Primary plasmacytoma of the lymph node (plasmocytic lymphoma). The differential diagnosis of nodal plasma-cell proliferates

Methods: A 60-year-old man was found on routine examination to have an enlarged, firm, cervical lymph node. He looked older than his age and his general condition was poor. He had no fever, nocturnal sweating or weight loss. Further examination revealed no hepatosplenomegaly on palpation, but numerous enlarged cervical lymph nodes were palpable. Methods: Histological investigation of a cervical lymph node revealed a marked increase in slightly pleomorphic plasma cells with monotypic expression of IgM-kappa. Multiple myeloma was excluded on the basis of histological and cytological findings in the bone marrow. Serology revealed a mild antibody deficiency syndrome (gamma-globulin 7.8%) with signs of acute inflammation and an increase in alpha 2-globulin. There was no evidence of a monoclonal gammopathy on electrophoresis. A diagnosis of primary nodal plasmacytoma was made.

Results: As the patient was asymptomatic at diagnosis he was not given chemotherapy. There was no evidence of tumour progression at follow-up examination two months later. His progress will be monitored closely.

Conclusions: This patient's history is consistent with the prognosis generally associated with primary nodal plasmacytoma that is much better than that of multiple myeloma.