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¹Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul-Turkey DOI : 10.5505/tjo.2018.1794 Primary malignant myelomatous pleural effusion (PMMPE) occurs in <1% of patients with multiple myeloma (MM) and is diagnosed by the appearance of plasma cells on cytology or by positive flow cytometry. The nucleus-to-cytoplasm ratio is high. In addition, immature plasma cells with the presence of nucleus, Mott cells, and Russell bodies are independent poor prognostic factors. Clinicians should be able to distinguish between PMMPE and secondary pleural effusions because PMMPE is significantly associated with poor prognosis and poor survival. Presently described is a case diagnosed as MM after pleural sampling and parenchymal wedge resection performed with video-assisted thoracoscopic surgery for pleural effusion. Keywords : Mutiple myeloma; pleural effusion; video-assisted thoracoscopic surgery