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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 33-35

Solitary plasmacytoma of the breast


Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Date of Submission14-Apr-2020
Date of Acceptance25-Apr-2020
Date of Web Publication23-Nov-2020

Correspondence Address:
Dr. Maitrik Mehta
Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrcr.jrcr_14_20

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  Abstract 


Plasma cell neoplasms consist of a range of disorders from Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma. Solitary plasmacytomas are a part of this. Most commonly occur in bone. Extramedullary solitary plasmacytomas are extremely rare. Here we report a case of solitary plasmacytoma of breast which is extremely rare. The incidence is of the order of 0.01%. A fifty-year old postmenopausal female came to our Opd with the chief complaint of lump in lower inner quadrant of left breast since thirty to forty days. History and physical examination revealed a 3*3 cm firm, non tender palpable lump in upper medial quadrant of left breast. The biopsy revealed to be plasmacytoma. The immunohistochemistry was positive for markers like A full workup was done to rule out lesions in bone and any other site which included Complete Blood Count, Renal function test Serum Calcium, Peripheral Smear, Urine and Serum protein electrophoresis, Bone marrow Biopsy and Bone Biopsy, Skeletal Survey, Whole body PET CT. All these findings confirmed the diagnosis of Extraosseous Solitary Plasmacytoma of Left Breast. The treatment offered was Curative Radiotherapy to Left breast using conformal technique (3DCRT) to a total dose of 40 Gy in 20 fractions (2 Gy/#). The patient was examined weekly for any skin reaction or any other side effect. Dose constraints to organs at risk were kept well within the prescribed limits. After completion of treatment the patient is kept on monthly follow up. Physical examination and routine blood investigations are a part of routine follow up. Solitary plasmacytomas being extremely rare and when occur in soft tissues usually involve the upper aerodigestive tract and oral cavity. Primary involvement of breast in case of solitary plasmacytoma is extremely rare.

Keywords: Breast, radiotherapy, solitary plasmacytoma


How to cite this article:
Mehta M, Shah A, Shah I, Shah R, Suryanarayan U. Solitary plasmacytoma of the breast. J Radiat Cancer Res 2021;12:33-5

How to cite this URL:
Mehta M, Shah A, Shah I, Shah R, Suryanarayan U. Solitary plasmacytoma of the breast. J Radiat Cancer Res [serial online] 2021 [cited 2021 Apr 17];12:33-5. Available from: https://www.journalrcr.org/text.asp?2021/12/1/33/301332




  Introduction Top


Plasma cell neoplasms consist of a range of disorders ranging from monoclonal gammopathy of undetermined significance to multiple myeloma. Solitary plasmacytomas are a part of this, and most commonly, they occur in bone. Extramedullary solitary plasmacytomas are extremely rare. Herein, we report a case of solitary plasmacytoma of breast, which is an extremely rare entity. The incidence is of the order of 0.01%.[1] The clinical diagnosis is difficult, as it mimics adenocarcinoma of the breast, and so confirmed histopathology is required to label it as plasma cell neoplasm.[2] To date, very few cases have been reported in the literature of solitary plasmacytoma of breast presenting as a primary neoplasm.


  Case Report Top


A 50-year-old postmenopausal female reported to our hospital with the chief complaint of a small painless lump in the left breast for 30 to 40 days, which gradually increased in size with no associated complaints of nipple discharge or fever or any history of trauma or previous surgery or radiation. History and physical examination revealed an approximately 3 cm × 3 cm firm, nontender palpable lump in the lower inner quadrant of the left breast with no clinically palpable axillary or supraclavicular lymph nodes. There was no evidence of skin involvement or fixity to the underlying structures. Clinical examination of the opposite right breast was done, which showed no abnormality or any palpable lymphadenopathy. Negative history ruled out any bony pain or loss of weight. [Figure 1] and [Figure 2] shows the mammographic view of the breast lesion. A tentative diagnosis of adenocarcinoma of the breast was done. A trucut biopsy from the palpable mass was taken, which came out to be plasmacytoma. The immunohistochemistry was positive for markers such as leukocyte common antigen, MUM1, cluster of differentiation (CD) 38, CD138, and lambda and negative for markers such as AE1, E-cadherin, mammaglobin, CD20 (Pan B), and kappa.[2] A full workup was done to rule out lesions in bone and any other site and to exclude the possibility of multiple myeloma, which included complete blood count, renal function test serum calcium, peripheral smear, serum and urine protein electrophoresis, bone marrow biopsy and bone biopsy, b/l mammosonography, skeletal survey, and whole-body positron emission tomography-computed tomography (PET CT). All these findings confirmed the diagnosis of extraosseous solitary plasmacytoma of the left breast. PET CT was done to rule out any synchronous solitary plasmacytomas in any other region.
Figure 1: Mediolateral mammogram view

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Figure 2 :Craniocaudal mammogram view

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The treatment offered was curative radiotherapy to the left breast using the conformal technique (three-dimensional conformal radiation therapy) to a total dose of 40 Gy in 20 fractions (2 Gy/#). [Figure 3] and [Figure 4] show the radiation planning process. The patient was examined weekly for any skin reaction or any other side effect. Dose constraints to organs at risk were kept well within the prescribed limits. After completion of treatment, the patient is kept on a monthly follow-up. Physical examination and routine blood investigations, including serum and urine protein electrophoresis and skeletal survey, are a part of the routine follow-up. There is no evidence of disease following radiotherapy both clinically and radiographically, both locally and systemically.
Figure 3: Contouring

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Figure 4: Cumulative Dose Volume Histogram and Planning

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  Discussion Top


The cell of origin of plasma cell neoplasm is mature B-cells. They are characterized by the proliferation of monoclonal plasma cells producing monoclonal immunoglobin. The range is from a single lesion known as solitary plasmacytoma to multiple lesions known as multiple myeloma.[3] Solitary plasmacytomas are extremely rare and when occurring in soft tissues usually involve the head-and-neck region mostly in the upper aerodigestive tract and oral cavity.[4] Although extraosseous involvement of soft tissues can occur in a known case of multiple myeloma, but then, they are not referred to as extraosseous solitary plasmacytoma. Solitary extramedullary plasmacytoma constitutes about 3% of plasma cell malignancies. The occurrence of solitary breast plasmacytoma is extremely rare as compared to the involvement of breast in multiple myeloma cases.[5] This can only be done histologically, with the histologic hallmark of a plasmacytoma being the presence of several atypical plasma cells containing irregular nuclei, prominent nucleoli, in association with mature plasma cells.[6] The general management generally requires wide local excision followed by curative radiotherapy;[7] however, literature also supports the role of definitive radiotherapy.[8] The transformation of extraosseous solitary plasmacytoma to multiple myeloma was 10%–40% of patients at 10 years, a regular long-term follow-up therefore required.


  Conclusion Top


We reported an extremely rare case of extraosseous solitary plasmacytoma of breast, which was managed as per the standard protocol, and the patient had excellent disease control and is currently undergoing follow-up.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
van Nieuwkoop C, Giard RW, Veen HF, Dees A. Extramedullary plasmacytoma of the breast simulating breast cancer. Neth J Med 2001;58:174-6.  Back to cited text no. 1
    
2.
De Chiara A, Losito S, Terracciano L, Di Giacomo R, Iaccarino G, Rubolotta MR. Primary plasmacytoma of the breast. Arch Pathol Lab Med 2001;125:1078-80.  Back to cited text no. 2
    
3.
Carson CP, Ackerman LV, Malty JD. Plasma cell myeloma. Ann Clin Pathol 1955;25:849-88.  Back to cited text no. 3
    
4.
Proctor NS, Rippey JJ, Shulman G, Cohen C. Extramedullary plasmacytoma of the breast. J Pathol 1975;116:97-100.  Back to cited text no. 4
    
5.
Luca G, Rawn S, Indira G, Lisa J, Robert S. Plasmacytoma of the breast. J Fam Pract 2011;20:86-8.  Back to cited text no. 5
    
6.
Cangiarella J, Waisman J, Cohen JM, Chhieng D, Symmans WF, Goldenberg A. Plasmacytoma of the breast. A report of two cases diagnosed by aspiration biopsy. Acta Cytol 2000;44:91-4.  Back to cited text no. 6
    
7.
Kaviani A, Djamali-Zavareie M, Noparast M, Keyhani-Rofagha S. Recurrence of primary extramedullary plasmacytoma in breast both simulating primary breast carcinoma. World J Surg Oncol 2004;2:29.  Back to cited text no. 7
    
8.
Goyal G, Bartley AC, Funni S, Inselman J, Shah ND, Marshall AL, et al. Treatment approaches and outcomes in plasmacytomas: Analysis using a national dataset. Leukemia 2018;32:1414-20.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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