Multiple plasmacytomas with thoracic and biliary involvement.

The course of a patient who had nonsecretory multiple myeloma was characterized by extraosseous plasmacytomas that were initially limited to pleural lesions with effusion and subcutaneous masses. Subsequently, we noted the development of obstructive jaundice caused by a mass at the head of the pancreas, which was diagnosed by abdominal ultrasound and responded to radiation therapy, and bilateral pulmonary nodules, which were visualized by fiberoptic bronchoscopy. Forceps biopsy of an endobronchial lesion showed plasmacytoma similar in histologic features to her original osseous lesions. The pulmonary nodules responded to cyclophosphamide and prednisone. During her course, she had three forms of intrathoracic myeloma: rib lesions extending into pulmonary tissue, pleural disease, and multiple endobronchial masses. The biliary and pulmonary manifestations of plasmacytomas are rarely seen. Diagnosis by noninvasive procedures and rapid response to conservative therapy were important in this patient's care.