title: Primary plasmacytoma involving mediastinal lymph nodes: A diagnostic mimicry of primary mediastinal lymphoma.
abstract: Plasmacytomas could involve any organ, and at times might pose a diagnostic challenge when the site of involvement is unusual, or if the presentation is similar to other diseases. We describe a 48-year-old man presenting with worsening shortness of breath and chest discomfort with radiologic evidence of mediastinal enlargement, mimicking a lymphoma with mediastinal involvement. An excisional biopsy of a mediastinal lymph node showed a plasma-cell infiltrate strongly positive for CD138, with a flow-cytometry analysis showing a population of lambda-restricted neoplastic plasma cells. He failed to respond to 50Gy involved-field radiotherapy, but achieved a partial response to combination chemotherapy. He underwent high-dose chemotherapy with melphalan (200mg/m(2)) followed by lenalidomide maintenance, and is in complete remission 18months postautografting. This case illustrates a unique and rare presentation of primary lymph-node plasmacytomas involving the mediastinum potentially mistaken as lymphoid malignancy. Clinicians should be aware of the plasma-cell origin of the mediastinal neoplastic process.
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Karma Z
authors.initials: KZ
authors.lastname: Salem
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA. Electronic address: Mohamed.Kharfan-Dabaja@Moffitt.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA; Division of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Horna
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Alsina
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D006801:Humans; D000077269:Lenalidomide; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D008482:Mediastinum / Q000473:pathology* / Q000528:radiation effects; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D010950:Plasma Cells / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D010954:Plasmacytoma / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D053668:Syndecan-1 / Q000032:analysis; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D018906:Antineoplastic Agents, Alkylating; D053668:Syndecan-1; D013792:Thalidomide; D000077269:Lenalidomide; D008558:Melphalan
keywords: Mediastinal involvement; Primary plasmacytoma