Blood Lines
synopsis Doj contents volume 14 number 9 september 2008 cutaneous metastatic plasmacytomas with tropism for a previously injured limb marta almeida pereira 1 , teresa baudrier 1 , alice costa 2 , joão magalhães 3 , filomena azevedo 1 dermatology online journal 14 (9): 16 1. Departments of dermatology and venereology, hospital s. João, porto, portugal. Martapereiraderma@gmail. Com2. Department of hematology, hospital s. João, porto, portugal3. viagra vision blue tint has less side effects viagra viagra viagra over the counter walmart viagra safe men viagra safe epileptics viagra side effects on eyes woman in viagra commercials Department of pathology, hospital s. João, porto, portugal abstract cutaneous plasmacytoma is an uncommon observation in clinical practice. It is usually a consequence of direct extension from an underlying bony lesion, in the setting of multiple myeloma. In our case, a 77-year-old woman, with stage iiia igg λ multiple myeloma for two years, presented with firm nodular violaceous cutaneous lesions on the left arm without underlying bone osteolytic lesions or subcutaneous tumors; the biopsy was consistent with plasmacytoma. The patient had suffered two spontaneous left humeral fractures treated with prosthesis replacement just before the initial diagnosis of multiple myeloma. She had also been submitted to radiotherapy for a subcutaneous plasmacytoma, detected some months before, at the same site of the cutaneous lesions. Despite optimal response of the cutaneous lesions to treatment, the disease progressed and the patient died from infectious complications eight months after the appearance of the tumors. Introduction multiple myeloma (mm) is a malignant hematologic disorder resulting from monoclonal proliferation of plasma cells. The classic diagnostic triad is marrow plasmacytosis (>10%), lytic bone lesions, and serum and urine monoclonal immunoglobulin [1-4]. Malignant plasma cells usually grow within the bone marrow, although they can proliferate in extramedullary sites, particularly the respiratory tract, oropharynx, upper gastrointestinal tract, spleen, lymph nodes, and rarely skin [3, 4]. Infiltration of the skin by malignant cells in mm gives rise to plasmacytoma, a well-recognized occurrence in this setting [1-8]. It results from direct extension to the skin from underlying osteolytic bone lesion or solitary plasmacytoma of bone. Very rarely, metastatic spreading of malignant cells without adjacent osseous lesions can occur. This usually occurs in late stages of mm when there is markedly increased tumor cell burden [1-6]. Case report figure 1 figure 2 figure 1. Nodulo-tumoral lesions of the left upper limbfigure 2. Fleshy and violaceous tumor in detail figure 3 figure 4 figure 3. Absence of osteolytic lesionsfigure 4. On h&e, infiltration with dysplastic multinucleated plasma cells a 77-year-old woman, with a two year diagnosis of stage iiia igg λ multiple myeloma, presented with cutaneous nodulo-tumoral lesions of the left upper limb (figs. 1 & 2). The tumors were non-tender, fleshy, and violaceous in color. They varied in size from 15 to 20mm (fig. 3). No osteolytic.
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