Case of lymphadenopathy with lytic bone lesions.
Plasmablastic lymphoma, a rare highly aggressive non-Hodgkin's lymphoma subtype, often associated with HIV infection, is a close differential diagnosis of plasmablastic myeloma. The 2 conditions may be morphologically and immunophenotypically identical. However, differentiating between the 2 conditions is critical for adequate patient management. Herein, we describe an unusual case of plasmablastic myeloma with biclonal gammopathy which was initially diagnosed as plasmablastic lymphoma based on lymph node biopsy and immunohistochemistry (IHC) results. The incidental finding of lytic bone lesion on imaging prompted further investigations. The presence of multiple osteolytic lesions, biclonal gammopathy on serum protein electrophoresis and immunofixation, negative Epstein-Barr virus-encoded small RNAs on IHC led to revision of the diagnosis to plasmablastic variant of multiple myeloma. The patient was initially started on bortezomib plus dose-adjusted EPOCH chemotherapy for plasmablastic lymphoma. Subsequently, he was treated with RVD (lenalidomide, bortezomib, dexamethasone) regimen for plasmablastic myeloma and he achieved stringent complete response after 4 cycles.
Medical College and Hospital Kolkata, Institute of Haematology and Transfusion Medicine, Kolkata, West Bengal, India.
Siddhesh Arun
http://orcid.org/0000-0001-6767-1544
SA
Kalantri
Department of Medical Oncology and Haematology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India.
Uttam Kumar
UK
Nath
Dr Tribedi and Roy, Diagnostic Laboratory, Kolkata, Kolkata, West Bengal, India.
Debasis
D
Banerjee
Medical College and Hospital Kolkata, Institute of Haematology and Transfusion Medicine, Kolkata, West Bengal, India.
Maitreyee
M
Bhattacharyya
D000069286:Bortezomib / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D033162:Incidental Findings; D000077269:Lenalidomide; D000072281:Lymphadenopathy / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology*; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide