Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2024; 12(17): 3226-3234
Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3226
Plasmacytosis mimicking multiple myeloma in angioimmunoblastic T-cell lymphoma: A case report and review of literature
Chia-Ching Lin, Hsu-Lin Lee, Hsin-Yi Chuo, Tuo-An Chen, Ming-Yueh Liu, Li-Mien Chen
Chia-Ching Lin, Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan
Chia-Ching Lin, Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Hsu-Lin Lee, Li-Mien Chen, Division of Hematology and Oncology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
Hsu-Lin Lee, Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Hsin-Yi Chuo, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan
Tuo-An Chen, Department of Pathology, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan
Ming-Yueh Liu, Department of Radiation Oncology, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan
Ming-Yueh Liu, Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Chen LM and Lee HL were the patient’s physician; Lin CC, Chuo HY and Lee HL collected the data and wrote the manuscript; Chen TA, Liu MY and Chen LM revised the manuscript. All authors approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Tri-Service General Hospital (IRB No. B202315170).
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Mien Chen, MD, Division of Hematology and Oncology, Department of Internal Medicine, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Zhongshan Road, Taichung 411, Taiwan. c332860@ms65.hinet.net
Received: February 23, 2024
Revised: March 18, 2024
Accepted: April 23, 2024
Published online: June 16, 2024
Processing time: 102 Days and 2.8 Hours
Abstract
BACKGROUND

Angioimmunoblastic T-cell lymphoma (AITL) is a common subtype of peripheral T-cell lymphoma. Approximately half of patients with AITL may concurrently present with hypergammaglobulinemia. Increased numbers of plasma cells in the bone marrow are commonly observed at diagnosis. These tumors mimic plasma cell myelomas, hindering a conundrum of clinical diagnoses and potentially delaying appropriate treatment.

CASE SUMMARY

A 78-year-old woman experienced poor appetite, weight loss of 5 kg, fatigue 2 months before presentation, and shortness of breath 2 d before presentation, but no fever or night sweats. Physical examination revealed splenomegaly and many palpable masses over the bilateral axillary regions, approximately > 2 cm in size, with rubbery consistency and no tenderness. Blood tests revealed anemia and thrombocytopenia, lactate dehydrogenase level of 153 U/L, total protein level of 10.9 g/dL, albumin to globulin ratio of 0.2, and immunoglobulin G level more than the upper limit of 3000 mg/dL. The free kappa and lambda light chain concentrations were 451 and 614 mg/L, respectively. A pathological examination confirmed the diagnosis of AITL. The initial treatment was the cyclophosphamide, epirubicin, vincristine, and prednisolone regimen. Following this treatment, pleural effusion was controlled, and the patient was discharged in a stable condition and followed up in our outpatient department.

CONCLUSION

This report highlights the importance of differentiating reactive plasmacytosis from plasma cell myeloma in patients with hypergammaglobulinemia. A precise diagnosis of AITL requires a comprehensive evaluation, involving clinical, immunophenotypic, and histological findings conducted by a multidisciplinary team to ensure appropriate treatment.

Keywords: Angioimmunoblastic T-cell lymphoma; Plasmacytosis; Multiple myeloma; Lymphoma, Hypergammaglobulinemia; Case report

Core Tip: Angioimmunoblastic T-cell lymphoma (AITL) is a common subtype of peripheral T-cell lymphoma. These tumors mimic plasma cell myelomas, hindering a conundrum of clinical diagnoses and potentially delaying appropriate treatment. A precise diagnosis of AITL requires a comprehensive evaluation, involving clinical, immunophenotypic, and histological findings conducted by a multidisciplinary team to ensure appropriate treatment. This report highlights the importance of differentiating reactive plasmacytosis from plasma cell myeloma in patients with hypergammaglobulinemia.