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Large Painless Intrathoracic Mass
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I
ROENTGENOGRAM OF THE MONTH
Large Painless lntrathoracic Mass Saroj Gupta, M.D.
his =year old man presented with a history of a Tgradually increasing swelling below his left n i p ple for the past six months. He gave no history of fever, cough, or local tenderness. Physical examination revealed an 8 cm x 8 cm mass situated near the *Assistant Professor in Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi. India.
CHEST, VOL. 64, NO. 5, NOVEMBER, 1973
anterior axillary line in relation to the fourth and fifth ribs. It was nontender, tense and appeared fixed to deeper structures. The overlying skin was free and showed no signs of idammation. Routine blood analysis and urine examination were normal. Erythrocytic sedimentation rate was 25 mm per hour.
SAROJ GUPTA Diagnosis: Phmacytoma of Left Fourth Rib with lntrathoracic Extension The PA roentgenogram (Fig 1 ) reveals a sharply outlined lesion in the left midlung field. The left fourth rib was destroyed anterolaterally (Fig 2). At thoracotomy, a vascular tumor was seen arising from the anterolateral part of the left fourth rib. It invaded the pectoralis minor muscle, and had a large extrapleural intrathoracic extension. Biopsy disclosed plasmacytoma. After biopsy, the lesion was given a course of radiotherapy and the soft tissue mass regressed. For two years, he remained asymptomatic with no clinical or radiologic recurrence or dissemination. A year later, he showed recurrence at the local site as well as lesions in other ribs (Fig 3), the vertebra and skull. Discrete intrathoracic plasmacytoma is rare.' Herskovic et all reviewed 303 cases of multiple myeloma seen over a period of five years at Mayo Clinic. Only 21 had intrathoracic plasmacytoma; 19 of these had disseminated myeloma at the time the diagnosis was established. Only two represented solitary plasmacytoma. The same authors reviewed the literature from 1911 to 1960, and found only 33 cases of intrathoracic plasmacytoma. Eight of these patients were regarded as having solitary intrathoracic plasmacytoma and were alive without evidence of diffuse multiple myeloma, from nine months to eight years after diagnosis. Two other patients had multiple plasmacytomas. Neither had evidence of disseminated myeloma 25 years and 7 years later. Radiologically, multiple myeloma involving a rib
frequently has an associated large soft tissue mass which may aid in its differentiation from metastatic carcinoma. Such large extrapleural lesions may be mistaken for pleural or pulmonary lesion^.^ Diagnosis is clinched by biopsy of the tumor. The histology is identical with that of multiple myeloma of the bone marrow.' Although the prognosis is better for the patient with solitary plasmacytoma, periodic study for dissemination should be made. ACKNOWLEDGMENT: It is pleasure to thank Mr. D. P. Mola for reproducing such excellent photographs. REFERENCES
1 Herskovic T, Andersen HA, Bayrd ED: Intrathoracic plasmacytomas: presentation of 21 cases and review of literature. Dis Chest 47:1, 1965 2 Cooley RN, Donner MW: Radiographic changes of the ribs. Am J Med Sci 253:586,1987
Call for Abstracts-American Thoracic Society The Annual Meeting Committee of the American Thoracic Society invites submission of abstracts on all scientific aspects of respiratory disease for presentation at the 1974 Annual Meeting in Cincinnati, May 12-15, 1974. Abstracts should be submitted before January 15 to the Chairman of the Annual Meeting
Committee (Joseph F. Tomashefski, M.D., American Thoracic Society, 1740 Broadway, New York City 10019). The required forms and instructions may be obtained from the Annual Meeting Committee. Applications for scientific exhibits and motion pictures will also be considered.
CHEST, VOL. 64, NO. 5, NOVEMBER, 1973
I
ROENTGENOGRAM OF THE MONTH
Large Painless lntrathoracic Mass Saroj Gupta, M.D.
his =year old man presented with a history of a Tgradually increasing swelling below his left n i p ple for the past six months. He gave no history of fever, cough, or local tenderness. Physical examination revealed an 8 cm x 8 cm mass situated near the *Assistant Professor in Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi. India.
CHEST, VOL. 64, NO. 5, NOVEMBER, 1973
anterior axillary line in relation to the fourth and fifth ribs. It was nontender, tense and appeared fixed to deeper structures. The overlying skin was free and showed no signs of idammation. Routine blood analysis and urine examination were normal. Erythrocytic sedimentation rate was 25 mm per hour.
SAROJ GUPTA Diagnosis: Phmacytoma of Left Fourth Rib with lntrathoracic Extension The PA roentgenogram (Fig 1 ) reveals a sharply outlined lesion in the left midlung field. The left fourth rib was destroyed anterolaterally (Fig 2). At thoracotomy, a vascular tumor was seen arising from the anterolateral part of the left fourth rib. It invaded the pectoralis minor muscle, and had a large extrapleural intrathoracic extension. Biopsy disclosed plasmacytoma. After biopsy, the lesion was given a course of radiotherapy and the soft tissue mass regressed. For two years, he remained asymptomatic with no clinical or radiologic recurrence or dissemination. A year later, he showed recurrence at the local site as well as lesions in other ribs (Fig 3), the vertebra and skull. Discrete intrathoracic plasmacytoma is rare.' Herskovic et all reviewed 303 cases of multiple myeloma seen over a period of five years at Mayo Clinic. Only 21 had intrathoracic plasmacytoma; 19 of these had disseminated myeloma at the time the diagnosis was established. Only two represented solitary plasmacytoma. The same authors reviewed the literature from 1911 to 1960, and found only 33 cases of intrathoracic plasmacytoma. Eight of these patients were regarded as having solitary intrathoracic plasmacytoma and were alive without evidence of diffuse multiple myeloma, from nine months to eight years after diagnosis. Two other patients had multiple plasmacytomas. Neither had evidence of disseminated myeloma 25 years and 7 years later. Radiologically, multiple myeloma involving a rib
frequently has an associated large soft tissue mass which may aid in its differentiation from metastatic carcinoma. Such large extrapleural lesions may be mistaken for pleural or pulmonary lesion^.^ Diagnosis is clinched by biopsy of the tumor. The histology is identical with that of multiple myeloma of the bone marrow.' Although the prognosis is better for the patient with solitary plasmacytoma, periodic study for dissemination should be made. ACKNOWLEDGMENT: It is pleasure to thank Mr. D. P. Mola for reproducing such excellent photographs. REFERENCES
1 Herskovic T, Andersen HA, Bayrd ED: Intrathoracic plasmacytomas: presentation of 21 cases and review of literature. Dis Chest 47:1, 1965 2 Cooley RN, Donner MW: Radiographic changes of the ribs. Am J Med Sci 253:586,1987
Call for Abstracts-American Thoracic Society The Annual Meeting Committee of the American Thoracic Society invites submission of abstracts on all scientific aspects of respiratory disease for presentation at the 1974 Annual Meeting in Cincinnati, May 12-15, 1974. Abstracts should be submitted before January 15 to the Chairman of the Annual Meeting
Committee (Joseph F. Tomashefski, M.D., American Thoracic Society, 1740 Broadway, New York City 10019). The required forms and instructions may be obtained from the Annual Meeting Committee. Applications for scientific exhibits and motion pictures will also be considered.
CHEST, VOL. 64, NO. 5, NOVEMBER, 1973