Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4999-5006
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4999
Primary pulmonary plasmacytoma accompanied by overlap syndrome: A case report and review of the literature
Yi Zhou, Xiao-Hong Wang, Shuang-Shuang Meng, Hui-Chao Wang, Yu-Xia Li, Rui Xu, Xu-Hong Lin
Yi Zhou, Department of Radiology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
Xiao-Hong Wang, Department of Invasive Technology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
Shuang-Shuang Meng, Yu-Xia Li, Rui Xu, Xu-Hong Lin, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
Hui-Chao Wang, Department of Nephrology, First Affiliated Hospital of Henan University, Kaifeng 475000, Henan Province, China
Author contributions: Zhou Y and Lin XH designed the report; Zhou Y, Meng SS, and Wang HC collected the patient’s clinical data; Li YX and Xu R prepared data of serum electrophoresis and serum immunofixation electrophoresis; Wang XH took pictures of computed tomography; Zhou Y took pictures of histopathological examination; Zhou Y and Lin XH wrote the paper.
Supported by the National Nature Science Foundation of China, No. 81500430 and No. U1304802; the Science and Technology Planning Project of Henan Province, No. 192102310045, No. 182102310544, No. 182102310566, and No. 182102310573; and the Henan Medical Science and Technology Tackling Project, No. 2018020337, No. 2018020332, No. 2018020334, and No. 2018020320.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xu-Hong Lin, MD, Associate Professor, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, No. 115 Ximen Street, Kaifeng 475000, Henan Province, China. 10220017@vip.henu.edu.cn
Received: April 28, 2020
Peer-review started: April 28, 2020
First decision: May 15, 2020
Revised: May 25, 2020
Accepted: August 27, 2020
Article in press: August 27, 2020
Published online: October 26, 2020
Processing time: 181 Days and 8.7 Hours
Abstract
BACKGROUND

Extramedullary plasmacytoma (EMP) is a rare kind of soft tissue plasma cell neoplasm without bone marrow involvement; this type of plasma cell neoplasm involves a lack of other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma (PPP), with no specific clinical manifestations, is an exceedingly rare type of EMP. Because of its complexity, PPP is often difficult to diagnose, and there is no report in the literature on cases accompanied by overlap syndrome (OS).

CASE SUMMARY

A 61-year-old woman without a familial lung cancer history was admitted to our hospital in 2018, for intermittent cough, expectoration, and a stuffy feeling in the chest for 50 years; these symptoms appeared intermittently, especially occurred after being cold, and had been aggravated for the last 10 d. She was diagnosed with pulmonary fibrosis and emphysema, bronchiectasis, OS, and autoimmune hepatic cirrhosis in 2017. A pulmonary examination revealed rough breath sounds in both lungs; other physical examinations found no obvious abnormalities. A routine laboratory work-up showed decreased haemoglobin, increased ESR, and abnormal GGT, ALT, IgG, γ-globulin, κ-light chain, λ-light chain, rheumatoid factor, and autoimmune antibodies. Emission computed tomography demonstrated abnormally concentrated 99mTc-MDP. Chest computed tomography revealed a soft tissue mass in the middle and lower lobes of the right lung. After right middle and inferior lobe resection with complete mediastinal lymph node dissection, immunohistochemical analysis revealed an isolated pulmonary plasmacytoma. The patient received chemotherapy for more than 1.5 years and remains in good general condition.

CONCLUSION

PPP is a type of EMP, and we report an exceedingly rare presentation of PPP accompanied by OS.

Keywords: Pulmonary neoplasms; Plasmacytoma; Overlap syndrome; Case report

Core Tip: Primary pulmonary plasmacytoma (PPP) is a rare type of extramedullary plasmacytoma, and non-specific clinical symptoms and signs make it difficult to diagnose. PPP accompanied by overlap syndrome is extremely rare; to our knowledge, no cases have been reported in the literature. Herein, we report a case and review the diagnostic process and treatment to improve the understanding of this disease and reduce the incidence of errors and missed diagnoses. We attempt to explore the relationship between PPP and overlap syndrome at the same time.