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Radiologic Manifestations of Primary Solitary Extramedullary and Multiple Solitary Plasmacytomas

Gaik Cheng Ooi1, James Chor-Sang Chim2, Wing-Yeh Au2 and Pek-Lan Khong1

1 Department of Diagnostic Radiology, The University of Hong Kong and Queen Mary Hospital, K405, Hong Kong SAR, Hong Kong.
2 Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong SAR, Hong Kong.


Figure 1
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  		Fig. 1A —58-year-old woman with treated primary extramedullary plasmacytoma of mediastinum who relapsed with multiple solitary plasmacytoma 9 months later. Axial enhanced CT scans show multiple enhancing cutaneous (arrowheads, A) and subcutaneous (arrows, A) lesions and heterogeneously enhancing pancreatic extramedullary plasmacytoma (arrows, B).

 

Figure 2
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  		Fig. 1B —58-year-old woman with treated primary extramedullary plasmacytoma of mediastinum who relapsed with multiple solitary plasmacytoma 9 months later. Axial enhanced CT scans show multiple enhancing cutaneous (arrowheads, A) and subcutaneous (arrows, A) lesions and heterogeneously enhancing pancreatic extramedullary plasmacytoma (arrows, B).

 

Figure 3
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  		Fig. 2 —63-year-old man with nasal extramedullary plasmacytoma. Unenhanced axial CT scan through head shows large soft-tissue mass arises from right nasal passage and extends anteriorly (black arrow) through nasal ala resulting in deviation and erosion of nasal septum and erosion of medial wall of right maxillary sinus (white arrows).

 

Figure 4
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  		Fig. 3A —53-year-old woman with multiple solitary plasmacytoma. Contrast-enhanced axial CT scan of thorax shows mass arising from left upper lobe with left pleural effusion.

 

Figure 5
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  		Fig. 3B —53-year-old woman with multiple solitary plasmacytoma. Coronal reformatted CT image shows second lesion arising from superior aspects of right atrium (arrowheads) with extension of intraatrial extramedullary plasmacytoma (arrows) into superior vena cava.

 

Figure 6
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  		Fig. 4A —49-year-old man with multiple solitary plasmacytomas arising from right kidney and mediastinum. Axial contrast-enhanced CT scans through abdomen show large right renal mass (arrows, B) with areas of necrosis encasing aorta, inferior vena cava, and superior mesenteric vessels; in B, large retroperitoneal and mesenteric lymph nodes are visible. Six months after radiation therapy and chemotherapy, recurrent solitary plasmacytomas were found in mediastinum and right adrenal.

 

Figure 7
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  		Fig. 4B —49-year-old man with multiple solitary plasmacytomas arising from right kidney and mediastinum. Axial contrast-enhanced CT scans through abdomen show large right renal mass (arrows, B) with areas of necrosis encasing aorta, inferior vena cava, and superior mesenteric vessels; in B, large retroperitoneal and mesenteric lymph nodes are visible. Six months after radiation therapy and chemotherapy, recurrent solitary plasmacytomas were found in mediastinum and right adrenal.

 

Figure 8
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  		Fig. 4C —49-year-old man with multiple solitary plasmacytomas arising from right kidney and mediastinum. Axial fast spin-echo T2-weighted scan of thorax shows hyperintense bilobed soft-tissue mass (arrows) in mediastinum encasing descending aorta and closely associated with left atrium.

 

Figure 9
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  		Fig. 4D —49-year-old man with multiple solitary plasmacytomas arising from right kidney and mediastinum. Axial postcontrast CT scan shows another extramedullary plasmacytoma (asterisks) with central necrosis and heterogeneous enhancement arising from right adrenal gland.

 

Figure 10
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  		Fig. 5A —51-year-old woman with multiple solitary plasmacytomas. Coronal CT scan through orbits shows slightly hyperdense intraorbital superior extraconal mass compressing left globe with erosion through roof of orbit (arrows) into anterior cranial fossa.

 

Figure 11
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  		Fig. 5B —51-year-old woman with multiple solitary plasmacytomas. On T1-weighted sagittal scan of brain, a second lesion (M) is revealed to arise behind dorsum sella and clivus. It appears isointense to white matter.

 

Figure 12
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  		Fig. 5C —51-year-old woman with multiple solitary plasmacytomas. Second lesion (M) is markedly enhancing with dural tail (arrowheads) on gadolinium-enhanced T1-weighted sagittal scan.

 

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