Presentation
Pain when walking for the past year.
Patient Data
Solid mass with well-defined borders, heterogeneous, predominantly hypoechoic, and central Doppler vascularity, located in the retrovesical region.
A solid mass measuring approximately 13.2 x 8.9 x 11.5 cm can be seen, which displaces vascular structures to the contralateral side, extends to the floor of the pelvis, and infiltrates the muscles: the right iliopsoas, obturator internus, medial aspect of the right gluteus medius, and right piriformis muscle. A bone window in an axial cut shows a lytic lesion at the level of the right iliac bone.
A sample of the affected area was obtained and examined under hematoxylin, eosin, and immunohistochemical staining. It was found that there were a lot of plasma cells present. These cells showed considerable atypia, with irregular and hyperchromatic nuclei. The staining tests showed positive Kappa light chains, KI67 positive in 70%, CD138 positive, cytokeratin AE1/AE3, cytokeratin 7, GATA-3, and negative lambda light chains and CD20.
Case Discussion
This is a case of a pathologically proven extramedullary plasmacytoma. This case illustrates the radiological appearances of a plasmacytoma by ultrasound and tomography, although the retroperitoneal location is not as frequent.
Co-authors: Cortez Evelyn, MD, radiology resident. Garrido Luis, MD, surgery resident. Del Cid Randall, MD, internal medicine resident.
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