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case_images: Abdominal and Chest Computerized Tomography Imagings (Case 1). An abdominal CT imaging of Case 1 showed multiple osteolytic lesions involving pelvic bones (Panel A, indicated by arrows). A Chest CT imaging showed a soft-tissue mass developed over the right chest wall (Panel B, indicated by an arrow).
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case_images: Computer tomography (CT) imaging showed multiple osteolytic lesions involving the mandible, sternum, ribs, vertebrae, and pelvic bones, as well as a soft-tissue mass developed over the right chest wall (Figure 1).
case_images: Histopathological analyses of the soft-tissue mass over the chest wall (Case 1). These abnormal cells were positive for CD138 which is a marker of plasmacytic differentiation (A), Multiple myeloma oncogene 1 (MUM1) which is normally expressed in terminal stages of differentiation of B-cells in the germinal center and plasma cells (B), and lambda-chain (C). These cells showed 30% of the Ki-67 index (D). A line of findings above was in agreement with the diagnosis of PBM.
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case_images: Biopsy of the soft-tissue mass over the chest wall demonstrated plasmacytoid cells positive for CD138, Bcl2, lambda-chain, and MUM1, but negative for CD3, CD10, CD30, CD79a, kappa (kappa)-chain, Bcl6, PAX5, and in situ hybridization for EBV-encoded RNA (EBER), with moderate Ki-67 staining of 30% of the cells (Figure 2). Based on the aforementioned findings atypical for MM, including the onset age and phenotype of myelofibrosis with splenomegaly, she was initially diagnosed as PBL.
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case_images: Abdominal computerized tomography imagings at the first presentation and plasmablastic transformation (Case 2). An abdominal CT imaging of obtained at the first presentation of Case 2 showed a noninvasive mass in the head of the pancreas (Panel A, indicated by an arrow) and multiple masses in the peritoneum (Panel B, indicated by an arrow). An abdominal CT imaging of obtained after local irradiation therapy for the head of the pancreas of Case 2 showed pan-peritonitis (Panel C) and massive ascites (Panel D).
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case_images: CT imaging showed a noninvasive mass in the head of the pancreas and multiple masses in the peritoneum (Figure 3). Although he received chemotherapy with DLd followed by local irradiation therapy, he rapidly developed panperitonitis and massive ascites filled with plasmablasts Figures 3 and 4.
case_images: Histopathological analyses of the pancreatic tumor at the first presentation and the ascites at the plasmablastic transformation (Case 2). Histopathological findings of the pancreatic tumor of Case 2 (Panel A-D). Abnormal cells were positive for CD138 which is a marker of plasmacytic differentiation (A), Multiple myeloma oncogene 1 (MUM1) which is normally expressed in terminal stages of differentiation of B-cells in the germinal center and plasma cells (B), and kappa-chain (C). These cells showed 50% of the Ki-67 index (D). A line of findings was in agreement with the diagnosis of PBM. Histopathological analysis of the ascites of Case 2 showed infiltration by plasma cells with plasmablastic features, diffusely positive for CD138 (Panel E). This finding suggests that the patient developed pan-peritonitis caused by a rapid progression of PBM.
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case_images: Bcl2, and kappa-chain but negative for CD30, CD79a, lambda-chain, Bcl6, PAX5, and EBER, with moderate Ki-67 staining of 50% of the cells (Figure 4). Because a biopsy of bone marrow showed no evidence of plasma cells, he was diagnosed with multiple myeloma initially. Although he received chemotherapy with DLd followed by local irradiation therapy, he rapidly developed panperitonitis and massive ascites filled with plasmablasts Figures 3 and 4.