A 56-year-old previously healthy man presented to the dermatology clinic with a 
2-year history of an expanding, violaceous, infiltrated plaque on the right 
flank. Biopsy revealed a diffuse dermal vascular proliferation of bland, 
capillary-sized vessels admixed with conspicuous fibrohistiocytic cells 
including scattered multinucleated floret cells. Further workup revealed a 
monoclonal gammopathy, an osteolytic chest wall plasmacytoma underlying the 
plaque, and regional lymphadenopathy leading to a diagnosis of adenopathy and 
extensive skin patch overlying a plasmacytoma (AESOP). Biopsy of an enlarged 
lymph node revealed Castleman disease. The patient subsequently developed 
polyneuropathy and peripheral edema, which supported an additional diagnosis of 
polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin 
changes (POEMS) syndrome. Herein, we discuss the unique findings of our patient, 
the potential pathogenesis of AESOP, and the link between these three rare 
paraneoplastic entities along with review of the literature.