Extraosseous plasmacytoma with an aggressive course occurring solely in the CNS.

Extraosseous (extramedullary) plasmacytoma is a relatively indolent neoplasm that constitutes 3-5% of all plasma cell neoplasms. Rare cases have been reported to truly occur in the CNS and not as an extension from a nasal lesion. EBV expression in plasma cell neoplasms has been reported in very few cases that are mainly post-transplant or occurring in severely immunosuppressed patients. We report a case of extraosseous plasmacytoma with an aggressive course in an HIV-positive individual that occurred solely in the CNS, showing EBV expression by in situ hybridization, and presenting as an intraparenchymal mass as well as in the CSF.

Asian-variant intravascular large B-cell lymphoma.

Intravascular large B-cell lymphoma (IVLBCL) is a rare and deadly malignancy involving the growth of lymphoma cells within vessel lumina of all organ types. IVLBCL is further divided into the hemophagocytic Asian variant and a classical Western variant. Both variants are difficult to diagnose by imaging, and although diagnostic criteria have been developed to guide workup, histopathological examination remains imperative. Treatment of IVLBCL remains difficult given the high mortality of the disease, but rituximab has emerged as a promising therapeutic option when combined with various cytotoxic regimens. The two main variants of IVLBCL generally manifest in their respective Asian or Western populations, and crossover between ethnicities is rare. We present the second described case of Asian-variant IVLBCL in an African American individual.

Treatment of Focal Segmental Glomerulosclerosis Recurrence in the Renal Allograft: A Report of Two Cases.

Focal segmental glomerulosclerosis (FSGS) causes glomerular lesions that can progress to end-stage renal disease. It is suspected to be caused by a circulating factor that is amenable to plasmapheresis removal and exhibits a risk for recurrence in the renal allograft. We present two patients with FSGS recurrence in their allograft kidneys diagnosed by biopsy after significant proteinuria developed in the posttransplant setting. Treatment with therapeutic plasma exchange induced long-term remission in both patients. Spot urine protein:creatinine ratios were monitored and treatment was continued until a target of <0.5 was achieved. In patient number two, a second peak in proteinuria and azotemia was ultimately attributable to ureteral stenosis and these values normalized following repair. In conclusion, therapeutic plasma exchange is an effective treatment for FSGS recurring following renal transplant.

Solitary plasmacytoma of the bone involving young individuals, is there a role for preceding trauma?

Solitary plasmacytoma of the bone (SPB) is a rare plasma cell neoplasm that usually presents as a lytic lesion mainly localized within the axial skeleton. The occurrence of SPB in young individuals is exceedingly rare but has been sporadically reported before. We report a case of SPB involving a 21 year-old male with a prior history of trauma at the same site. We also reviewed all previous cases of SPB in young individuals that were accessible to us to investigate the incidence of prior trauma in such cases and to investigate a potential role that trauma may play in the pathogenesis of such lesions.