Extramedullary plasmacytoma in the right pulmonary hilum

Radiol Bras. 2015 Nov/Dez;48(6):399–403 401 http://dx.doi.org/10.1590/0100-3984.2015.0119 ing from sequelae, generally associated with tuberculosis. The occurrence of lung cancer in cavities mimicking fungus ball or air crescent sign is quite rare. The tumor tends to infiltrate in the adjacent pulmonary parenchyma causing a paracicatricial effect, and may lead to emphysematous or cystic changes adjacent to the neoplastic process. In conclusion, lung cancer must be considered in the differential diagnosis for patients who present with a fungus ball-like lesion, particularly in cases where the nodule is fixed to the cavity wall.

Extramedullary plasmacytoma in the right pulmonary hilum Plasmocitoma extramedular no hilo pulmonar direito

Dear Editor,
A 53-year-old black, asymptomatic man, driver, being assessed to be released for physical activity. The patient denied smoking as well as having comorbidities.
Chest radiography performed on February 1st, 2011 showed ovoid opacity in the right hilar region, with no other abnormality ( Figure 1A). Chest computed tomography (CT) performed on March 13, 2011 identified circumscribed round opacity with soft parts attenuation in the right hilar region, presenting enhancement after intravenous contrast agent injection, adjacent to the ipsilateral main pulmonary artery and its branches. Absence of other findings ( Figures 1B and 1C).
The investigation proceeded with abdominal CT (on May 16, 2011) that showed the presence of a liver cyst and signs of fat infiltration into the liver; normal blood count; negative Bence-Jones proteinuria; protein electrophoresis with no abnormalities; absence of noteworthy findings at bone scintigraphy and bone marrow aspiration.
Radiotherapy was the treatment of choice, with satisfactory response.
Chest CT performed on November 9, 2012 ( Figure 1D) and other radiological studies with no suspect finding of disease recurrence/progression until May 20, 2015.
Plasmacytoma are primarily classified into solitary bone marrow/bone plasmacytoma (solitary myeloma), extramedullary plasmacytoma or one of multiple myeloma components (1,2) . Such showing ovoid opacity in the right hilar region. Axial chest CT section (B) at precontrast phase demonstrating circumscribed, round opacity with soft parts attenuation in the hilar region at right, and presenting enhancement after intravenous contrast agent injection, observed at coronal tomographic reconstruction (C). Contrast-enhanced axial chest CT section (D) after radiotherapy, where the previously described opacity is not characterized anymore, suggesting a good therapeutic response. tumors are constituted of plasmacytoid cells, presenting malignant degeneration and producing a specific immunoglobulin molecule (3)(4)(5)(6)(7) .
Generally, they present as masses with nonspecific soft parts density (3) . Histologically, such tumors do not originate directly from the bone marrow and cannot be distinguished from multiple myelomas. Also the differentiation from plasmacytoid cell granulomas and other inflammatory reactions is difficult, essentially requiring immunophenotyping (1,4) .
PET/CT and brown fat in the evaluation of treatment response in Hodgkin lymphoma PET/CT e gordura marrom na avaliação da resposta terapêutica no linfoma de Hodgkin Dear Editor, A female, 15-year-old patient presented with insidious onset of weight loss and low fever. Hodgkin's lymphoma was diagnosed after biopsy of a palpable enlarged lymph node. 18 F-FDG PET/ CT was performed during the initial staging, demonstrating hy-permetabolic mediastinal, axillary and cervical lymph node enlargement ( Figure 1). The findings were interpreted as lymphoma in activity in the mentioned sites. At basal PET/CT study, one could not observe metabolic activity in brown fat. Chemotherapy was initiated with adriblastine, bleomycine, vinblastine and dacarbazine at days D1 and D15 for every 28-day cycles.
Six chemotherapy cycles were uneventfully performed. A new FDG PET/CT performed after about three months to evaluate the therapeutic response demonstrated complete regression of all the lesions interpreted as lymphoma in activity at the first study.