Solitary plasmacytoma (SP) is a tumor with evidence of clonal plasma cells and no other features of multiple myeloma
(MM). We report a case of SP which showed multiple recurrences of SP and then evolution into overt MM. A 56-year-old
man presented with the 5-month-history of right nasal obstruction and intermittent epistaxis. He had SP (extraosseous) of
right nasopharynx (3.5 × 2 × 2.5 cm), with no paraproteinaemia. He received radiotherapy (56 Gy), achieving complete
remission. Ten years later, he had recurrence of SP (osseous) in left tibia, presenting with pathological fracture. He
received radiotherapy (50 Gy), achieving partial response. Three years later, he had recurrence of SP (osseous) in right
tibia, presenting with right leg pain. He received radiotherapy (45 Gy). While receiving treatment, he had progressive
swelling in the area around right eye, double vision and headache. Imaging scans showed multiple plasmacytomas. There
were presence of monoclonal paraprotein, hypercalcemia and lytic bone lesions. He was diagnosed as MM (at the age
of 70 years) and treated with Bortezomib-based therapy. Currently, after one cycle of treatment, clinical improvement is
achieved. The importance of multi-disciplinary team approach for managing patients with plasmacytoma is highlighted
in order to achieve the holistic approach of management.
Most breast cancer recurrences occur in the surgical scars or within other quadrants of the same breast. Isolated tumour recurrence occurring in the nipple after breast-conserving surgery and radiotherapy is extremely unusual. The reason for this is unknown, but is speculated to be due to involved surgical margins or an occult involvement of the nipple-areolar complex in a breast cancer of the same breast. We present a case of a 44-year-old Indian woman who had recurrent tumour over her right nipple after an ipsilateral breast-conserving surgery that was followed by adjuvant chemotherapy and radiotherapy. There was no typical malignancy features from the mammogram. However, histopathological study confirmed a malignant growth that infiltrated into the dermis and the underneath breast tissue. Completion mastectomy was then performed and the patient was later treated with Taxane-based chemotherapy. Nipple recurrence after breast-conserving surgery and adjuvant radiotherapy may be confused with other nipple conditions such as Paget's disease of the breast. Comprehensive assessments, which include mammogram and biopsy, have proved that such recurrence do occur, as presented in this case. This warrants a specific management strategy.