Adenopathy and Extensive Skin Patch Overlying a Plasmacytoma (AESOP) Syndrome Associated With a Solitary Bone Plasmacytoma of the Left Scapula: A Rare Paraneoplastic Presentation Managed With High-Precision Radiotherapy.

Authors

Aaditya Prakash, Amitabh Kumar Upadhyay, Chitra Sukumari, Pravesh Kumar, Subhankar Show, Ajithkumar M, Abhijin Satheeshkumar

Published in

Cureus. Volume 18. Issue 9. Pages e116234. Epub Sep 14, 2026.

Abstract

Adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome is a rare paraneoplastic manifestation characterized by three cardinal components: the underlying pathology (plasma cell dyscrasia), the cutaneous lesion (vascular cutaneous lesion), and the skeletal/nodal manifestation (solitary plasmacytoma/regional lymphadenopathy). Scapular involvement is exceptionally uncommon and may represent an early indicator of progression within the polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) spectrum. A 47-year-old male with essential hypertension presented with a 12-month history of an insidiously expanding, progressive reddish-brown skin patch over the left anterior chest wall and upper lateral torso, together with localized pain in the left scapular region. After the patient's history and examination, further workup for malignancy was advised. A baseline ¹⁸F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography) scan demonstrated an avidly hypermetabolic, destructive osteolytic bone lesion strictly localized to the body of the left scapula (maximum standardized uptake value (SUV_max) 18.3), alongside hypermetabolic left axillary lymphadenopathy (3.4 × 2.7 cm, SUV_max 3.5) and additional subcarinal, infraclavicular, and pretracheal hypermetabolic lymph nodes. A core biopsy of the left scapular mass confirmed a plasma cell neoplasm featuring dense sheets and cords of cells with plasmacytoid morphology. Immunohistochemistry (IHC) displayed absolute CD138 positivity and strict lambda light chain restriction while remaining negative for epithelial markers (AE1/AE3). Left axillary lymph node evaluation revealed reactive lymphoid cell proliferation with a preserved follicular dendritic network, successfully ruling out low-grade B-cell non-Hodgkin lymphoma. Bone marrow aspirate showed normocellular bone marrow with no evidence of lymphoma/myeloma (2-3% plasma cells). Laboratory evaluation confirmed a profound monoclonal gammopathy and severe light-chain distortion. The patient was finally diagnosed with AESOP syndrome secondary to a solitary plasma cell neoplasm of the left scapula with minimal bone marrow involvement. He was successfully treated with a definitive dose of precision-based external beam radiotherapy using image-guided intensity-modulated radiotherapy (IMRT), targeting the left scapular lesion to a total curative dose of 50.4 Gy in 28 fractions and utilizing conformal beam arrangements to safeguard adjacent organs at risk (OARs), including the lung, heart, and spinal cord. Follow-up imaging confirmed complete structural, biochemical, and metabolic remission. This case highlights the rare scapular manifestation of AESOP syndrome and emphasizes the importance of recognizing characteristic cutaneous findings as a clue to an underlying plasma cell neoplasm. Prompt diagnosis through clinicopathological correlation and histopathological confirmation, followed by definitive radiotherapy, resulted in durable local disease control and resolution of paraneoplastic manifestations.

PMID:
42877906
Bibliographic data and abstract were imported from PubMed on 16 Oct 2026.

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