Primary cutaneous plasmacytoma. Report of a case and review of the literature

Abstract

Clinical, laboratory, and pathologic findings from a case of malignant extramedullary plasmacytoma of the skin are presented. To our knowledge, this is the 11th reported case of extramedullary plasmacytoma of the skin and the second reported case with a complete follow-up and postmortem examination. In these two cases, surgical excision of the tumor mass, radiation therapy, and chemotherapy were ineffective. At necropsy, visceral metastases were found, but there was no bone marrow involvement.

Treatment and Outcomes for Primary Cutaneous Extramedullary Plasmacytoma: A Case Series

“…It is also possible that benign plasmacytoses were included in the analysis because information about monoclonality was not available for all reported cases; that limitation is acknowledged by Muscardin et al 1 in their earlier review. Indeed, 3 of the historical patients in the review 15,16,18 could potentially have had benign tumours with plasma cell infiltrates or plasmacytic granulomas 23,26,31,32,49,68 ; diagnosis requires careful histologic and immunohistochemical analysis 9 . Exclusion of the former 3 patients does not change the survival analysis, because follow-up for them was unavailable.…”

“…Two patients received surgery and adjuvant radiation as primary treatment: the dose for one patient was unknown 17 , and it was 20 Gy in 5 fractions for the other (patient 1 in the present report). One patient received 50 Gy in 25 fractions to a left cheek primary, with no response; salvage surgery was subsequently performed 32 . As with radiation doses, chemotherapy regimens ranged widely; the most commonly used regimen was melphalan combined with a corticosteroid.…”

“…Distant skin recurrences in 5 patients were initially treated with surgery alone 32 , surgery and rt 17 , rt alone (2 patients) 2,64 , or chemotherapy alone 45 . Finally, 2 patients experienced a distant recurrence; those patients were initially treated with rt 44 or observation 58 .…”

Treatment and Outcomes for Primary Cutaneous Extramedullary Plasmacytoma: A Case Series

“…It is also possible that benign plasmacytoses were included in the analysis because information about monoclonality was not available for all reported cases; that limitation is acknowledged by Muscardin et al 1 in their earlier review. Indeed, 3 of the historical patients in the review 15,16,18 could potentially have had benign tumours with plasma cell infiltrates or plasmacytic granulomas 23,26,31,32,49,68 ; diagnosis requires careful histologic and immunohistochemical analysis 9 . Exclusion of the former 3 patients does not change the survival analysis, because follow-up for them was unavailable.…”

“…Two patients received surgery and adjuvant radiation as primary treatment: the dose for one patient was unknown 17 , and it was 20 Gy in 5 fractions for the other (patient 1 in the present report). One patient received 50 Gy in 25 fractions to a left cheek primary, with no response; salvage surgery was subsequently performed 32 . As with radiation doses, chemotherapy regimens ranged widely; the most commonly used regimen was melphalan combined with a corticosteroid.…”

“…Distant skin recurrences in 5 patients were initially treated with surgery alone 32 , surgery and rt 17 , rt alone (2 patients) 2,64 , or chemotherapy alone 45 . Finally, 2 patients experienced a distant recurrence; those patients were initially treated with rt 44 or observation 58 .…”

Treatment and Outcomes for Primary Cutaneous Extramedullary Plasmacytoma: A Case Series

“…It is also possible that benign plasmacytoses were included in the analysis because information about monoclonality was not available for all reported cases; that limitation is acknowledged by Muscardin et al 1 in their earlier review. Indeed, 3 of the historical patients in the review 15,16,18 could potentially have had benign tumours with plasma cell infiltrates or plasmacytic granulomas 23,26,31,32,49,68 ; diagnosis requires careful histologic and immunohistochemical analysis 9 . Exclusion of the former 3 patients does not change the survival analysis, because follow-up for them was unavailable.…”

“…Two patients received surgery and adjuvant radiation as primary treatment: the dose for one patient was unknown 17 , and it was 20 Gy in 5 fractions for the other (patient 1 in the present report). One patient received 50 Gy in 25 fractions to a left cheek primary, with no response; salvage surgery was subsequently performed 32 . As with radiation doses, chemotherapy regimens ranged widely; the most commonly used regimen was melphalan combined with a corticosteroid.…”

“…Distant skin recurrences in 5 patients were initially treated with surgery alone 32 , surgery and rt 17 , rt alone (2 patients) 2,64 , or chemotherapy alone 45 . Finally, 2 patients experienced a distant recurrence; those patients were initially treated with rt 44 or observation 58 .…”

Treatment and Outcomes for Primary Cutaneous Extramedullary Plasmacytoma: A Case Series

“…It is also possible that benign plasmacytoses were included in the analysis because information about monoclonality was not available for all reported cases; that limitation is acknowledged by Muscardin et al 1 in their earlier review. Indeed, 3 of the historical patients in the review 15,16,18 could potentially have had benign tumours with plasma cell infiltrates or plasmacytic granulomas 23,26,31,32,49,68 ; diagnosis requires careful histologic and immunohistochemical analysis 9 . Exclusion of the former 3 patients does not change the survival analysis, because follow-up for them was unavailable.…”

“…Two patients received surgery and adjuvant radiation as primary treatment: the dose for one patient was unknown 17 , and it was 20 Gy in 5 fractions for the other (patient 1 in the present report). One patient received 50 Gy in 25 fractions to a left cheek primary, with no response; salvage surgery was subsequently performed 32 . As with radiation doses, chemotherapy regimens ranged widely; the most commonly used regimen was melphalan combined with a corticosteroid.…”

“…Distant skin recurrences in 5 patients were initially treated with surgery alone 32 , surgery and rt 17 , rt alone (2 patients) 2,64 , or chemotherapy alone 45 . Finally, 2 patients experienced a distant recurrence; those patients were initially treated with rt 44 or observation 58 .…”