F-18 FDG PET evaluation of bronchial plasmacytoma with CT and MRI correlation.

We present the case of a 59-year-old man diagnosed with primary solitary endobronchial plasmacytoma (PSEP). The patient presented for evaluation of an episode of hemoptysis and shortness of breath. Chest CT revealed a right hilar soft tissue mass causing stenosis of the right upper lobe and right middle lobe pulmonary arteries resulting from an extrinsic mass effect, a 2-cm nodule within the right middle lobe, and bulky right paratracheal mediastinal adenopathy. The tumor mass extended into the right mainstem bronchus, bronchus intermedius, and right upper lobe bronchus. Further evaluation with bronchoscopic biopsy and washings revealed the tissue diagnosis of endobronchial anaplastic plasmacytoma. To exclude systemic involvement by multiple myeloma, a bone survey was performed and was negative. F-18 FDG PET scan was positive in the right upper lung mass as well as in paratracheal and hilar areas. The patient received external radiation therapy and returned at 3 months for restaging with PET. Follow-up FDG PET revealed residual pulmonary disease as well as multiple new osseous lesions. MRI of the lumbar spine confirmed the presence of lesions consistent with multiple myeloma.