Myelomatous pleural effusion: a case series in a single institution and literature review.
BACKGROUND
Myelomatous pleural effusion (MPE) is rare in myeloma patients. We present a consecutive series of patients with MPE in a single institution.


METHODS
We retrospectively reviewed the medical records of 19 patients diagnosed with MPE between 1989 and 2008 at the Asan Medical Center. Diagnoses were confirmed by cytologic identification of malignant plasma cells in the pleural fluid.


RESULTS
Our patients showed dominance of IgA (36.8%) and IgD (31.6%) subtypes. Of 734 myeloma patients, the incidence of MPE was remarkably high for the IgD myeloma subtype (16.7%), compared to the other subtypes (1.4% for IgG and 4.6% for IgA). At the time of diagnosis of MPE, elevated serum β2-microglobulin, anemia, elevated serum lactate dehydrogenase, and elevated creatinine levels were found in 100%, 89.5%, 83.3%, and 57.9% of the patients, respectively. Approximately one-third (31.3%) of the patients had adenosine deaminase (ADA) activities in their pleural fluid exceeding the upper limit of the reported cutoff values for tuberculous pleural effusion (55.8 U/L). Chromosome 13 abnormality was seen in 77.8% of the tested patients. The median survival period from the development of MPE was 2.8 months.


CONCLUSIONS
Patients with MPE have aggressive clinical and laboratory characteristics. The preponderance of IgD myeloma in MPE patients is a noteworthy finding because IgD myeloma is a rare subtype. Elevated ADA activity in the pleural fluid is also noteworthy, and may be helpful for detecting MPE. Physicians treating myeloma patients should monitor the development of MPE and consider the possibility of a worse clinical course.
Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Young-Uk
YU
Cho
Hyun-Sook
HS
Chi
Chan-Jeoung
CJ
Park
Seongsoo
S
Jang
Eul-Ju
EJ
Seo
Cheolwon
C
Suh
D000243:Adenosine Deaminase / Q000378:metabolism; D000328:Adult; D000368:Aged; D002882:Chromosomes, Human, Pair 13; D003401:Creatine / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism; D007072:Immunoglobulin D / Q000378:metabolism; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis; D010950:Plasma Cells / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D001613:beta 2-Microglobulin / Q000097:blood
D007070:Immunoglobulin A; D007072:Immunoglobulin D; D001613:beta 2-Microglobulin; D007770:L-Lactate Dehydrogenase; D000243:Adenosine Deaminase; D003401:Creatine