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- Title
DIAGNOSTIC CHALLENGES AND MANAGEMENT OF THORACIC PLASMACYTOMA.
- Authors
Ilie, Vlăduţ Liviu; Luchi, Alina-Sabina; Iosif, Antonia-Elena; Mastan, Adina; Oprinca, George-Calin
- Abstract
Introduction: Plasmacytoma represents a malignant tumor of plasma cells, most commonly developing in soft tissues or bones. Skeletal forms usually have other occult tumors and frequently disseminate to multiple myeloma within 5-10 years. Soft tissue forms usually occur in the upper respiratory tract, rarely disseminate, and are cured by resection. Most cases produce paraproteinemia. Case Report: We present the case of a 50-year-old man admitted to the Thoracic Surgery Department of the Emergency County Clinical Hospital Sibiu for evaluation of a tumor on the right thoracic wall. During admission, other conditions such as acromegaly, central adrenal insufficiency, post-cholecystectomy syndrome, and dysmetabolic cardiomyopathy were noted. Additionally, tissue sampling was performed for biopsy and histopathological examination. Histopathological examination revealed a solid tumor proliferation, with features of small and medium-sized cells, round, relatively monotonous, surrounded by incomplete fibro-hyaline septa, forming pseudorosettes and trabeculae, with a mitotic rate of 5 mitoses/10 HPF. Absence of necrosis, angiolymphatic invasion, or perineural infiltration was observed in all examined sections. These morphological characteristics raised suspicion of initial lymphoproliferation. An immunohistochemical profile 219 POSTER - NON - SURGICAL was used with antibodies against CK AE1/3, Bcl2, CD3, CD5, CD10, CD20, CD23, CD30, DBA44, CyD1, Vimentin, Actin, TTF1, and Ki67. All lymphocytic markers were negative, excluding lymphocytic origin of the tumor. Additionally, negativity for CK7 and TTF1 markers excluded pulmonary adenocarcinoma metastasis, while negativity of CK AE1/3 marker excluded mesothelioma. A second immunohistochemical profile included antibodies against CD168, HMB45, S100, Chromogranin, and Synaptophysin. Negative HMB45 and S100 markers excluded malignant melanoma metastasis, negative Chromogranin and Synaptophysin excluded neuroendocrine carcinoma metastasis, while tumor positivity for CD168 marker definitively established the diagnosis of plasmacytoma. Multiple myeloma and plasmacytoma diagnoses were subsequently confirmed through additional hematological examinations and laboratory analyses. Discussions : In the presented case, the treatment of choice consisted of polychemotherapy and radiotherapy. The patient underwent repeated investigations for managing complications and side effects of the disease and treatment. Careful monitoring and proper management of multiple conditions were essential for adequate care and optimizing his prognosis. Conclusions: The histopathological examination, coupled with immunohistochemical profiling, served as the cornerstone in confirming the diagnosis of plasmacytoma and excluding other pathologies in this case. This emphasises their pivotal role in achieving accurate diagnoses and guiding therapeutic strategies for thoracic plasmacytoma.
- Subjects
ROMANIA; SPINAL tumors; CONFERENCES &; conventions; PLASMACYTOMA
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p219
- ISSN
2668-7755
- Publication type
Article