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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 43-44
 

Fungating extramedullary plasmocytoma of breast; a unique case presentation


1 Department of Gen Surgery, Skims Srinagar Jammu and Kashmir, India
2 Department of Medical Oncology, Skims Srinagar Jammu and Kashmir, India
3 Department of Pathology, Skims Srinagar Jammu and Kashmir, India

Date of Web Publication3-Feb-2016

Correspondence Address:
A H Sarmast
Department of Gen Surgery, Skims Srinagar Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175600

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How to cite this article:
Naqash S, Sarmast A H, Showkat H I, Wani M, Besina S, Banday M, Shah M. Fungating extramedullary plasmocytoma of breast; a unique case presentation. Indian J Cancer 2015;52:43-4

How to cite this URL:
Naqash S, Sarmast A H, Showkat H I, Wani M, Besina S, Banday M, Shah M. Fungating extramedullary plasmocytoma of breast; a unique case presentation. Indian J Cancer [serial online] 2015 [cited 2019 Aug 21];52:43-4. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/43/175600


Sir,

A 35-year-old married female presented to our OPD with complaints of a mass in right breast with bloody discharge of 3 months duration. Patient was previously healthy with non-significant family history. On examination, there was a 9 × 8.5 cm fungating growth involving whole of the breast tissue, which had eroded the nipple areola complex, was infiltrating skin with purulent and bloody discharge as shown in [Figure 1] and [Figure 2]. She had another mass located in left breast 3 × 3 cm mobile, hard retroareolar in location. Axillary examination was normal on both sides. A provisional diagnosis of locally advanced ca breast on right side and early stage ca breast on left side was made. fine needle aspiration cytology (FNAC) on both side surprisingly showed sheets of mature and immature plasma cells suggestive of plasmocytoma. A repeat FNAC showed same results. A formal workup for multiple myeloma was made. No Bence Jones or other M components were detected in the urine. Serum electrophoresis was also negative showing no M bands. Skeletal survey was normal. There was mild anemia with Hb of 10.5 g/dl; however, there was no evidence of hypercalcemia, renal dysfunction. A bone marrow biopsy disclosed that less than 3% of plasma cells were present. So, a diagnosis of bilateral plasmocytoma breast was made. In view of the fungating and infected growth of right breast, mastectomy was performed with adjuvant chemotherapy. No axillary sampling or dissection was done. Histopathological examination of the mastectomy specimen showed sheets of plasma cells confirming the diagnosis as shown in [Figure 3]. Immunohistochemical analysis of the specimen showed it to be positive for CD-38, CD56, CD79a, and was also reactive for epithelial membrane antigen and vimentin. Cytogenetic study was not possible. Left breast was primarily treated with radiotherapy. Post-operative follow-up of 1 year proved to be uneventful.
Figure 1: A huge fungating polyploidal ulcerated and infected growth involving whole of right breast

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Figure 2: Right mastectomy specimen

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Figure 3: Histo-pathological examination, showing sheets of plasma cells

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Most patients with plasma cell neoplasia have generalized disease at diagnosis, fulfilling the diagnosis of multiple myeloma (MM). However, a minority of patients present with either a single bone lesion (solitary plasmacytoma of bone; SBP), or less commonly, a soft tissue mass of monoclonal plasma cells (solitary extramedullary plasmacytoma; SEP). Breast involvement is a rare type of SEP, and only a few cases have been reported.[1],[2] The most common site of the extramedullary plasmacytoma is the head and neck region, lymph node, and skin. Metastatic tumors or the plasmacytoma, which is secondary manifestation of myeloma, have bad prognosis.[3] Extramedullary plasmacytomas are known to occur in many different organs, such as skin, lung, gastrointestinal tract, and bladder, but especially in the head and neck region. Occasional cases of extramedullary plasmacytomas are reported in the breast. They usually represent secondary involvement by a systemic process.[4],[5] The majority of breast plasmacytomas are reported in women. The mean age at presentation was 53 years, with tumor size ranging from 1 to 7.5 cm. Distinguishing an extramedullary plasmacytoma of the breast from primary mammary adenocarcinoma is critical to avoid unnecessary surgery and guide therapy. FNAC or trucut biopsy has proven to be an excellent method in diagnosing primary and secondary malignancies.[1],[2] The Guidelines Working Group of the UK Myeloma Forum (UKMF), presented their guidelines on the diagnosis and management of solitary plasmacytoma of the bone and solitary extramedullary plasmacytoma (SEP) in 2003,[2] which remain unrevised in July 2010. They stated that SEP are less common than SBP and have a better prognosis, and the majority can be cured with local radiotherapy. Post-radiotherapy, the local recurrence rate is less than 5%, and the risk of distant relapse is less than 30%. Chemotherapy is indicated for patients with refractory and/or relapsed disease.[2]

 
  References Top

1.
Brem RF, Revelon G, Willey SC, Gatewood OM, Zeiger MA. Bilateral plasmacytoma of the breast: A case report. Breast J 2002;8:393-5.  Back to cited text no. 1
    
2.
Guidelines working group of the UK Myeloma Forum (UKMF) [internet]. Guidelines on the diagnosis and management of solitary plasmacytoma of bone (SBP) and solitary extramedullary plasmacytoma 2003;1-5. Available from: http://www.ukmf.org.uk/guidelines/gdmsp/sep.htm  Back to cited text no. 2
    
3.
Pai R, Kini H, Ghartimagar D. Secondary extramedullary plasmacytoma of the breast: Diagnosed by fine needle aspiration cytology. Kathmandu Univ Med J (KUMJ) 2007;5:538-40.  Back to cited text no. 3
    
4.
Craft IL. The late appearance of extramedullary lesions in myelomatosis. Br J Cancer 1967;21:501-4.  Back to cited text no. 4
[PUBMED]    
5.
Ross JS, King TM, Spector JI, Zimbler H, Basile RM. Plasmacytoma of the breast: An unusual case of recurrent myeloma. Arch Intern Med 1987;147:1838-40  Back to cited text no. 5
    


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