Solitary plasmacytoma with VEGF overproduction: Report of a patient with polyneuropathy

Solitary plasmacytoma frequently involves polyneuropathy.1 Although several possible mechanisms, such as immunologic reaction of M proteins2 and neurotoxic substances, have been suggested, the pathogenesis of polyneuropathy has not yet been elucidated. Recently, we saw a patient with polyneuropathy and a solitary plasmacytoma. Her plasma vascular endothelial growth factor (VEGF) level was markedly increased, and rapidly decreased after resection of the tumor, followed by neurologic improvement. A 62-year-old Japanese woman was admitted to our hospital in May 1999 because of gait disturbance. The results of physical examination were unremarkable except for bilateral pretibial edema. Neurologic findings showed prominent muscle wasting and weakness in distal limbs and stoking and glove sensory disturbance. Deep tendon reflexes were absent or diminished in all four limbs. Laboratory studies revealed normal values of fasting blood sugar, vitamins, and thyroid function. M proteins were not detected by immunoelectrophoresis or immunofixation. Antinuclear antibody and anti-ganglioside antibodies were not detected. Her plasma VEGF level …