cureus.7418

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…Extramedullary cardiac plasmacytoma is extremely rare in patients with MM. Cardiac involvement of MM includes pericardial effusion [ 4 ], pericardial mass [ 5 ], intracardiac mass [ 2 , 3 , 6 , 7 ], and myocardial infiltration [ 8 , 9 ]. Extramedullary cardiac plasmacytoma may be either the initial or secondary presentation of MM [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal therapy or management for intracardiac plasmacytoma is not yet well defined. Surgical resection, radiotherapy, and chemotherapy, alone or in combination, have been reported in a few cases to significantly decrease the size of intracardiac plasmacytoma and control cardiovascular symptoms but not to achieve long-term success [ 3 , 6 , 9 , 13 ]. Admittedly, the appraisal and data of therapeutic strategy and outcome are limited due to the rarity of this disease.…”

Section: Discussionmentioning

confidence: 99%

“…Extramedullary MM is distinctly uncommon in the heart, but it most often involves the upper respiratory tract, soft tissue, and gastrointestinal tract [ 9 ]. The clinical symptoms of extramedullary MM depend on the organs of involvement.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recognition of the poor prognosis of extramedullary MM, treatment and outcomes have not been fully studied. The data on chemotherapy, radiotherapy, surgical resection, and hematopoietic stem cell transplantation are limited [ 9 ]. Multimodal therapy may be associated with superior outcomes but needs adequately powered future studies.…”

Section: Discussionmentioning

confidence: 99%

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Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report

Peng

Wang

2021

BMC Surg

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Background Extramedullary intracardiac multiple myeloma (MM) is extremely rare. Patients with extramedullary intracardiac MM may suffer from a poor prognosis. Experience in the diagnosis and therapy of cardiac involvement in MM is limited. Herein, we describe a 67-year-old male with extramedullary intracardiac MM who was initially misdiagnosed with a thrombus. Case presentation A 67-year-old male was admitted for exertional dyspnea and fatigue. The patient was diagnosed with MM one year earlier and had complete remission after chemotherapy. He was implanted with a permanent pacemaker two months prior due to sick sinus syndrome. After this admission, transthoracic echocardiography (TTE) and computed tomography (CT) confirmed the existence of a large right atrial mass extending to the superior and inferior vena cava. We initially considered the right atrial mass as a thrombus and performed surgical treatment for the patient. The surgical intervention partially relieved the obstruction of the superior and inferior vena cava and improved hemodynamics. Postoperative pathological examination of the right atrial mass suggested malignant plasmacytoma associated with MM. After recovery from the surgery, the patient received one cycle of chemotherapy. A follow-up of seven months revealed that our patient was still alive with a good general condition. Conclusions Increasing the awareness of extramedullary intracardiac lesions in patients with MM is warranted. Our case confirmed that surgical intervention followed by adjuvant chemotherapy could improve the patient’s hemodynamics and achieve remission of cardiac symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report

Peng

Wang

2021

BMC Surg

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“…We searched for cases of MM with cardiac solid space-occupying lesions reported in the last 10 years on PubMed and only found 11 other cases. [3][4][5][6][7][8][9][10][11] We used a table to list the sex, age, symptoms, disease course, imaging method used for mass diagnosis, site and size of mass, treatment method, and outcome of these patients (including the current case) (Table 1). These 12 patients comprised eight males (67%) and four females (33%), with a mean age of 64. and spread along the endocardium to surrounding tissues; this leads to embolism or obstruction and corresponding clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Multiple myeloma with cardiac involvement accompanied by partial superior vena cava obstruction: A case report and literature review

et al. 2021

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Multiple myeloma is a malignant proliferative disorder of plasma cells. Extramedullary involvement of the endocardium is rare in multiple myeloma. Here, we reported a 57-year-old male, once was diagnosed with multiple myeloma. The echocardiography reveled multiple solid masses in the right atrium, along with partial obstruction of superior vena cava. The mass resection alleviated the edema of upper limbs and identified the mass as extramedullary plasmablastic transformation and endocardial involvement. We also conducted a literature review and summary analysis of space-occupying lesions in the heart in 12 patients with multiple myeloma (including the current case) in the last 10 years. Echocardiography is the preferred radiologic examination method for diagnosis and follow-up in multiple myeloma with cardiac involvement, and surgical resection is effective for alleviating symptoms.

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Cardiovascular Involvement of a CD138-Negative Anaplastic Myeloma: A Diagnostic Dilemma

et al. 2023

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Anaplastic myeloma (AM) is an extremely rare and aggressive histological variant of myeloma. It is characterized by extramedullary presentation in the young and has a poor prognosis. It can be a diagnostic challenge when myeloma is not suspected and even more when the immunophenotype is unexpected. We present a rare presentation of anaplastic myeloma with cardiovascular involvement. Though the patient did not have the typical clinical features of myeloma, except lytic lesion in the femur, the cardiac biopsy showed sheets of anaplastic cells, and some with multinucleation. There were also some areas with a more plasmacytoid appearance. The initial immunohistochemical panel was negative for CD3, CD20, CD138, AE1/3, and kappa. It was positive for lambda. This led to an extended panel which showed positivity for CD79a and MUM1 and negative for LMP-1, HHV-8, CD43, CD117, CD56, and CD30. Even the flow cytometry on the bone marrow showed a small population of atypical cells positive for CD38 and negative for CD138 with lambda restriction. This is an unusual case of anaplastic myeloma with cardiovascular involvement and CD138 negativity. This case highlights the need to add a panel of plasma cell markers when myeloma is suspected, and it is pertinent to read flow cytometry with caution to avoid missing atypical plasma cells which maybe CD38+/CD138−.

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Extramedullary Plasmacytoma Involving the Heart: A Case Report and Focused Literature Review

Cited by 3 publications

References 19 publications

Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report

Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report

Multiple myeloma with cardiac involvement accompanied by partial superior vena cava obstruction: A case report and literature review

Cardiovascular Involvement of a CD138-Negative Anaplastic Myeloma: A Diagnostic Dilemma

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