Nobumasa Hojo

Extramedullary plasmacytoma arising from an adrenal gland

Extramedullary plasmacytoma is a rare malignant neoplasm typically arising outside the bone marrow of patients who show no clinical evidence of multiple myeloma. We report a rare case of extramedullary plasmacytoma that was primarily found in a right adrenal lesion. Surgical excision and radiotherapy were performed for treatment of the primary lesion. Although laboratory examinations demonstrated the presence of M-protein and elevation of monoclonal IgG-lambda, a surgically excised mass revealed monoclonality of IgG-kappa. We therefore diagnosed extramedullary plasmacytoma independent of simultaneous benign M proteinemia, because the types of M-protein were quite different. One year after radiotherapy, no local recurrence was observed.

Non-Hodgkin's lymphoma developing in a pacemaker pocket

A 29-year-old man developed diffuse large B-cell lymphoma in a subpectoral pacemaker pocket that 6 years previously had been created in the chest for a titanium-covered pulse generator. The patient had an 8-cm—diameter dark red tumor with necrotic tissue on a keloidal surgical scar in the left side of the chest. Left axillary lymphadenopathy also was present. Laboratory studies showed an increased level of soluble interleukin 2 receptor and a normal level of lactose dehydrogenase. A biopsy specimen showed a diffuse large B-cell phenotype and monoclonal immunoglobulin H gene rearrangement. A gallium scintigraphy study showed abnormal accumulation in the left chest and left axilla. On the basis of these findings, we diagnosed diffuse large B-cell lymphoma, stage II. The patient received THP-COP chemotherapy (pirarubicin, cyclophosphamide, vincristine, and prednisolone) and radiotherapy, achieved complete remission, and was free of disease for 16 months after treatment. This case suggests that there was a relationship between the development of non-Hodgkin’s lymphoma and the presence of chronic inflammation in the pulse generator pocket.