title: Multiple bulky cutaneous plasmacytomas with CNS relapse without bone marrow involvement during the course of a lambda light chain myeloma.
abstract: BACKGROUND
  Primary cutaneous plasmacytomas, a localized collection of neoplastic plasma cells, may present without bone marrow involvement. Secondary plasmacytomas can complicate the clinical course of multiple myeloma (MM). Both types of cutaneous plasmacytoma are commonly observed in the terminal stages of MM.
  
  
  METHODS
  We present the case of a 37-year-old Turkish man diagnosed with lambda light chain MM. The patient had numerous firm plaque-shaped cutaneous lesions on the left side of the chest, the left shoulder, and the right preauricular region without concurrent bone marrow disease. Histopathological examination of the cutaneous plaque on the left side of the chest revealed neoplastic plasma cells infiltrating the dermal region. Furthermore, the cytologic examination of cerebrospinal fluid disclosed lymphoplasmacytic cells. The patient was treated with VDTPACE (bortezomib + dexamethasone + thalidomide + adriamycin + cyclophosphamide + etoposide), and the cutaneous lesions disappeared. Central nervous system involvement was treated with craniospinal irradiation and intrathecal chemotherapy.
  
  
  CONCLUSIONS
  Cutaneous involvement of MM is an unusual clinical presentation, but a high level of suspicion is advisable in patients with MM and skin lesions. The involvement of the skin was associated with advanced disease status and, therefore, with a poor prognosis. This is the first reported case of cutaneous involvement of lambda light chain MM.
authors.affiliation: Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey. dr.songul1978@yahoo.com
authors.forename: Songul
authors.initials: S
authors.lastname: Serefhanoglu
authors.forename: Ibrahim C
authors.initials: IC
authors.lastname: Haznedaroglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Goker
authors.forename: Yahya
authors.initials: Y
authors.lastname: Buyukasik
authors.forename: Osman I
authors.initials: OI
authors.lastname: Ozcebe
mesh_terms: D000328:Adult; D019046:Bone Marrow Neoplasms / Q000175:diagnosis; D001932:Brain Neoplasms / Q000175:diagnosis*; D006801:Humans; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008297:Male; D009101:Multiple Myeloma / Q000097:blood* / Q000175:diagnosis*; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000175:diagnosis*
chemical_list: D007146:Immunoglobulin lambda-Chains