Skin dissemination of myeloma

According to the WHO classification of tumors of hematopoietic and lymphoid tissues, there are three types of plasma cell neoplasms: plasma cell myeloma (PCM), solitary plasmacytoma of bone and extraosseous plasmacytoma [1]. These tumors are characterized by proliferation of immature or atypical plasma cells in the bone marrow or tissue out of the marrow. We report a case of a patient with cutaneous involvement associated to multiple myeloma (MM), which is rarely seen [2].
A 72-year-old man was admitted to the Department of Dermatology to diagnose firm subcutaneous nodules of violaceous color located at the trunk, abdomen, limbs and scalp (Figure 1). The patient suffered from numerous internal disorders, including immunoglobulin G  multiple myeloma, type 2 diabetes, hypertension, stable angina pectoris, chronic gastritis, ulcerative colitis, asthma, prostatic hypertrophy and hypercholesterolemia and took insulin therapy, indapamide, acyclovir, ramipril, amlodipine, doxazosin, vinpocetine, ciclesonide, ipratropium bromide and salmeterol. The first symptoms of multiple myeloma occurred 2 years earlier as episodes of anemia and severe pain of the lumbar spine. Bone marrow biopsy showed 42.4% of plasmocytes and the skull X-ray revealed disseminated osteolytic lesions. Immunofixation confirmed the presence of the kappa type IgG monoclonal protein. The patient was treated with cyclophosphamide, thalidomide and dexamethasone for a year and partial remission was achieved. After 5 months, recurrence of the disease occurred. Treatment with bortezomib, cyclophosphamide and dexamethasone was initiated and continued for 6 months. One month before the completion of therapy, skin lesions occurred as described above. The patient was admitted to the Department of Dermatology. Laboratory examinations showed pancytopenia and an elevated C-reactive protein level. Abdominal ultrasonography showed gallbladder polyps and chest X-ray revealed a complete fracture of the sixth left rib. Histopathology of the nodule demonstrated infiltration of plasmacytoma cells (Figures 2 A, B). Immunohistochemistry was characteristic of plasmablastic lymphoma with round and extended cells with abundant, basophilic cytoplasm, eccentrically localized nuclei containing expressed nucleoli, giant cells and stroma fibrosis. Immunohistochemical characteristics: CD20, CD5, CD10, CD30 – negative reaction; CD138, CD79, bcl-2 – positive reaction; Ki67 up to 100% of cells with positive reaction...


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