Baylor University Medical Center Proceedings April 2017 - 204

These neoplasms are usually cured
with local radiation therapy and/or chemotherapy; however, regional recurrences
can occur in up to 25% of patients (5).
Metastasis to distant extramedullary sites
is not uncommon, and 30% to 50% of
patients may progress to multiple myeloma
with a median time of 1.5 to 2.5 years (1).
Conversely, plasmacytomas may be secondary to disseminated multiple myeloma. In a
study by Surov et al, 8 of 53 patients (15%)
d
c
presented with a primary breast plasmacytoma, and the remaining 45 patients (85%)
had secondary breast plasmacytoma from
spread of multiple myeloma (2). It may be
prudent, therefore, to perform bone marrow biopsy and laboratory testing, such as
serum and urine protein electrophoresis
and immunoﬁxation, in patients who are
diagnosed with breast plasmacytoma to rule
out multiple myeloma. Primary breast plasmacytomas have a better prognosis than
e
f
secondary involvement of the breast by
multiple myeloma (2). After successful
treatment of the tumor, 70% of patients
remain disease free at 10 years (5).
The reported incidence of plasmablastic
breast plasmacytomas is very rare. Given
the patient's history of multiple myeloma,
the presence of an extramedullary plasmacytoma could be a manifestation of recurrent multiple myeloma or an independent,
primary process. The nature of the original
Figure 1. (a) Solid mass of atypical plasma cells measuring 8.8 cm in greatest dimension. (b) Atypical cells
with enlarged, eccentric nuclei and prominent nucleoli. There is background eosinophilic stroma. (c) CD138 myeloma as to light chain restriction could
immunostain is diffusely positive for plasma cells. (d) CD56 is positive in 50% of the plasma cells. (e) Kappa in not be obtained. Clinically and microscopisitu hybridization is negative in plasma cells. (f) Lambda in situ hybridization is 100% positive in plasma cells. cally, plasmacytomas can mimic other processes, both benign and malignant, as in this
2016. She underwent a bone marrow biopsy and aspirate that
case. It is important for clinicians and pathologists to be knowledgeshowed no evidence of a plasma cell dyscrasia.
able about this entity to ensure correct diagnosis and therapy.
a

DISCUSSION
Primary breast plasmacytomas are not common. Approximately 45 cases of breast plasmacytoma have been published in
the literature since 1928 (7). The prevalence of breast plasmacytomas at one institution (out of all identiﬁed plasmacytomas)
was reported at 1.5% (1). Both primary and secondary plasmacytomas can be misdiagnosed as primary breast carcinoma or
even a benign process. Clinically, the majority of cases occur in
women with a mean age of 53 years (3). Patients present with a
palpable breast mass. Skin thickening and inﬂammatory signs
may occur and suggest a breast abscess or inﬂammatory carcinoma. Patients have no clinical or imaging features of multiple
myeloma. There is an absence of hypercalcemia, renal insuﬃciency, anemia, and lytic bone lesions. About 20% of patients
have a small M-protein, most commonly IgA. Serum or urinary
paraprotein levels are <2 g/dL (1).
204

1.
2.
3.

Park YM. Imaging ﬁndings of plasmacytoma of both breasts as a preceding
manifestation of multiple myeloma. Case Rep Med 2016;2016:6595610.
Surov A, Holzhausen HJ, Ruschke K, Arnold D, Spielmann RP. Breast
plasmacytoma. Acta Radiol 2010;51(5):498-504.
Ross JS, King TM, Spector JI, Zimbler H, Basile RM. Plasmacytoma
of the breast. An unusual case of recurrent myeloma. Arch Intern Med
1987;147(10):1838-1840.
De Chiara A, Losito S, Terracciano L, Di Giacomo R, Iaccarino G,
Rubolotta MR. Primary plasmacytoma of the breast. Arch Pathol Lab
Med 2001;125(8):1078-1080.
Swerdlow SH, Campo E, Harris NL, Jaﬀe ES, Pileri SA, Stein H, Thiele J,
Vardiman JW (Eds.). WHO Classiﬁcation of Tumours of Haematopoietic
and Lymphoid Tissues, 4th ed. Lyon, France: IARC, 2008.
Govender D, Harilal P, Dada M, Chetty R. CD31 (JC70) expression in
plasma cells: an immunohistochemical analysis of reactive and neoplastic
plasma cells. J Clin Pathol 1997;50(6):490-493.
Kaviani A, Djamali-Zavareie M, Noparast M, Keyhani-Rofagha S. Recurrence of primary extramedullary plasmacytoma in breast both simulating
primary breast carcinoma. World J Surg Oncol 2004;2(1):29.

Baylor University Medical Center Proceedings

Volume 30, Number 2

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