Case Report: Cytoreductive surgery as a therapeutic attempt in the treatment of extramedullary plasmacytoma.

Introduction: Multiple myeloma is a haematological malignancy based on pathological monoclonal proliferation of plasma cells, which usually occurs in the bone marrow. Known aspects of its symptomatology include anaemia, renal failure, hypercalcaemia, osteolytic bone lesions and potentially consequences of AL amyloidosis. Diagnostics is multimodal and relies on laboratory and imaging methods of conventional radiology and nuclear medicine. Treatment is then the domain of the haematologist-oncologist. One form of this disease is extramedullary plasmacytoma, i.e., a solitary or multiple focus of multiple myeloma, which is not anatomically associated with bone marrow. This case report focuses on a patient with an advanced form of extramedullary plasmacytoma, who underwent partial cytoreductive surgery as a therapeutic attempt after exhausting all lines of conventional treatment. Case presentation: A 67-year-old male patient with an advanced form of extramedullary plasmacytoma was referred by his attending haematologist to the 1st Department of Surgery of General University Hospital in Prague of his attending haematologist to assess the possibility of extirpation of EMP lesions, due to the exhaustion of systemic therapy options. The aim of considered intervention was one of the macroscopically manifested soft tissue lesions of extramedullary plasmacytoma, which appeared suitable for surgical removal. After comprehensive preoperative assessment the elective surgical cytoreduction of the large lesion of extramedullary plasmacytoma above the right scapula was successfully performed. From the surgeon's perspective, the postoperative course was quite favourable without periprocedural complications, which ultimately led to the complete healing of the surgical wound. Despite achieving the primary surgical goal and the ongoing systemic treatment, the underlying disease developed to the stage beyond all possible therapeutic options, which ultimately led to the death of the patient. Discussion: In conclusion, despite the overall result of this case, it can be said about this therapeutic attempt that, assuming careful consideration of indications within the framework of interdisciplinary cooperation, considering all eventualities, this may be a relatively undemanding and safe procedure that does not exceed the capabilities of a standard surgical facility, is reproducible and potentially available as an addition to conventional treatment of extramedullary plasmacytoma in highly specific cases.