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BMJ Case Reports 2017; doi:10.1136/bcr-2016-218901
  • CASE REPORT

Case of lymphadenopathy with lytic bone lesions

  1. Maitreyee Bhattacharyya1
  1. 1Medical College and Hospital Kolkata, Institute of Haematology and Transfusion Medicine, Kolkata, West Bengal, India
  2. 2Department of Medical Oncology and Haematology, All India Institute of Medical Sciences—Rishikesh, Rishikesh, Uttarakhand, India
  3. 3Dr Tribedi and Roy, Diagnostic Laboratory, Kolkata, Kolkata, West Bengal, India
  1. Correspondence to Dr Siddhesh Arun Kalantri, sidkalantri{at}gmail.com
  • Accepted 3 March 2017
  • Published 20 March 2017

Summary

Plasmablastic lymphoma, a rare highly aggressive non-Hodgkin's lymphoma subtype, often associated with HIV infection, is a close differential diagnosis of plasmablastic myeloma. The 2 conditions may be morphologically and immunophenotypically identical. However, differentiating between the 2 conditions is critical for adequate patient management. Herein, we describe an unusual case of plasmablastic myeloma with biclonal gammopathy which was initially diagnosed as plasmablastic lymphoma based on lymph node biopsy and immunohistochemistry (IHC) results. The incidental finding of lytic bone lesion on imaging prompted further investigations. The presence of multiple osteolytic lesions, biclonal gammopathy on serum protein electrophoresis and immunofixation, negative Epstein-Barr virus-encoded small RNAs on IHC led to revision of the diagnosis to plasmablastic variant of multiple myeloma. The patient was initially started on bortezomib plus dose-adjusted EPOCH chemotherapy for plasmablastic lymphoma. Subsequently, he was treated with RVD (lenalidomide, bortezomib, dexamethasone) regimen for plasmablastic myeloma and he achieved stringent complete response after 4 cycles.

Footnotes

  • Contributors SAK managed the case and wrote the manuscript, UKN diagnosed the case. DB provided IHC and HPE image. MB did final proof reading.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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