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Figure 1. A 59-year-old woman had recently been diagnosed with stage IIIA multiple myeloma, presenting with paraplegia due to spinal cord compression. She was treated with decompression laminectomy and radiotherapy. Evaluation after 3 cycli of chemotherapy (adriamycin, dexamethason) showed a supposed partial remission: bone marrow plasma cell infiltration <5%, serum M-protein reduction from 18.4 g/l to not measurable and 24-hrs urine M-protein decreasing from 1100 mg to 70 mg/day. At the same time, she presented with generalized weakness and growing subcutaneous soft tumors on her head. Biopsy revealed monotypic plasma cells consistent with extramedullary plasmacytoma. The patient died a few weeks later due to progressive clinical deterioration leading to secondary pneumonia. Extramedullary plasmacytomas are relatively rare, both at diagnosis and during the course of multiple myeloma. Sites of predilection for extramedullary plasmacytoma are the upper aero-digestive tract. Cutaneous involvement typically occurs during end stage and is associated with high degree of chemoresistance.
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