Primary plasmacytoma involving mediastinal lymph nodes: A diagnostic mimicry of primary mediastinal lymphoma

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• 作者：Karma Z. Salem^a ; ^b ; ¹ ; Taiga Nishihori^a ; ^c ; ¹ ; Mohamed A. Kharfan-Dabaja^a ; ^c ; ^{Mohamed.Kharfan-Dabaja@Moffitt.org" class="auth_mail" title="E-mail the corresponding author} ; Pedro Horna^c ; ^d ; Melissa Alsina^a ; ^c
• 关键词：Mediastinal involvement ; Primary plasmacytoma
• 刊名：Hematology/Oncology and Stem Cell Therapy
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：9
• 期：1
• 页码：26-29
• 全文大小：1380 K

文摘

Plasmacytomas could involve any organ, and at times might pose a diagnostic challenge when the site of involvement is unusual, or if the presentation is similar to other diseases. We describe a 48-year-old man presenting with worsening shortness of breath and chest discomfort with radiologic evidence of mediastinal enlargement, mimicking a lymphoma with mediastinal involvement. An excisional biopsy of a mediastinal lymph node showed a plasma-cell infiltrate strongly positive for CD138, with a flow-cytometry analysis showing a population of lambda-restricted neoplastic plasma cells. He failed to respond to 50 Gy involved-field radiotherapy, but achieved a partial response to combination chemotherapy. He underwent high-dose chemotherapy with melphalan (200 mg/m²) followed by lenalidomide maintenance, and is in complete remission 18 months postautografting. This case illustrates a unique and rare presentation of primary lymph-node plasmacytomas involving the mediastinum potentially mistaken as lymphoid malignancy. Clinicians should be aware of the plasma-cell origin of the mediastinal neoplastic process.