Clinical Oncology Letters
https://www.clinicaloncologyletters.com/article/5c7004910e88253f488e6fd6
Clinical Oncology Letters
Relato de Caso

Multiple myeloma with secondary cutaneous plasmacytomas: case report

Mieloma múltiplo com plasmocitomas cutânea secundária: relato de caso

Noriega LF, Borducchi DM, Bergamo L, Matushita CM, Pallotta R, Salgues AC, Torres MI

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Abstract

Multiple myeloma is a neoplasm characterized by abnormal and monoclonal proliferation of plasmacytes in the bone marrow. About 5-10% of patients develop skin lesions, which can be classified into nonspecific or specific. The specific impairment is rare and called secondary plasmacytoma of the skin. Typically, it manifests in the form of erythematous plaques or nodules in the cephalic segment, upper limbs, or trunk. It may be directly related to an underlying bone lesion or the hematogenous dissemination. We describe the case of a 50-year-old female patient diagnosed with Lambda light chain multiple myeloma, Durie and Salmon stage III A and high risk IPSS. Despite being on chemotherapeutic treatment, she developed after 11 months of disease onset, medullary compression by plasmacytomas at the C5-C6-T1 level, manifested with paresis of the upper limbs and plegia of the lower limbs. In association, she developed erythematous nodules on the scalp. The histopathological analysis of the skin lesion revealed dense infiltrate of plasmacytes with nuclear hyperchromasia, forming mantles in the dermis and hypodermis. The immunohistochemistry indicated compatible profile with plasmacytoma and the cranial x-ray showed osteolytic lesions, which established the diagnosis of secondary cutaneous plasmacytoma by extension of bone lesion. After 5 months of skin affection, the patient died. We concluded that skin affection tends to occur in patients with multiple myeloma in late stages of the disease and shows a high tumor load, thereby leading to the association with a worse prognosis, with survival of few months.

Keywords

Multiple myeloma, skin, plasmacytoma

Resumo

O mieloma múltiplo é uma neoplasia, que se caracteriza pela proliferação anormal e monoclonal de plasmócitos na medula óssea. Cerca de 5 a 10 % dos pacientes desenvolvem lesões cutâneas, que podem ser classificadas em inespecíficas ou específicas. O comprometimento específico é raro e denomina-se plasmocitoma cutâneo secundário. Normalmente se manifesta sob a forma de placas ou nódulos eritematosos no segmento cefálico, membros superiores ou tronco. Pode estar relacionado à extensão direta de uma lesão óssea subjacente ou à disseminação hematogênica. Descrevemos o caso de uma paciente de 50 anos, diagnosticada com mieloma múltiplo secretor de cadeia leve lambda, Durie e Salmon III A e IPSS de alto risco. Apesar de estar em tratamento quimioterápico, após 11 meses do início do quadro desenvolveu compressão medular a nível C5-C6-T1 por plasmocitomas, manifestando-se com paresia de membros superiores e plegia de membros inferiores. Associado desenvolveu nódulos eritematosos no couro cabeludo. A análise histopatológica da lesão cutânea revelou denso infiltrado de plasmócitos com hipercromasia nuclear, na derme e hipoderme. A imuno-histoquímica indicou perfil compatível com plasmocitoma e a radiografia de crânio demonstrou lesões osteolíticas, estabelecendo-se o diagnóstico de plasmocitoma cutâneo secundário por extensão de lesão óssea. Após 5 meses do acometimento cutâneo, a paciente evoluiu a óbito. Concluímos que o comprometimento cutâneo em pacientes com mieloma múltiplo tende a ocorrer em estágios tardios da doença e demonstra uma alta carga tumoral, assim associa-se a um pior prognóstico, com sobrevida de poucos meses.

Palavras-chave

Mieloma múltiplo, pele, plasmocitoma

Referências

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