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Pleural involvement in plasma cell neoplasm

A 57 year old male admitted with back pain, fatigue and weight loss and he diagnosed as multiple myeloma (MM). He had back pain due to T11-12 vertebral involvement. The patient was given zoledronic acid plus 3 cycles of VAD chemotherapy (vincristine, adriamycin and dexamethasone) and received palliative radiotherapy to T11-12 vertebrae. Response to VAD was insufficient. Due to the reimbersment problems patient received 4 cycles of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) chemotherapy an autologous stem cell transplantation (ASCT). Massive pleural effusion, dyspnea, hyperglobulinemia, hypoalbuminemia, M-peak and high β2 microglobulin levels were detected. Adenosine deaminase (ADA) in pleural fluid was within normal limits. Pleural cytology and pleural biopsy showed malignant plasma cells and plasmacytoma infiltration, respectively. In pleural biopsy sample cytokeratin and lambda were negative while kappa was positive. Bortezomib was started, then patient lost to follow-up.