Benbarka S S, Shubert P T, Irusen E M, Allwood B W, Koegelenberg C F N
Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
Division of Anatomical Pathology, Department of Pathology, Stellenbosch University and NHLS, Tygerberg Academic Hospital, Cape Town, South Africa.
Afr J Thorac Crit Care Med. 2022 Dec 19;28(4). doi: 10.7196/AJTCCM.2022.v28i4.242. eCollection 2022.
Plasmacytoma is a plasma cell dyscrasia originating from a single clone of plasma cells of B-lymphocyte lineage and produces a monoclonal immunoglobulin. Transthoracic fine-needle aspiration (TTNA) under ultrasound (US) guidance is a well-validated technique for the diagnosis of many neoplasms and has been shown to be safe and cost effective, with diagnostic yields comparable to more invasive techniques. However, the role of TTNA in the diagnosis of thoracic plasmacytoma is not well established.
The aim of this study was to assess the utility of TTNA and cytology in confirming a diagnosis of plasmacytoma.
All cases of plasmacytoma diagnosed from January 2006 to December 2017 by the Division of Pulmonology, Tygerberg Hospital, were retrospectively identified. All patients who underwent an US-guided TTNA and of whose clinical records could be retrieved were included in this cohort. The International Myeloma Working Group's definition of a plasmacytoma was used as the gold standard.
A total of 12 cases of plasmacytoma were identified and 11 patients included (one patient was excluded owing to missing medical records). Six of the 11 patients (mean age 59.5 ± 8.5 years) were male. Radiologically, most had multiple lesions (n=7), most commonly bony (n=6) with vertebral body involvement (n=5) and pleural-based lesions (n=2). Rapid onsite evaluation (ROSE) was performed and documented in 6 of the 11 cases, and a provisional diagnosis of plasmacytoma was suggested in 5 of the 6 patients (83.3%). The final laboratory cytological diagnoses of all 11 cases were compatible with plasmacytoma which was further confirmed via a bone marrow biopsy (n=4) and by serum electrophoresis (n=7).
US-guided fine-needle aspiration is feasible and is useful to confirm a diagnosis of plasmacytoma. Its minimally invasive nature may be the ideal investigation of choice in suspected cases.
浆细胞瘤是一种起源于B淋巴细胞系单个浆细胞克隆的浆细胞发育异常，可产生单克隆免疫球蛋白。超声（US）引导下经胸细针穿刺抽吸（TTNA）是诊断多种肿瘤的一种经过充分验证的技术，已被证明是安全且具有成本效益的，其诊断率与更具侵入性的技术相当。然而，TTNA在胸浆细胞瘤诊断中的作用尚未明确。
本研究旨在评估TTNA及细胞学检查在确诊浆细胞瘤中的效用。
回顾性确定2006年1月至2017年12月期间由泰格堡医院肺病科诊断的所有浆细胞瘤病例。所有接受超声引导下TTNA且临床记录可检索的患者均纳入该队列。采用国际骨髓瘤工作组对浆细胞瘤的定义作为金标准。
共识别出12例浆细胞瘤病例，纳入11例患者（1例患者因病历缺失被排除）。11例患者中有6例（平均年龄59.5±8.5岁）为男性。影像学上，大多数患者有多个病灶（n=7），最常见的是骨病灶（n=6），累及椎体（n=5）和胸膜下病灶（n=2）。11例病例中有6例进行了快速现场评估（ROSE）并记录，6例患者中有5例（83.3%）初步诊断为浆细胞瘤。所有11例病例的最终实验室细胞学诊断均与浆细胞瘤相符，其中4例通过骨髓活检进一步确诊，7例通过血清电泳进一步确诊。
超声引导下细针穿刺抽吸可行，有助于确诊浆细胞瘤。其微创性质可能是疑似病例的理想检查选择。
