title: Development of POEMS syndrome after an initial manifestation of solitary plasmacytoma.
abstract: A 44-year-old male was admitted for numbness in the left arm. CT showed a tumor impacting on the spinal cord with an adjacent thoracic vertebral osteosclerotic lesion. The histopathology of the tumor showed diffuse proliferation of atypical plasma cells with expressed vascular endothelial growth factor (VEGF), which is a known etiological factor in POEMS syndrome. Though serum VEGF (sVEGF) level was elevated, a diagnosis of solitary plasmacytoma with an osteosclerotic lesion was made as the patient presented no polyneuropathy, organomegaly, endocrinopathy, or skin changes. The patient experienced muscle weakness of the lower limbs and skin pigmentation/hemangioma one year after irradiation of the osteosclerotic lesion. Laboratory tests revealed hypothyroidism, hyperglycemia, serum monoclonal gammopathy, further elevation of sVEGF, and increased atypical bone marrow plasma cells. CT imaging showed splenomegaly, and a nerve conduction test revealed demyelinating motor peripheral neuropathy. The patient was therefore diagnosed with POEMS syndrome. Plasmacytoma is very rare as an initial manifestation of POEMS syndrome. Patients presenting with plasmacytoma with an osteosclerotic lesion should be carefully observed and evaluated for the expression of sVEGF and development of POEMS syndrome, as most bone plasmacytomas in POEMS syndrome patients are reported to be osteosclerotic. This is to our knowledge the first case of osteosclerotic plasmacytoma that progressed to POEMS syndrome, with an increase of sVEGF.
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Shindo
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan. satofam@asahikawa-med.ac.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Yasumichi
authors.initials: Y
authors.lastname: Toki
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Hatayama
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ito
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ichiki
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Naoka
authors.initials: N
authors.lastname: Okamura
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hosoki
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Ikuta
authors.affiliation: Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan.
authors.forename: Junki
authors.initials: J
authors.lastname: Inamura
authors.affiliation: Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Oncology Center, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Torimoto
authors.affiliation: Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000378:metabolism; D000328:Adult; D001853:Bone Marrow / Q000473:pathology; D015174:Epidural Neoplasms / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D010026:Osteosclerosis / Q000000981:diagnostic imaging; D016878:POEMS Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D010954:Plasmacytoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D011859:Radiography; D013904:Thoracic Vertebrae / Q000473:pathology; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D042461:Vascular Endothelial Growth Factor A; D051997:ADP-ribosyl Cyclase 1