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Iosif E, Rees C, Beeslaar S, Shamali A, Lauro R, Kyriakides C. Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature. World J Gastrointest Endosc 2019. [DOI: 10.4253/wjge.v11.i4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Iosif E, Rees C, Beeslaar S, Shamali A, Lauro R, Kyriakides C. Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature. World J Gastrointest Endosc 2019; 11:308-321. [PMID: 31040892 PMCID: PMC6475702 DOI: 10.4253/wjge.v11.i4.308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment.
CASE SUMMARY Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search (PubMed database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma (EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males (67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach (41%), followed by the duodenum (15%). The most common presenting complaint was melena (44%). In the majority of cases, the EMPs were a secondary manifestation (63%) at the background of multiple myeloma (26%), plasmablastic myeloma (7%) or high-grade plasma cell myeloma (4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs.
CONCLUSION Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy.
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Affiliation(s)
- Evangelia Iosif
- Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Clare Rees
- Department of Haematology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Salome Beeslaar
- Department of Histopathology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Awad Shamali
- Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Roberto Lauro
- Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Charis Kyriakides
- Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
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Kang DY, Kim GB, Choi BS, Seo JW, Lim HJ, Hong R, Park SG. Successful treatment of a primary gastric plasmacytoma mimicking intractable gastric ulcer by using high-dose dexamethasone therapy: a case report. J Med Case Rep 2016; 10:79. [PMID: 27036197 PMCID: PMC4818398 DOI: 10.1186/s13256-016-0863-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/09/2016] [Indexed: 12/22/2022] Open
Abstract
Background Extramedullary plasmacytoma is a plasma cell neoplasm that presents as a solitary lesion in soft tissue. Most extramedullary plasmacytomas involve the nasopharynx or upper respiratory tract. Primary plasmacytoma of the stomach is extremely rare. Case presentation A 78-year-old Korean woman presented with epigastric pain for 3 months. She had a history of an intractable gastric ulcer despite repeated endoscopic biopsies and appropriate medical therapy for the ulcer. She underwent another endoscopy and a biopsy was performed for multiple large and deep specimens. Ultimately, primary gastric plasmacytoma was confirmed. However, she and her attendant refused standard local radiotherapy or surgical resection. She came to our emergency room 3 months later with hematemesis due to a large gastric ulcer, despite management with medication for over 3 months at a local clinic. We again recommended local radiation or surgical resection. However, as she was willing to undergo only medical therapy, she was prescribed high-dose dexamethasone. Surprisingly, her ulcer completely regressed and remission was maintained for over 1 year. Conclusions We report successful treatment of a rare primary gastric plasmacytoma mimicking intractable ulcer by using high-dose dexamethasone. To the best of our knowledge, this is the first reported case successfully treated with only high-dose dexamethasone.
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Affiliation(s)
- Da-yeong Kang
- Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Gee-Bum Kim
- Department of Medicine, Graduated School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Byung-Seok Choi
- Department of Medicine, Graduated School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Jun-won Seo
- Department of Medicine, Graduated School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Hyun-Jong Lim
- Department of Medicine, Graduated School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Ran Hong
- Department of Pathology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
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Sunnetcioglu A, Ekin S, Bayram I, Ekinci O, Bugday IB. Endobronchial plasmacytoma in patient with multiple myeloma. CLINICAL RESPIRATORY JOURNAL 2015; 11:1057-1059. [PMID: 26505886 DOI: 10.1111/crj.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/26/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022]
Abstract
Endobronchial plasmacytoma is a rare manifestation of extramedullary plasmacytoma. A 49-year-old woman with a history of multiple myeloma consulted to our pulmonary service with progressive dyspnoea and cough and abnormal chest X-ray. A lesion measuring 6 × 5 cm in size existed in anterior baseline of the right lung's lower lobe in thoracic computed tomography in addition to right bronchial narrowing and atelectasis distal in lesions. Diagnostic bronchoscopy was performed previously for the obstruction and biopsy was taken from the lesion in the right middle lobe bronchus. Endobronchial biopsies showed extensive tumour infiltration with plasmocytoid cells. Immunohistochemistry was positive CD138 and Lamda. Microscopic and immunohistochemical findings supported the diagnosis of extramedullary endobronchial plasmacytoma.
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Affiliation(s)
- Aysel Sunnetcioglu
- Department of Chest Diseases, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Selami Ekin
- Department of Chest Diseases, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Irfan Bayram
- Department of Pathology, Yuzuncu Yil, Faculty of Medicine, Van, Turkey
| | - Omer Ekinci
- Department of Hematology, Yuzuncu Yil, Faculty of Medicine, Van, Turkey
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Syal G, Sethi S, Dang S, Aduli F. Rare Synchronous Gastrointestinal Plasmacytomas of Colon and Stomach. ACG Case Rep J 2015; 2:224-6. [PMID: 26203446 PMCID: PMC4508948 DOI: 10.14309/crj.2015.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/01/2015] [Indexed: 12/22/2022] Open
Abstract
Gastrointestinal (GI) plasmacytomas, though relatively uncommon, can occur with or without multiple myeloma. The small intestine is the most commonly involved GI site, followed by stomach, colon, and esophagus. Synchronous plasmacytomas involving 2 anatomically distinct regions of gastrointestinal tract have never been reported in the literature. We report a case of a multiple myeloma patient who had acute-onset hematochezia and was found to have synchronous plasmacytomas of the colon and stomach.
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Affiliation(s)
- Gaurav Syal
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Supreet Sethi
- Department of Internal Medicine, Duke University, Durham, NC
| | - Shyam Dang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Farshad Aduli
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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Yılmaz B, Köklü S, Kulaç İ. Relapse of multiple myeloma presenting with melena. Dig Endosc 2013; 25:208-9. [PMID: 23368727 DOI: 10.1111/den.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bülent Yılmaz
- Department of Gastroenterology; Hacettepe University School of Medicine; Ankara; Turkey
| | - Seyfettin Köklü
- Department of Gastroenterology; Hacettepe University School of Medicine; Ankara; Turkey
| | - İbrahim Kulaç
- Department of Gastroenterology; Hacettepe University School of Medicine; Ankara; Turkey
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Garrett J, Klimberg VS, Anaissie E, Barlogie B, Turnage R, Badgwell BD. The surgical management of abdominal pain in the multiple myeloma patient. Am J Surg 2012; 203:127-31. [DOI: 10.1016/j.amjsurg.2011.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 02/01/2011] [Accepted: 02/01/2011] [Indexed: 01/16/2023]
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Abstract
Extramedullary plasmacytoma (EMP) of the small intestine is an unusual plasma cell neoplasm in this anatomic region with only 61 cases described so far. Clinical suspicion is infrequent owing to its location and nonspecific manifestations such as abdominal pain, obstructive symptoms or even bleeding. Diagnosis is reached through histopathological examination coupled with immunohistochemistry of the endoscopic biopsy or surgical resection specimens. Nevertheless, the differential diagnosis between EMP, lymphoma and other kinds of tumors can sometimes be troublesome. The managements include surgery, radiotherapy or chemotherapy. Generally, the prognosis of EMP is favorable, but occasionally it may relapse, or progress to a plasma cell myeloma. EMP should therefore be followed-up for a long period after treatment. In this comprehensive review of the current literature, the patients' characteristics, clinical manifestations, diagnosis, differential diagnosis, treatment and outcome were discussed.
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Karam AR, Semaan RJ, Buch K, Shankar S. Extramedullary duodenal plasmacytoma presenting with gastric outlet obstruction and painless jaundice. J Radiol Case Rep 2010; 4:22-8. [PMID: 22470749 DOI: 10.3941/jrcr.v4i8.487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Malignant plasma cells in multiple myeloma are predominantly confined to the medullary space of the skeletal system, therefore the disease course will be dominated by signs and symptoms related to bone marrow infiltration and destructive bone lesions with their consequences as well as abnormal protein production. Visceral extramedullary plasmacytoma involving the gastrointestinal system and particularly the duodenum is a rare manifestation of the disease. We report a case of duodenal extramedullary plasmacytoma presenting with gastric outlet obstruction and painless jaundice, in a patient treated for multiple myeloma. Diagnosis was first suggested on imaging, and proved by endoscopic biopsy. The duodenal mass resolved following chemotherapy.
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Affiliation(s)
- Adib R Karam
- Radiology Department, University of Massachusetts Medical School, Worcester, MA, USA
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West RL, Sonneveld P, de Jonge V, Hordijk ML, Kuipers EJ. Gastrointestinal plasmacytomas: a rare finding with important consequences. Am J Gastroenterol 2008; 103:2413-4. [PMID: 18844638 DOI: 10.1111/j.1572-0241.2008.02010_13.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Masood A, Hudhud KH, Hegazi A, Syed G. Mediastinal plasmacytoma with multiple myeloma presenting as a diagnostic dilemma. CASES JOURNAL 2008; 1:116. [PMID: 18717993 PMCID: PMC2533298 DOI: 10.1186/1757-1626-1-116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/21/2008] [Indexed: 02/02/2023]
Abstract
Plasmacytoma are extramedullary accumulations of plasma cells. Most extramedullary Plasmacytomas are associated with the upper respiratory tract. The mediastinum is rarely involved. We report a rare case of mediastinal plasmacytoma with multiple myeloma. The patient is 66 year old woman presented with bone pains and mediastinal mass on CT scan and MRI. The preliminary diagnosis of occult lung cancer with mediastinal involvement, and widespread skeletal metastasis was made, although lymphoproliferative disorder along with germ cell tumor was also kept in differentials. The diagnosis of mediastinal plasmacytoma with multiple myeloma was made after extensive investigations
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Affiliation(s)
- Ashiq Masood
- Cancer care center of Frederick, Frederick, MD, USA.
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