# A rare presentation of multiple myeloma with concurrent paraskeletal extramedullary thoracic plasmacytoma: A case report

## TL;DR

This case report describes a rare instance of multiple myeloma with a concurrent chest wall tumor, highlighting the importance of considering this condition in older patients with chest masses.

## Contribution

The paper presents a rare clinical case of paraskeletal extramedullary plasmacytoma co-occurring with multiple myeloma.

## Key findings

- Paraskeletal extramedullary plasmacytoma can present as a chest wall mass with localized symptoms.
- The VTD-Zometa regimen is effective for treatment, with surgery or radiation considered for large masses.
- Early diagnosis and differential diagnosis are critical for optimal treatment outcomes.

## Abstract

•Paraskeletal extramedullary plasmacytoma can co-occur with multiple myeloma, presenting as a chest wall mass, a rare clinical manifestation.•Paraskeletal extramedullary plasmacytoma could present with localized chest pain and swelling, as seen in this case.•Paraskeletal extramedullary plasmacytoma should be considered in the differential diagnosis of chest wall masses in older patients.•Treatment with the VTD-Zometa regimen (bortezomib, thalidomide, dexamethasone) is effective; surgery or radiation may be considered for large masses.

Paraskeletal extramedullary plasmacytoma can co-occur with multiple myeloma, presenting as a chest wall mass, a rare clinical manifestation.

Paraskeletal extramedullary plasmacytoma could present with localized chest pain and swelling, as seen in this case.

Paraskeletal extramedullary plasmacytoma should be considered in the differential diagnosis of chest wall masses in older patients.

Treatment with the VTD-Zometa regimen (bortezomib, thalidomide, dexamethasone) is effective; surgery or radiation may be considered for large masses.

Multiple myeloma is a hematological malignancy that results from the proliferation of abnormal plasma cells, typically invading the bone marrow but occasionally involving other areas of the body. We present a rare case of a 58-year-old male patient who presented with right-sided thoracic wall mass, which was eventually diagnosed through imaging and biopsy as paraskeletal extramedullary plasmacytoma with concurrent multiple myeloma. The patient exhibited symptoms of chest pain and swelling, with radiological features of a large right-sided chest wall mass. The diagnosis shows the fact that radiological presentations are quite nonspecific, often mimicking other malignancies. Such cases, therefore, require further assistance from thoracic surgery and interventional radiology in addition to advanced imaging techniques such as FDG- PET. He was subsequently treated with a three-drug regimen (VTD-Zometa protocol) including velcade, thalidomide, and dexamethasone, considering radiation versus complete surgical exicion due to the size of the mass. This case also supports the idea that clinical diversity exists among multiple myeloma and that considering paraskeletal extramedullary plasmacytoma must be given due importance when dealing with differential diagnosis of chest wall tumors in old age, although extremely rare. Early diagnosis and exclusion of all other possible diagnoses are also critical for the best possible treatment planning and outcome.