MM-626 A Rare Presentation of a Rare Disease, A Case Report of Breast Plasmacytoma

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 23; p. S513
• Main Authors: Elbogdady, Mohamed, Awad, Mohamed, Eldaly, Usama, Abass, Ramy, Abdelhakiem, Mustafa
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2023
• Subjects: breast; CyBorD; plasmacytoma; MM; CyBorD; breast; plasmacytoma; case
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)01478-7

Solitary plasmacytoma (SP) is a rare cancer that has affected approximately 0.191 and 0.090/100.000 men and women worldwide.
Breast plasmacytoma (BP) is a rare form of plasma cell tumor. According to the literature, BP accounted for roughly 1.5% of all the occurred plasmacytoma; of which, 15% of these were primary BP, whereas the rest were secondary MM events.
This is a case report of our first encountered case with BP.
Case report of BP case referred to OCMU and its management.
A 30-year-old female patient who had a past history of humoral lesion being diagnosed as Ewing Sarcoma 7 years ago with MRI brain showing metastasis, she received VACA/IE protocol with good response but she lost follow up, showed up 4 years later with a huge left breast mass where the FNAC showing plasma cell myeloma +ve LCA, CD138, -ve CK, ER, PR, HER2 and Ki 67 70%.
BMA and BMB, protein electrophoresis were normal with bone survey showing osteolytic lesions. She started CyBorD protocol 3 cycles with mild regression in the breast mass, shifted to VRD 3 cycles with no response regarding the mass and the same outcome came after VTD-Pace 2 cycles which required revaluation of the case.
Revaluation was done to assess the cause of refractoriness and the proper diagnosis of the case.
On revaluation breast biopsy revision showed the same previously reported result. Now the BMA and BMB showed infiltration with plasma cells, PEP monoclonal band, positive Bence Jones protein with IPT confirming the result. Approximately 75% of BM cells were abnormal plasma cells that express bright CD138, bright CD38, bright CD56, CD81. Patient refused further treatment except for supportive care.
Overall survival of this case was 29 months. It started as EMP but developed resistance and a more aggressive MM pattern.