Cutaneous Extramedullary Plasmacytoma after Bone Fracture ( 2 фото )

A 69-year-old man presented to the dermatology clinic with a 2-month history of an enlarging purple skin mass on his right shoulder. One year before presentation, the patient had received a diagnosis of multiple myeloma and treatment had been initiated. Three months before presentation, he had sustained a pathologic closed fracture of the right humerus and had subsequently undergone surgical repair with an intramedullary nail. On physical examination at the current presentation, violaceous nodules and plaques were noted over the surgical site on the right arm and shoulder (Panel A). Histopathological analysis of a skin-biopsy sample showed diffuse dermal infiltration with monotonous cells characterized by vesicular chromatin and prominent nucleoli (Panel B, arrow). Immunohistochemical staining was positive for CD138, CD45, and CD56 and negative for CD20, CD3, and CD30. A diagnosis of a cutaneous extramedullary plasmacytoma after a bone fracture was made. Extramedullary plasmacytomas are masses of monoclonal plasma cells found outside the bone that may rarely develop in the skin after bone trauma. Proposed mechanisms include cytokine-mediated plasma-cell migration and direct extension of tumor cells from the bone marrow at the time of fracture or surgical repair. Autologous stem-cell transplantation was performed. One year later, the patient died from respiratory failure.
Madeline Conlon, M.D. and Katie McBee, M.P.H.Author
Published June 21, 2025
N Engl J Med 2025;392: e56
DOI: 10.1056/NEJMicm2500986
VOL. 392 NO. 24


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