Primary cutaneous plasmacytoma: treatment with intralesional tumour necrosis factor-α

Abstract

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,

Primary cutaneous plasmacytoma in an HIV‐positive patient

“… found intralesional tumor necrosis factor‐α reduced tumor size in a patient with multiple cutaneous plasmacytomas; however, lesion size did not change after the fourth injection. Oral cyclophosphamide and prednisolone were used subsequently, which reduced the tumor size and recurrence . Follow‐up is imperative in PCP.…”

“…6,13,21 Risk factors for a poor prognosis include multiple lesions, tumor size > 5 cm, IgA-secreting tumors, and a compromised immune system. 5,18,21 Tsuboi et al 22 found intralesional tumor necrosis factor-a reduced tumor size in a patient with multiple cutaneous plasmacytomas; however, lesion size did not change after the fourth injection. Oral cyclophosphamide and prednisolone were used subsequently, which reduced the tumor size and recurrence.…”

“…Oral cyclophosphamide and prednisolone were used subsequently, which reduced the tumor size and recurrence. 22 Follow-up is imperative in PCP. These lesions may represent primary tumors that respond well to treatment without recurrence; however, they may later prove to represent the initial findings of myelomatosis.…”

Multiple cutaneous plasmacytomas following an autologous peripheral stem cell transplant

“…Single nodules can be resected, but plasmacytomas are radiosensitive, and electron beam radiotherapy is effective for large or deep lesions 4,5 . Other treatments tried include intralesional steroid and tumour necrosis factor‐α 10,11 . In the presence of extensive involvement, often with underlying marrow involvement, chemotherapy in conjunction with radiotherapy remains the treatment of choice 5,7 , 8 .…”

“…4,5 Other treatments tried include intralesional steroid and tumour necrosis factor-a. 10,11 In the presence of extensive involvement, often with underlying marrow involvement, chemotherapy in conjunction with radiotherapy remains the treatment of choice. 5,7,8 Adjuvant a-interferon has been tried as primary treatment 12 but also following relapsed myeloma after an autologous stem cell transplant.…”