title: Asymptomatic Multiple Myeloma Presenting as a Nodular Hepatic Lesion: A Case Report and Review of the Literature.
abstract: BACKGROUND
  Plasma cell myeloma is the most common primary bone malignancy in adults. However, liver involvement in the form of an initial and asymptomatic nodular plasmacytoma is exceedingly rare.
  
  
  METHODS
  A 64-year-old male was found to have a right hepatic lobe nodule on a routine abdominal ultrasound prior to bariatric surgery. Liver biopsy revealed a plasma cell neoplasm that, given the location of the lesion, was favored to represent a lymphoma with prominent plasmacytic differentiation. Positron emission tomography (PET) demonstrated a hypermetabolic hepatic mass and identified multiple destructive bony lesions. Biopsy of a clavicular lesion revealed sheets of plasma cells and confirmed the diagnosis of multiple myeloma. The patient underwent 6 cycles of chemotherapy with cyclophosphamide, bortezomib, and dexamethasone before transitioning to lenalidomide and dexamethasone because of early disease progression. Although the patient had International Staging System I (low-risk) disease, his disease demonstrated an aggressive clinical course and resistance to multiple lines of therapy.
  
  
  CONCLUSIONS
  Extramedullary nodular hepatic plasmacytoma is exceedingly rare. Nevertheless, extramedullary plasmacytomas should be included in the differential diagnosis of patients with indistinct hepatic lesions visualized on computed tomography scan, especially if PET scans show associated bony lesions. In general, extramedullary plasmacytomas are a poor prognostic sign and a harbinger of an aggressive clinical course in the context of multiple myeloma.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN ; These authors contributed equally to this work.
authors.forename: Hans
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN ; These authors contributed equally to this work.
authors.forename: Fateh
authors.initials: F
authors.lastname: Bazerbachi
authors.affiliation: Department of Pathology and Laboratory Medicine, Minneapolis VA Health Care System, Minneapolis, MN.
authors.forename: Hector
authors.initials: H
authors.lastname: Mesa
authors.affiliation: Division of Hematology/Oncology, Minneapolis VA Health Care System, Minneapolis, MN.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Gupta
keywords: Hypercalcemia; liver neoplasms; multiple myeloma; neoplasms–plasma cell; plasmacytoma