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Neumología y cirugía de tórax

Print version ISSN 0028-3746

Neumol. cir. torax vol.75 n.2 México Apr./Jun. 2016


Cartas al Editor

Chest wall plasmacytoma

Plasmocitoma de la pared torácica

Vitorino Modesto dos Santos

To Editor: Primary bone tumors of chest wall are rare, and near 50% are malignant.1),(2 Solitary plasmacytoma is a rare condition that may affect bones or soft tissues, and can evolve to overt multiple myeloma if not early detected and controlled.1),(2 Bone plasmacytoma often occurs in vertebrae, femur, iliac, sternum and ribs, and the outcomes are usually favorable if treated by surgery or radiotherapy.1),(2 Authors call attention to differential diagnosis, including metastasis, sarcoma, lymphoma, neurectodermal and giant cell tumors, histiocytoma, chondroma, chondroblastoma, fibroma, fibrous dysplasia, and lipoma and bone infarction.2

Arévalo-Zamora et al. described a 55-year-oldman with long standing chest pain due to an unsuspected solitary plasmacytoma of the sternum, which was diagnosed by typical histology findings in bone marrow biopsy; in addition to normal levels of serum immunoglobulins and kappa and lambda light chains.1 These features were consistent with the diagnosis of solitary plasmacytoma; and, in addition, the possibility of coexistent multiple myeloma was ruled out.1),(2 The authors emphasized the lack of consensual procedures-either surgery or radiotherapy, for the best management of this scarcely reported condition.1 They substituted the sternal body by a biological mesh, plus titanium bars; radiotherapy was utilized to treat a residual lesion showed by control images.1 The authors believe that the approach reduces complications, yielding good quality of life;1 therefore, their case report should stimulate confirmatory studies.

In this setting, I would like to comment the report by Santos et al. about rib plasmacytoma and overt multiple myeloma in a 65-year-old Brazilian woman.2 The patient with uncontrolled hypertension and type 2 diabetes, had severe anemia, heart insufficiency, renal failure, hypercalcemia and hyper viscosity.2 Further investigations showed monoclonal IgA/Kappa, 51% of plasmacytes in bone marrow, highly elevated beta-2 micro globulins, and a solitary osteolytic lesion disclosed in the right fourth rib by images of the computed tomography.2 Unsuccessfully, the patient underwent three sessions of plasmapheresis and dexamethasone to control the hyper viscosity manifestations; after initial improvement, the patient died because of irreversible pulmonary acute edema. This debilitated old woman was considered to have a long standing undetected solitary rib plasmacytoma that might have evolved to a generalized myeloma.2 The authors emphasized diagnostic challenges related to the co morbidities and the role of late diagnosis of plasma cell malignancies in the present case study.2 Should the diagnosis of rib plasmacytoma be established in an earlier phase, the outcome of the patient would be favored by surgery and radiotherapy.1),(2

The commented reports may enhance the suspicion about this rare bone tumor, and call attention to biological mesh plus titanium bars as good options.


1. Arévalo-Zamora C, Remolina-Medina CE, Borraez-Segura BA. Plasmocitoma de esternón: reconstrucción esternal con malta biológica y barras de titanio. Reporte de caso. Neumol Cir Thorax 2015;74(4):276-280. [ Links ]

2. Santos VM, Brito EFO, Paz BCS, Leal CT. Rib pasmacytoma and IgA multiple myeloma with hyperviscosity syndrome. Arch Iran Med 2012;15(8):517-519. [ Links ]

2Financial disclosure: There was no grant support for this study.

*Correspondence to: MD, PhD. Vitorino Modesto dos Santo, Santos VM, Internal Medicine, Armed Forces Hospital and Catholic University of Brasília-DF, Brazil. E-mail:

Disclosure of potential conflicts of interest: The author had full freedom of manuscript preparation and there were no potential conflicts of interest.

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