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Extended Resection of a Plasmocytoma of Bone and an Amyloidoma of the Chest Wall

2013; Elsevier BV; Volume: 96; Issue: 6 Linguagem: Inglês

10.1016/j.athoracsur.2013.04.109

1552-6259

Seyer Safi, Jan op den Winkel, Philipp A. Schnabel, Ute Hegenbart, Kai Neben, Thomas Schneider, Hendrik Dienemann,

Peptidase Inhibition and Analysis

Solitary plasmocytoma of bone is a rare condition of plasma cell neoplasia that presents as a single lesion. Amyloidoma of the chest wall is an uncommon presentation of solitary tissue amyloid deposition in the absence of systemic light-chain amyloidosis. This report describes a patient with both uncommon conditions. The tumor originated from the spine and invaded the right lung. In this exceedingly rare case, radiotherapy and a two-step resection of the right lower lobe, full-thickness chest wall, diaphragm, and vertebral body of T9 provided local control of the tumor. Spondylodesis of T7 to T11 provided spine stability. Solitary plasmocytoma of bone is a rare condition of plasma cell neoplasia that presents as a single lesion. Amyloidoma of the chest wall is an uncommon presentation of solitary tissue amyloid deposition in the absence of systemic light-chain amyloidosis. This report describes a patient with both uncommon conditions. The tumor originated from the spine and invaded the right lung. In this exceedingly rare case, radiotherapy and a two-step resection of the right lower lobe, full-thickness chest wall, diaphragm, and vertebral body of T9 provided local control of the tumor. Spondylodesis of T7 to T11 provided spine stability. Plasma cell neoplasms can present as single (solitary plasmocytoma) or multiple lesions (multiple myeloma). Solitary plasmocytomas develop from a monoclonal plasma cell infiltrate and most frequently occur in bone. However, less than 5% of all plasma cell neoplasms demonstrate as solitary plasmocytomas of bone. Although local radiotherapy is the treatment of choice, surgical intervention may be necessary in patients with vertebral instability [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar].Amyloidoma of the chest is an extremely rare entity consisting of a solitary tumor-like extracellular deposit of amyloid. It can mimic malignant tumors, causing local destruction and lung infiltration. Complete surgical resection of amyloidoma provides local control and low recurrence rates [2Krishnan J. Chu W.S. Elrod J.P. Frizzera G. Tumoral presentation of amyloidosis (amyloidomas) in soft tissues. A report of 14 cases.Am J Clin Pathol. 1993; 100: 135-144Crossref PubMed Scopus (112) Google Scholar].A 62-year-old white man with a medical history significant for myocardial infarction 10 years previously and prostatectomy for prostate cancer 7 years previously presented with a progressive painless swelling in his back. He reported back pain 12 months ago when he noticed the swelling for the first time. On physical examination, a right paravertebral mass could be palpated. The tumor was nontender and appeared fixed to the skin. The remainder of his physical examination was unremarkable.A chest roentgenogram showed a paravertebral thoracic mass (Fig 1). A bone scan, a cranial computed tomography scan, and abdominal ultrasound imaging were without pathologic findings in other locations.An open excisional biopsy of the mass revealed a plasmocytoma. Immunohistochemistry studies showed neoplastic cell infiltrates with immunoreactivity for cluster of differentiation 138 embedded in dense deposits of amyloid positive for Congo red. In situ hybridization light-chain messenger RNA showed high expression of immunoglobulin-λ light chain. Serum immunofixation revealed an unspecific immunoglobulin G-κ monoclonal gammopathy. No urinary paraprotein was detectable. In the free light-chain assay, however, a predominance of λ could be detected (free light-chain-λ, 66 mg/L; free light-chain-κ 22 mg/L). Cytologic analysis of the bone marrow showed the fraction of plasma cells was normal, at 4%. Organ dysfunction by amyloid deposits or evidence for systemic amyloidosis could be excluded.External-beam radiotherapy was indicated for this localized condition. A total of 50 Gy (40 Gy in fractions of 2 Gy and a single boost of 10 Gy) was applied into the tumor. At 5 months after radiotherapy, a complete remission of gammopathy and 50% tumor mass reduction were noted. However, 17 months after radiotherapy, considerable tumor progression (Fig 2), accompanied by worsening dyspnea on exertion and a new onset of hemoptysis, prompted surgical reassessment.Fig 2The chest computed tomography scan 17 months after radiotherapy shows the right lower-lobe tumor with infiltration of the chest wall, destruction of vertebral bodies T8 to T10, and invasion of the dural sac.View Large Image Figure ViewerDownload (PPT)Decortication and an en bloc resection encompassing the right lower lobe, diaphragm, ribs T8, T9, and T10, the chest wall tumor, with all surrounding tissue, vertebral body resection T9, with cage reconstruction and implantation of Marlex (Bard Medical, Covington, GA) mesh were performed through an anterolateral thoracotomy at the sixth intercostal space. In a second step, minimally invasive percutaneous dorsal screw-rod spondylodesis of T7 to T11 completed the repair.The whitish chest wall mass measured 13 cm in diameter and had invaded bone, pericostal soft tissue, and lung parenchyma. The vertebral body T9 lesion appeared brown-gray and measured 4 cm in diameter. Histologic studies demonstrated an infiltrative tumor composed mainly of neoplastic plasma cells that appeared to originate from vertebral body T9, with transition to an amorphous eosinophilic Congo-red amyloidoma (Fig 3). All margins were tumor-free.Fig 3A large-section sample morphology of the chest wall lesion stained with (A) hematoxylin and eosin and (B) Congo-red (original magnification x10) shows a dense atypical plasma cell infiltrate (*) and adjacent congophilic amyloid (arrow).View Large Image Figure ViewerDownload (PPT)The patient had no postoperative complications. He was discharged home 8 days after the operation and was followed up at 1, 4, 7, and 10 months. At 15 months after the operation, the patient was stable, with no evidence of recurrence (Fig 4).Fig 4A coronal-view whole-body magnetic resonance imaging scan demonstrates stable disease at 10 months after complete surgical resection along with stabilization and reconstruction of spine and chest wall.View Large Image Figure ViewerDownload (PPT)CommentWe here report a 62-year-old patient who had two uncommon pathologic entities: solitary plasmocytoma of vertebral body T9 and an adjacent primary amyloid tumor of the chest wall that had invaded the lung. To our knowledge, this represents the first case reported showing an advanced amyloid tumor of the chest wall secondary to plasmocytoma of bone for which complete extended resection provided local control of the tumor and spine stability.Thoracic vertebrae are the most commonly involved sites in patients with plasmocytoma of bone. Localized radiotherapy is the treatment of choice. However, surgical treatment is indicated when patients present with pain, structural instability of the bone, or neurologic compromise. Excellent postoperative results in neurologic recovery, pain relief, and spine stability have been reported [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 4Takahashi T. Koshu K. Tominaga T. Takahashi A. Yoshimoto T. Solitary plasmocytoma in the thoracic spine. Two case reports.Neurosurg Rev. 1998; 21: 121-125Crossref PubMed Scopus (21) Google Scholar].Amyloidosis usually presents in a systemic form. Localized amyloidosis in soft tissues is a rare entity. Tumor-like localized amyloid deposits, also called amyloidoma, are even less common, and we only found three reports of amyloidoma of the chest wall [2Krishnan J. Chu W.S. Elrod J.P. Frizzera G. Tumoral presentation of amyloidosis (amyloidomas) in soft tissues. A report of 14 cases.Am J Clin Pathol. 1993; 100: 135-144Crossref PubMed Scopus (112) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar, 6Munoz J.A. Gil A. Arnalich F. et al.[Transformation of a rib plasmocytoma into an amyloid tumor (author's transl)].Med Clin (Barc). 1981; 76: 267-270PubMed Google Scholar]. Primary amyloidoma of the chest wall presents like an aggressive tumor that causes local destruction. It is best treated with wide local excision and reconstruction of soft tissue and bone, which usually is curative [7Iannettoni M.D. Wiechmann R.J. Kirsh M.M. Primary amyloidoma of the chest wall.Ann Thorac Surg. 1995; 59: 1583-1586Abstract Full Text PDF PubMed Scopus (9) Google Scholar].Localized amyloidosis can be a feature of solitary plasmocytoma of bone, and it is hypothesized that the former is secondary to the latter process. Primary amyloidosis (amyloid light-chain type) is due to deposition of protein derived from immunoglobulin light-chain fragments, as seen in patients with plasma cell dyscrasia. The exact pathogenesis of amyloidoma of the chest wall is unclear, however [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar]. Polarized microscopy of the specimen from our patient revealed a transition of plasma cell infiltrate into a tumor-like amyloid deposit. Overall, the clinical and radiographic features strongly argue for a reactive process and suggest that the localized amyloidosis is secondary to plasmocytoma of bone, which is only rarely found [5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar].However, myeloma develops in most patients with apparent solitary plasmocytoma of bone, with a median time to progression of 2 to 4 years [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar], which is why these patients also require medical follow-up. Complete surgical resection with stabilization and reconstruction of spine and chest wall as required should be performed in selected patients. Although long-term analysis is missing for this intensive approach, surgical resection provides best local control, with negligible local recurrence rate and immediate spine stability [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar, 3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar]. Plasma cell neoplasms can present as single (solitary plasmocytoma) or multiple lesions (multiple myeloma). Solitary plasmocytomas develop from a monoclonal plasma cell infiltrate and most frequently occur in bone. However, less than 5% of all plasma cell neoplasms demonstrate as solitary plasmocytomas of bone. Although local radiotherapy is the treatment of choice, surgical intervention may be necessary in patients with vertebral instability [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar]. Amyloidoma of the chest is an extremely rare entity consisting of a solitary tumor-like extracellular deposit of amyloid. It can mimic malignant tumors, causing local destruction and lung infiltration. Complete surgical resection of amyloidoma provides local control and low recurrence rates [2Krishnan J. Chu W.S. Elrod J.P. Frizzera G. Tumoral presentation of amyloidosis (amyloidomas) in soft tissues. A report of 14 cases.Am J Clin Pathol. 1993; 100: 135-144Crossref PubMed Scopus (112) Google Scholar]. A 62-year-old white man with a medical history significant for myocardial infarction 10 years previously and prostatectomy for prostate cancer 7 years previously presented with a progressive painless swelling in his back. He reported back pain 12 months ago when he noticed the swelling for the first time. On physical examination, a right paravertebral mass could be palpated. The tumor was nontender and appeared fixed to the skin. The remainder of his physical examination was unremarkable. A chest roentgenogram showed a paravertebral thoracic mass (Fig 1). A bone scan, a cranial computed tomography scan, and abdominal ultrasound imaging were without pathologic findings in other locations. An open excisional biopsy of the mass revealed a plasmocytoma. Immunohistochemistry studies showed neoplastic cell infiltrates with immunoreactivity for cluster of differentiation 138 embedded in dense deposits of amyloid positive for Congo red. In situ hybridization light-chain messenger RNA showed high expression of immunoglobulin-λ light chain. Serum immunofixation revealed an unspecific immunoglobulin G-κ monoclonal gammopathy. No urinary paraprotein was detectable. In the free light-chain assay, however, a predominance of λ could be detected (free light-chain-λ, 66 mg/L; free light-chain-κ 22 mg/L). Cytologic analysis of the bone marrow showed the fraction of plasma cells was normal, at 4%. Organ dysfunction by amyloid deposits or evidence for systemic amyloidosis could be excluded. External-beam radiotherapy was indicated for this localized condition. A total of 50 Gy (40 Gy in fractions of 2 Gy and a single boost of 10 Gy) was applied into the tumor. At 5 months after radiotherapy, a complete remission of gammopathy and 50% tumor mass reduction were noted. However, 17 months after radiotherapy, considerable tumor progression (Fig 2), accompanied by worsening dyspnea on exertion and a new onset of hemoptysis, prompted surgical reassessment. Decortication and an en bloc resection encompassing the right lower lobe, diaphragm, ribs T8, T9, and T10, the chest wall tumor, with all surrounding tissue, vertebral body resection T9, with cage reconstruction and implantation of Marlex (Bard Medical, Covington, GA) mesh were performed through an anterolateral thoracotomy at the sixth intercostal space. In a second step, minimally invasive percutaneous dorsal screw-rod spondylodesis of T7 to T11 completed the repair. The whitish chest wall mass measured 13 cm in diameter and had invaded bone, pericostal soft tissue, and lung parenchyma. The vertebral body T9 lesion appeared brown-gray and measured 4 cm in diameter. Histologic studies demonstrated an infiltrative tumor composed mainly of neoplastic plasma cells that appeared to originate from vertebral body T9, with transition to an amorphous eosinophilic Congo-red amyloidoma (Fig 3). All margins were tumor-free. The patient had no postoperative complications. He was discharged home 8 days after the operation and was followed up at 1, 4, 7, and 10 months. At 15 months after the operation, the patient was stable, with no evidence of recurrence (Fig 4). CommentWe here report a 62-year-old patient who had two uncommon pathologic entities: solitary plasmocytoma of vertebral body T9 and an adjacent primary amyloid tumor of the chest wall that had invaded the lung. To our knowledge, this represents the first case reported showing an advanced amyloid tumor of the chest wall secondary to plasmocytoma of bone for which complete extended resection provided local control of the tumor and spine stability.Thoracic vertebrae are the most commonly involved sites in patients with plasmocytoma of bone. Localized radiotherapy is the treatment of choice. However, surgical treatment is indicated when patients present with pain, structural instability of the bone, or neurologic compromise. Excellent postoperative results in neurologic recovery, pain relief, and spine stability have been reported [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 4Takahashi T. Koshu K. Tominaga T. Takahashi A. Yoshimoto T. Solitary plasmocytoma in the thoracic spine. Two case reports.Neurosurg Rev. 1998; 21: 121-125Crossref PubMed Scopus (21) Google Scholar].Amyloidosis usually presents in a systemic form. Localized amyloidosis in soft tissues is a rare entity. Tumor-like localized amyloid deposits, also called amyloidoma, are even less common, and we only found three reports of amyloidoma of the chest wall [2Krishnan J. Chu W.S. Elrod J.P. Frizzera G. Tumoral presentation of amyloidosis (amyloidomas) in soft tissues. A report of 14 cases.Am J Clin Pathol. 1993; 100: 135-144Crossref PubMed Scopus (112) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar, 6Munoz J.A. Gil A. Arnalich F. et al.[Transformation of a rib plasmocytoma into an amyloid tumor (author's transl)].Med Clin (Barc). 1981; 76: 267-270PubMed Google Scholar]. Primary amyloidoma of the chest wall presents like an aggressive tumor that causes local destruction. It is best treated with wide local excision and reconstruction of soft tissue and bone, which usually is curative [7Iannettoni M.D. Wiechmann R.J. Kirsh M.M. Primary amyloidoma of the chest wall.Ann Thorac Surg. 1995; 59: 1583-1586Abstract Full Text PDF PubMed Scopus (9) Google Scholar].Localized amyloidosis can be a feature of solitary plasmocytoma of bone, and it is hypothesized that the former is secondary to the latter process. Primary amyloidosis (amyloid light-chain type) is due to deposition of protein derived from immunoglobulin light-chain fragments, as seen in patients with plasma cell dyscrasia. The exact pathogenesis of amyloidoma of the chest wall is unclear, however [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar]. Polarized microscopy of the specimen from our patient revealed a transition of plasma cell infiltrate into a tumor-like amyloid deposit. Overall, the clinical and radiographic features strongly argue for a reactive process and suggest that the localized amyloidosis is secondary to plasmocytoma of bone, which is only rarely found [5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar].However, myeloma develops in most patients with apparent solitary plasmocytoma of bone, with a median time to progression of 2 to 4 years [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar], which is why these patients also require medical follow-up. Complete surgical resection with stabilization and reconstruction of spine and chest wall as required should be performed in selected patients. Although long-term analysis is missing for this intensive approach, surgical resection provides best local control, with negligible local recurrence rate and immediate spine stability [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar, 3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar]. We here report a 62-year-old patient who had two uncommon pathologic entities: solitary plasmocytoma of vertebral body T9 and an adjacent primary amyloid tumor of the chest wall that had invaded the lung. To our knowledge, this represents the first case reported showing an advanced amyloid tumor of the chest wall secondary to plasmocytoma of bone for which complete extended resection provided local control of the tumor and spine stability. Thoracic vertebrae are the most commonly involved sites in patients with plasmocytoma of bone. Localized radiotherapy is the treatment of choice. However, surgical treatment is indicated when patients present with pain, structural instability of the bone, or neurologic compromise. Excellent postoperative results in neurologic recovery, pain relief, and spine stability have been reported [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 4Takahashi T. Koshu K. Tominaga T. Takahashi A. Yoshimoto T. Solitary plasmocytoma in the thoracic spine. Two case reports.Neurosurg Rev. 1998; 21: 121-125Crossref PubMed Scopus (21) Google Scholar]. Amyloidosis usually presents in a systemic form. Localized amyloidosis in soft tissues is a rare entity. Tumor-like localized amyloid deposits, also called amyloidoma, are even less common, and we only found three reports of amyloidoma of the chest wall [2Krishnan J. Chu W.S. Elrod J.P. Frizzera G. Tumoral presentation of amyloidosis (amyloidomas) in soft tissues. A report of 14 cases.Am J Clin Pathol. 1993; 100: 135-144Crossref PubMed Scopus (112) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar, 6Munoz J.A. Gil A. Arnalich F. et al.[Transformation of a rib plasmocytoma into an amyloid tumor (author's transl)].Med Clin (Barc). 1981; 76: 267-270PubMed Google Scholar]. Primary amyloidoma of the chest wall presents like an aggressive tumor that causes local destruction. It is best treated with wide local excision and reconstruction of soft tissue and bone, which usually is curative [7Iannettoni M.D. Wiechmann R.J. Kirsh M.M. Primary amyloidoma of the chest wall.Ann Thorac Surg. 1995; 59: 1583-1586Abstract Full Text PDF PubMed Scopus (9) Google Scholar]. Localized amyloidosis can be a feature of solitary plasmocytoma of bone, and it is hypothesized that the former is secondary to the latter process. Primary amyloidosis (amyloid light-chain type) is due to deposition of protein derived from immunoglobulin light-chain fragments, as seen in patients with plasma cell dyscrasia. The exact pathogenesis of amyloidoma of the chest wall is unclear, however [3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar]. Polarized microscopy of the specimen from our patient revealed a transition of plasma cell infiltrate into a tumor-like amyloid deposit. Overall, the clinical and radiographic features strongly argue for a reactive process and suggest that the localized amyloidosis is secondary to plasmocytoma of bone, which is only rarely found [5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar]. However, myeloma develops in most patients with apparent solitary plasmocytoma of bone, with a median time to progression of 2 to 4 years [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar], which is why these patients also require medical follow-up. Complete surgical resection with stabilization and reconstruction of spine and chest wall as required should be performed in selected patients. Although long-term analysis is missing for this intensive approach, surgical resection provides best local control, with negligible local recurrence rate and immediate spine stability [1Dimopoulos M.A. Moulopoulos L.A. Maniatis A. Alexanian R. Solitary plasmocytoma of bone and asymptomatic multiple myeloma.Blood. 2000; 96: 2037-2044PubMed Google Scholar, 3Soutar R. Lucraft H. Jackson G. et al.Guidelines on the diagnosis and management of solitary plasmocytoma of bone and solitary extramedullary plasmocytoma.Br J Haematol. 2004; 124: 717-726Crossref PubMed Scopus (318) Google Scholar, 5Fierens J. Mees U. Vanbockrijck M. Hendrikx M. Amyloidoma of the chest wall: a rare entity.Interact Cardiovasc Thorac Surg. 2008; 7: 1194-1195Crossref PubMed Scopus (13) Google Scholar].