#Plasmacytoma of breast

[hilaris1]

Solitary Extramedullary Plasmacytoma of Breast- A Rare Case Report

Ramanan, Ramchandar, G.Suresh, A. Sureshkumar and Siva Kaarthikeyan. “Solitary Extramedullary Plasmacytoma of Breast- A Rare Case Report.” J Surg 18 (2022): 019.

Abstract Background: Extramedullary plasmacytoma accounts for less than 5% of plasma cell neoplasm. Primary breast plasmacytoma is extremely rare condition encountered in clinical practice without any bone marrow involvement or as secondary from multiple myeloma. It can mimic various benign and malignant lesions in the breast hence it should be kept in differential diagnosis as management would completely differ. Meticulous approach is needed in evaluation like CT scan of upper airway, Histopathological examination, Bone marrow biopsy, emphasizing the importance of each in arriving at a diagnosis. The incidence of breast plasmacytoma is very rare accounting to less than 5% in which only 15-16 cases of solitary breast plasmacytoma have been reported over the last 80 years and hence there is a lack of standard clinical or radiological criteria criteria in the diagnosis and management of breast plasmacytoma. In this study we report solitary extramedullary plasmacytoma of left breast in 70-year-old women with meticulous stepwise approach.

To submit manuscript online please click here: https://www.scholarscentral.org/submissions/surgery-jurnalul-de-chirurgie.html

To send as attachment, email to jsurgery@journalres.com

[lokesh4544]

Spine Tumor Specialist in Gurgaon

A vertebral tumor is a type of spinal tumor affecting the bones or vertebrae of the spine. Spinal tumors that begin within the spinal cord or the covering of the spinal cord (dura) are called spinal cord tumors.

Tumors that affect the vertebrae have often spread (metastasized) from cancers in other parts of the body. But there are some types of tumors that start within the bones of the spine, such as chordoma, chondrosarcoma, osteosarcoma, plasmacytoma and Ewing's sarcoma.

A vertebral tumor can affect neurological function by pushing on the spinal cord or nerve roots nearby. As these tumors grow within the bone, they may also cause pain, vertebral fractures or spinal instability.

Whether cancerous or not, a vertebral tumor can be life-threatening and cause permanent disability.

There are many treatment options for spine tumors, including surgery, radiation therapy, chemotherapy, medications or sometimes just monitoring the tumor.

Types of

spine tumors

Your spine is made up of small bones (vertebrae) stacked on top of one another that enclose and protect the spinal cord and its nerve roots.

Spine tumors are classified according to their location in the spine or vertebral column. Vertebral tumors are also known as extradural tumors because they occur outside the spinal cord itself.

Most tumors that affect the vertebrae have spread (metastasized) to the spine from another place in the body — often the prostate, breast, lung or kidney. Multiple myeloma is a type of cancer that often metastasizes to the spine. Although the original (primary) cancer is usually diagnosed before back problems develop, back pain may be the first symptom of disease in people with metastatic vertebral tumors.

Tumors that begin in the bones of the spine (primary tumors) are far less common. Plasmacytoma is one type of primary vertebral tumor.

Other tumors, such as osteoid osteomas, osteoblastomas and hemangiomas, also can develop in the bones of the spine.

https://g.page/r/CZs7wVn_ODfhEAE

https://g.page/r/CS-wJ9nI0cIsEAE

[juniperpublisherscasestudies]

Juniper Publishers- Open Access Journal of Case Studies

Extra Medullary Multiple Myeloma in Breast

Authored by Ravi Shankar B

Introduction

Multiple myeloma is a disease of plasma cells and accounts for 1% of all 10% of haematological malignancies [1]. It is a systemic disease in the elderly. The primary site of involvement in the disease is the skeletal system which accounts for 97% of the cases. Multiple Myeloma may involve extra osseous sites. About 3% of the cases involve the soft tissues [2]. Its incidence in patients younger than 40 years is rare. Only in rare cases it is observed in the breast. First case of myeloma breast was reported in the year 1925 [3]. Since then only 20 cases of myeloma Breast had been reported till now. More than half of the cases reported had bilateral breast involvement. We are reporting one such rare case of bilateral myeloma breast with a brief review of literature.

Case Presentation

A 32yr multiparous premenopausal female presented to our OPD at Queens NRI Hospital, Visakhapatnam, with bilateral breast lumps of 4 months duration. It started as a small lump in Right breast 4 months ago which gradually progressed in size. A similar small lump showed up in the Left breast 3 months later. Both the lumps were not associated with pain. There was no associated fever, weight loss. She had no history of (H/o) trauma in the past, no H/o Tuberculosis, no significant Family History. She was a diagnosed case of Multiple Myeloma treated for 3yrs (from 2012-2015) with Thalidomide and Dexamethasone but had stopped taking medication since 2015. On examination a single 15X15cm firm lobulated mass occupying almost the entire Right breast with infiltration of the overlying skin in the upper outer quadrant was seen with normal looking Nipple Areola Complex (NAC). Left breast showed multiple discrete firm mobile lumps in the upper outer and inner quadrants with the largest measuring 6X5cm with normal NAC and overlying skin (Figure 1). Bilateral axillae and supraclavicular fossae were normal. Tru-cut biopsy from right as well as left breast lump came out as plasma cell myeloma. Microscopic pictures of the specimen showed multiple plasma cells arranged in sheets with eccentrically placed nuclei and abundant cytoplasm confirming the diagnosis of plasma cell myeloma (Figure 2 & 3).

Discussion

Multiple myeloma is a primary malignancy of bone marrow characterized by clonal proliferation of plasma cells and production of monoclonal immunoglobulins. Soft tissue involvement is often secondary to skeletal involvement. Isolated involvement of soft tissues is much rare. The differential diagnosis in this case can be a primary breast cancer as there is literature with the presentation of breast carcinoma in patients with a known history of lymphoma or multiple myeloma [4].

The clinical course of patients with breast myeloma depends on whether the lesion is solitary or part of disseminated myeloma [5]. The overall prognosis in primary breast plasmacytoma is excellent [6]. In contrast, metastatic tumours have poor prognosis. Plasmacytomas are often a late manifestation of the disease and their appearance in a known case of multiple myeloma indicates failure of apparently successful therapy [7].Patients with a low beta2-microglobulin level tend to have a better prognosis. The presence of a chromosome 13 deletion has been shown to have a significant negative impact on outcome and also an elevated lactate dehydrogenase level is associated with a very bad prognosis [8].

Conclusion

Diagnosis of breast myeloma should always be considered in a patient with multiple breast masses, especially when bilateral, more so in a known case of myeloma and also as a differential of metastases.

For more articles in Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/index.php

[cancersfakianakis1]

The role of initial 18 F-FDG PET/CT in the management of patients with suspected extramedullary plasmocytoma

Abstract

Background

Extramedullary plasmacytoma (EMP) is a plasma cell malignancy that originates in soft tissues without evidence of systemic spread, and its management differs from other plasma cell neoplasms. The purpose of the present study was to evaluate the role of initial 18F-FDG PET/CT in the management of patients with clinical suspected EMP.

Methods

18F-FDG PET/CT scans performed in 21 patients (M/F = 12/9, mean age 51.1 ± 15.3 years) with clear suspicion of EMP from 2006 to 2015 were analysed retrospectively. The detection of new lesions and the change in treatment were evaluated.

Results

PET/CT detected new lesions in 38.1% (8/21) of patients with 17 lesions, and lymph nodes were the most common site, accounting for 70.6% (12/17) of all lesions, followed by bone (n = 2), and less frequently, breast (n = 1), lung (n = 1), and stomach (n = 1). These findings resulted in treatment changes in 7 patients with EMP. Among these, 4 patients had major treatment changes and 3 patients had minor changes. Of the 21 patients, progression to MM was observed in 8 patients (8/21, 38.1%). In univariate analysis, tumour size > 4 cm and partial response (PR) after treatment were significant prognostic factors for Progression-free survival (PFS).

Conclusions

Our data indicated that 18F-FDG PET/CT is helpful in the detection of additional lesions throughout the body, including lymph node involvement and distant additional lesion, which may have resulted in treatment change.

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[cancersfakianakis1]

Cooperative Targets of Combined mTOR/HDAC Inhibition Promote MYC Degradation

Cancer treatments often require combinations of molecularly targeted agents to be effective. mTORi (rapamycin) and HDACi (MS-275/entinostat) inhibitors have been shown to be effective in limiting tumor growth, and here we define part of the cooperative action of this drug combination. More than 60 human cancer cell lines responded synergistically (CI<1) when treated with this drug combination compared with single agents. In addition, a breast cancer patient–derived xenograft, and a BCL-XL plasmacytoma mouse model both showed enhanced responses to the combination compared with single agents. Mice bearing plasma cell tumors lived an average of 70 days longer on combination treatment compared with single agents. A set of 37 genes cooperatively affected (34 downregulated; 3 upregulated) by the combination responded pharmacodynamically in human myeloma cell lines, xenografts, and a P493 model, and were both enriched in tumors, and correlated with prognostic markers in myeloma patient datasets. Genes downregulated by the combination were overexpressed in several untreated cancers (breast, lung, colon, sarcoma, head and neck, myeloma) compared with normal tissues. The MYC/E2F axis, identified by upstream regulator analyses and validated by immunoblots, was significantly inhibited by the drug combination in several myeloma cell lines. Furthermore, 88% of the 34 genes downregulated have MYC-binding sites in their promoters, and the drug combination cooperatively reduced MYC half-life by 55% and increased degradation. Cells with MYC mutations were refractory to the combination. Thus, integrative approaches to understand drug synergy identified a clinically actionable strategy to inhibit MYC/E2F activity and tumor cell growth in vivo. Mol Cancer Ther; 16(9); 2008–21. ©2017 AACR.

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[cancersfakianakis1]

Cooperative Targets of Combined mTOR/HDAC Inhibition Promote MYC Degradation

Cancer treatments often require combinations of molecularly targeted agents to be effective. mTORi (rapamycin) and HDACi (MS-275/entinostat) inhibitors have been shown to be effective in limiting tumor growth, and here we define part of the cooperative action of this drug combination. More than 60 human cancer cell lines responded synergistically (CI<1) when treated with this drug combination compared to single agents.  In addition, a breast cancer patient-derived xenograft, and a BCL-XL plasmacytoma mouse model both showed enhanced responses to the combination compared to single agents.  Mice, bearing plasma cell tumors lived an average of 70 days longer on combination treatment compared to single agents. A set of 37 genes cooperatively affected (34 down-regulated; 3 up-regulated) by the combination responded pharmacodynamically in human myeloma cell lines,  xenografts, and a P493 model, and were both enriched in tumors, and correlated with prognostic markers in myeloma patient datasets. Genes down-regulated by the combination were overexpressed in several untreated cancers (breast, lung, colon, sarcoma, head and neck, myeloma) compared to normal tissues. The MYC/E2F axis, identified by upstream regulator analyses and validated by immunoblots, was significantly inhibited by the drug combination in several myeloma cell lines.  Furthermore, 88% of the 34 genes downregulated have MYC binding sites in their promoters, and the drug combination cooperatively reduced MYC half-life by 55% and increased degradation. Cells with MYC mutations were refractory to the combination. Thus, integrative approaches to understand drug synergy identified a clinically actionable strategy to inhibit MYC/E2F activity and tumor cell growth in vivo.

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