Sains Malaysiana 47(9)(2018): 2113–2118

http://dx.doi.org/10.17576/jsm-2018-4709-20

Multi-Disciplinary Approach for Managing Plasmacytoma: A Case Report

(Pendekatan Pelbagai Disiplin untuk Menguruskan Plasmasitoma: Laporan Kes)

WINT WINT THU NYUNT¹, RAHAYU DRAMAN², AIDA WIDURE MOHD MUSTAPHA³, NORALISA ABDUL KARIM¹, MOHD RAZIF MOHD IDRIS¹, NORAIMY ABDULLAH¹, TANG YEE LOONG², WAN FARIZA WAN JAMALUDIN¹, NORAIDAH MASIR² & S. FADILAH S. ABDUL WAHID^1*

¹Cell Therapy Centre, UKM Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Federal Territory, Malaysia

²Department of Pathology, UKM Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Federal Territory, Malaysia

³Department of Radiology, UKM Medical Centre (UKMMC), Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Federal Territory, Malaysia

Diserahkan: 12 Mac 2018/Diterima: 4 Mei 2018

ABSTRACT

Solitary plasmacytoma (SP) is a tumor with evidence of clonal plasma cells and no other features of multiple myeloma (MM). We report a case of SP which showed multiple recurrences of SP and then evolution into overt MM. A 56-year-old man presented with the 5-month-history of right nasal obstruction and intermittent epistaxis. He had SP (extraosseous) of right nasopharynx (3.5 × 2 × 2.5 cm), with no paraproteinaemia. He received radiotherapy (56 Gy), achieving complete remission. Ten years later, he had recurrence of SP (osseous) in left tibia, presenting with pathological fracture. He received radiotherapy (50 Gy), achieving partial response. Three years later, he had recurrence of SP (osseous) in right tibia, presenting with right leg pain. He received radiotherapy (45 Gy). While receiving treatment, he had progressive swelling in the area around right eye, double vision and headache. Imaging scans showed multiple plasmacytomas. There were presence of monoclonal paraprotein, hypercalcemia and lytic bone lesions. He was diagnosed as MM (at the age of 70 years) and treated with Bortezomib-based therapy. Currently, after one cycle of treatment, clinical improvement is achieved. The importance of multi-disciplinary team approach for managing patients with plasmacytoma is highlighted in order to achieve the holistic approach of management.

Keywords: Multiple myeloma; plasmacytoma; plasma cell proliferative disorder

ABSTRAK

Plasmasitoma bersendirian (SP) adalah tumor yang menunjukkan kewujudan sel plasma klon dan tidak menunjukkan ciri-ciri mieloma multipel (MM). Kami melaporkan kes SP yang berlaku berulang kali dan kemudian berevolusi menjadi MM yang nyata. Seorang pesakit lelaki berusia 56 tahun mengalami halangan hidung kanan selama 5 bulan dan epistaksis berkala. Beliau mempunyai SP (extraosseous) di nasofarinks kanan (3.5 × 2 × 2.5 cm) dan tiada paraproteinemia. Beliau telah menerima rawatan radioterapi (56 Gy) dan mencapai remisi lengkap. Sepuluh tahun kemudian, beliau mengalami keberulangan SP (osseous) di tibia kiri dengan patah patologi. Beliau menerima radioterapi (50 Gy) dan mencapai tindak balas separa. Tiga tahun kemudian, beliau mengalami keberulangan SP (osseous) di tibia kanan, dengan kesakitan pada kaki kanan. Beliau menerima radioterapi (45 Gy). Semasa menerima rawatan, beliau mengalami pembengkakan progresif di kawasan mata kanan, penglihatan berganda dan sakit kepala. Pengimbasan imej menunjukkan plasmasitoma berbilang. Terdapat kehadiran paraprotein monoklon, hiperkalsemia dan lesi tulang lytik. Beliau didiagnosis sebagai MM (pada usia 70 tahun) dan dirawat dengan terapi Bortezomib. Selepas satu kitaran rawatan, beliau menunjukkan peningkatan secara klinikal. Kepentingan pendekatan pelbagai disiplin dalam pengurusan pesakit plasmasitoma perlu difokuskan demi mencapai pendekatan pengurusan yang holistik.

Kata kunci: Gangguan proliferatif sel plasma; mieloma multipel; plasmasitoma

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*Pengarang untuk surat-menyurat; email: sfadilah@ppukm.ukm.edu