Imaging Findings of Plasmacytoma of Both Breasts as a Preceding Manifestation of Multiple Myeloma

Figure 1

Gray scale (a) and color Doppler (b) sonograms of the breast show multiple, circumscribed, markedly hypoechoic, round or oval masses with highly increased vascularity. Mammograms (c) show circumscribed irregular conglomerated hyperdense masses invading both entire breasts. T2-weighted image of breast magnetic resonance imaging (MRI) (d) shows multiple, circumscribed, oval or round masses of high signal intensity (SI) in both breasts. The masses reveal high SI on diffusion-weighted image (e) with a low apparent diffuse coefficient value (not shown) suspicious for malignancy. Early phase of dynamic contrast-enhanced sagittal T1-weighted MRI (f) shows multiple circumscribed masses with strong homogeneous enhancement. Time-intensity curve of dynamic contrast-enhanced MRI (g) shows early strong (780% of the baseline value) and fast/delayed washout enhancement kinetics, suggestive of malignancy. Follow-up positron emission tomography-computed tomography scan (h) reveals massive breast plasmacytomas (SUVmax 6.3), invading both entire breasts. Metastatic lymphadenopathies throughout the whole body and metastatic masses in the abdomen, left cheek, both shoulders, chest wall, right buttock, and both thighs are shown.

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