[Plasmacytoma of chest wall]

Area of Science:

• Oncology
• Surgical Pathology

Background:

• Plasmacytomas are rare plasma cell neoplasms that can occur in various locations, including the chest wall.
• Diagnosis and management of primary chest wall tumors can be challenging.

Observation:

• A 70-year-old male presented with a 6 cm elastic hard mass on the right 4th rib.
• Imaging revealed an enhanced mass with 4th rib destruction; needle aspiration cytology was inconclusive.
• Surgical resection and reconstruction were performed, with histological diagnosis of IgG lambda type plasmacytoma.

Findings:

• The patient experienced recurrence 5 months post-surgery, treated with 50 Gy radiotherapy.
• A second recurrence at the lower sternum 14 months post-surgery was managed with chemotherapy (ranimustine, vincristine, melpharan, dexamethasone).
• The patient remains disease-free 2 years and 9 months post-surgery without progression to myeloma.

Implications:

• Aggressive multimodal treatment, including surgery, radiotherapy, and chemotherapy, can be effective for managing chest wall plasmacytomas.
• This case highlights the importance of thorough diagnostic workup and tailored treatment strategies for rare tumors.
• Long-term surveillance is crucial for patients with plasmacytoma to monitor for recurrence or transformation.