Hepatic plasmacytosis as a manifestation of relapse in multiple myeloma treated with thalidomide.
Thalidomide and its analogs have been extensively studied in patients with multiple myeloma. We present the case of a 58-year-old female patient with immunoglobulin GA-kappa multiple myeloma who was receiving thalidomide after failing an autologous transplant. She presented with profound asthenia and several space-occupying hepatic lesions, one of which was shown by a CT-guided percutaneous biopsy to be plasmacytoma. The patient then received bortezomib and had a transient response. Because thalidomide may also increase the expression of cytoadhesion molecules in myeloma cells and in the bone marrow microenvironment, it is possible that some patients with multiple myeloma who relapse on thalidomide may present with extramedullary plasmacytomas, as seen in this case. Therefore, whenever symptoms arise in patients with multiple myeloma who are receiving thalidomide, extramedullary plasmacytomas should be considered.
del Giglio
Auro
A
Disciplina de Hematologia e Oncologia da Faculdade de Medicina da Fundação, ABC, Departamento de Patologia do Hospital Sírio Libanês de São Paulo, São Paulo, Brazil. sandrabr@netpoint.com.br
Weinschenker
Patricia
P
Manhani
Ana Rita de Araújo Burgos
AR
Carbonell
Ana Lucia Ippolito
AL
Mitteldorf
Cristina A T S
CA
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001247:Asthenia / Q000209:etiology; D001706:Biopsy; D001854:Bone Marrow Cells / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D010954:Plasmacytoma / Q000188:drug therapy / Q000473:pathology*; D011719:Pyrazines / Q000627:therapeutic use; D012008:Recurrence; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib