Alsaleh Bano, Alanzi Ahmed, Alsaeed Mai, Farahat Abdulrahman, Alsaleh Mohammed, Mohamed Hosameldin
Radiology, King Hamad University Hospital, Muharraq, BHR.
Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR.
Cureus. 2024 Oct 5;16(10):e70906. doi: 10.7759/cureus.70906. eCollection 2024 Oct.
Breast plasmacytoma is an uncommon extramedullary manifestation of multiple myeloma (MM). This case presents a primary extramedullary plasmacytoma and progression to MM with breast involvement after 12 years of discovering the disease. The patient is a 54-year-old woman who initially presented with a right humerus pathological fracture that turned out to be a primary extramedullary plasmacytoma. She received chemotherapy and achieved remission. Six years later, the disease recurred as a mass in the sternum, which was treated with radiation and chemotherapy but without improvement. The disease then progressed to MM with lesions in various bones. Following the first radiation treatment, the patient developed a new-onset cough, leading to a high-resolution CT, which incidentally revealed multiple bilateral breast lesions suggestive of malignancy. Mammography and sonography indicated multiple nodular densities warranting biopsy. Tru-cut biopsy confirmed plasmacytic neoplasm consistent with MM. Subsequent imaging showed the progression of breast lesions with increasingly aggressive features. Biopsies consistently indicated refractory progressive MM. This case highlights the aggressive, multisystemic nature of MM and the challenge of managing refractory disease with extensive systemic involvement, including rare bilateral breast lesions.
乳腺浆细胞瘤是多发性骨髓瘤（MM）一种罕见的髓外表现。该病例呈现为原发性髓外浆细胞瘤，并在发现疾病12年后进展为累及乳腺的MM。患者为一名54岁女性，最初表现为右肱骨病理性骨折，结果诊断为原发性髓外浆细胞瘤。她接受了化疗并实现缓解。6年后，疾病复发，表现为胸骨肿块，接受放疗和化疗但无改善。随后疾病进展为MM，出现多处骨骼病变。在首次放疗后，患者出现新发咳嗽，进行高分辨率CT检查时偶然发现双侧乳腺多处病变，提示为恶性。乳腺钼靶和超声检查显示多处结节状密度影，需进行活检。粗针活检证实为与MM一致的浆细胞性肿瘤。随后的影像学检查显示乳腺病变进展，特征愈发侵袭性。活检一直提示为难治性进展性MM。该病例突出了MM侵袭性、多系统的本质，以及管理伴有广泛全身受累（包括罕见的双侧乳腺病变）的难治性疾病的挑战。
