Multiple Myeloma Presenting Initially with Pleural Effusion and a Unique Paraspinal Tumor in the Thorax
ABSTRACT We herein report an extremely rare case of a patient with IgD-lambda positive multiple myeloma presenting with myelomatous pleural effusion and ascites. A 58-year-old man visited our hospital with dyspnea as his initial symptom. His chest radiograph findings on admission revealed a left pleural effusion, and later, bilateral involvement. Computed tomography (CT) of the chest showed a paraspinal tumor with extension from the upper mediastinum to the abdomen. The cytological examination demonstrated myeloma cells in the pleural effusion and ascites, and histologically, in the pleura, an abdominal subcutaneous tumor and bone was observed. The pleural effusion was an exudate and slightly bloody. The ADA was 70 IU/L. Pleural effusion accompanying myeloma or primary pleural myeloma is very rare and, furthermore, the extremely rare findings of both myeloma cells in the ascites (although the ascites was mainly caused by liver cirrhosis) and a high ADA activity in the pleural fluid were also observed in this case.
Chest 04/2014; 145(4):913-8. DOI:10.1378/chest.13-1662 · 7.13 Impact Factor
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ABSTRACT: Pleural effusions are a common problem in patients with malignancies. It can present as an isolated entity or be associated with parenchymal lung abnormalities. Patients with hematological malignancies (HM) can present with pleural effusion at diagnosis or may develop it during the course of their underlying disease. Regarding etiology, various causes can stimulate the accumulation of pleural fluid: the disease itself, drug toxicity, radiotherapy, underlying infections, secondary malignancies, autoimmunity, extramedullary hematopoiesis and other complications. Thoracentesis is a simple, safe and well-tolerated procedure in patients with HM.
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ABSTRACT: Objective: Discuss and improve the understanding of the clinical characters and diagnostic methods of myelomatous pleurisy, particularly of the patients with pleural effusion as an initial manifestation. Background: A 53-year-old male, who had been misdiagnosed as tuberculous pleurisy in a local hospital, was diagnosed as multiple myeloma (MM) with pleural infiltration. We reviewed the literature on clinical manifestations, serum and pleural effusion characters, treatment and diagnostic options of this exceptionally rare presentation of MM. Methods: We conducted a search of the published medical literature since 2000 in MEDLINE and PubMed using search criteria [("pleural effusion" and "MM") or "myelomatous pleural effusions"]. The search led to 64 case reports, and 16 cases with pleural effusion as an initial manifestation were included in this review. We have also searched for recent advances in diagnosis. Results and conclusions: Myelomatous pleurisy is a rare complication of MM. Its clinical and laboratory findings are non-specific. Definitive diagnosis relies on the histopathology of pleural biopsy or pleural effusion. Thoracoscopic pleural biopsy is reliable, safe and effective. Chemotherapy is the mainstay of treatment for myelomatous pleural effusion. However, the response rate is low with an overall median survival time of 4 months.07/2014; 6(7):E152-9. DOI:10.3978/j.issn.2072-1439.2014.06.48