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706 standardized uptake, infiltrating the ascending colon wall, and an osteolytic lesion in the right ischial tuberosity (Figure 1D and 1e). Given the risk of colon perforation, the patient underwent right hemicolectomy. The colonic le‐ sion was identified as an extramedullary plasma‐ cytoma infiltrating the intestinal muscular lay‐ er and focally invading the serosa, without an‐ gioinvasion and with negative surgical margins. The patient received radiotherapy to the right ischial tuberosity area (50 Gy in 25 fractions), which resulted in complete hematologic remission (CR). However, PET ‐CT performed a month later showed disease progression, with a focal increase in 18F ‐fluoro ‐ethyl ‐tyrosine uptake in the ster‐ num, multiple plasmacytomas in the left fourth rib, and a persisting osteolytic lesion in the right ischial tuberosity (Figure 1F–1H). After achieving complete remission with 6 cycles of VTD (bortezo‐ mib, thalidomide, dexamethasone), the patient underwent tandem autologous hematopoietic A 54 ‐year ‐old woman presented with a pea ‐sized solid lump in the sacral region, surrounded by a red areola and neither painful nor itchy. A histo‐ pathologic examination showed diffuse infiltrate (Figure 1A) composed of atypical plasma cells posi‐ tive for light chains (Figure 1B), CD56, CD138 (Sup‐ plementary material, Figure S1) and negative for CD3, CD20, CD30, CD123, anaplastic lymphoma kinase and κ light chains (Supplementary materi‐ al, Figure S2), with a Ki‐67 proliferation index of 50%. The lesion was identified as an extramedul‐ lary plasmacytoma. Intact immunoglobulins and free light chains remained within normal limits, and a slightly separated immunoglobulin A zone was revealed on immunofixation. No protein was detected on urinalysis. Bone marrow trephine bi‐ opsy showed 4% to 5% of dispersed CD138+ plas‐ ma cells with a normal immunohistochemical reaction to light (κ/λ) chains (Figure 1C). Fusion positron ‐emission tomography–computed tomog‐ raphy (PET ‐CT) revealed a mass with an elevated CLiNiCAL iMAge

Primary solitary extramedullary plasmacytoma progressing to multiple bone plasmacytomas: a rare condition with therapeutic dilemmas