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Mathieu C, Le Mouel JP, Moslemi A, Morel P, Tesson JR, Chatelain D. [Gastric and colic digestive localizations of myeloma; 3 case studies and literature review]. Ann Pathol 2024:S0242-6498(24)00129-9. [PMID: 38965025 DOI: 10.1016/j.annpat.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
Multiple myeloma is a malignant plasma cell proliferation located in the bone marrow and bones. It can secondarily manifest with extraosseous involvement, but the gastro-intestinal tract locations are rare. We report 3 cases of gastric and colonic localizations of myeloma in two males and one female, aged 66, 71 and 77years. Multiple myeloma had been diagnosed 1 to 7years before. Digestive symptoms were epigastric pain, rectal bleeding or an obstructive syndrome. Endoscopy revealed ulcerated and budding tumors in the stomach, and nodular pseudo-polypoid tumor formations or an ulcerated erythematous area in the colon. Histopathological examination of the biopsies showed a diffuse tumor cell proliferation in the lamina propria composed of cells with a plasmacytoid or plasmablastic appearance, expressing plasma cell markers such as CD138 on immunohistochemistry. The 3 patients died in the weeks following the diagnosis. The prognosis of digestive localizations of multiple myeloma remains very poor despite new therapies. In the presence of any digestive symptoms in these patients with multiple myeloma, more systematic endoscopy may allow an earlier diagnosis and the implementation of more effective therapies.
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Affiliation(s)
- Camille Mathieu
- Service d'anatomie et cytologie pathologiques du CHU d'Amiens, 1, place Victor-Pauchet, Amiens, France.
| | - Jean-Philippe Le Mouel
- Service d'hépato-gastro-entérologie du CHU d'Amiens, 1, rue du Professeur-Christian-Cabrol, Amiens, France
| | - Amine Moslemi
- Service d'anatomie et cytologie pathologiques du CHU d'Amiens, 1, place Victor-Pauchet, Amiens, France
| | - Pierre Morel
- Service d'hématologie du CHU Amiens, 1, rue du Professeur-Christian-Cabrol, Amiens, France
| | - Jean-René Tesson
- Service d'anatomie et cytologie pathologiques du CHU d'Amiens, 1, place Victor-Pauchet, Amiens, France
| | - Denis Chatelain
- Service d'anatomie et cytologie pathologiques du CHU d'Amiens, 1, place Victor-Pauchet, Amiens, France
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Lee JS, Park SH, Choi SJ. Radiologic Review of Small Bowel Malignancies and Their Mimicking Lesions. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:110-126. [PMID: 36818705 PMCID: PMC9935952 DOI: 10.3348/jksr.2021.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022]
Abstract
Because of their small size, small bowel malignancies are often easily missed when radiologists read CT images, which can lead to errors in the normal small bowel due to their similar enhancement to the small bowel or non-specific enhancement. In addition, small bowel malignancies are sometimes mistaken for masses of other origins, such as the uterus, rectum, or omentum. In this article, we describe various small-bowel malignancies, their mimicking lesions and the typical and atypical features on CT imaging along with their clinical manifestations.
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Affiliation(s)
- Jong Soo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Park KB, Kwon HJ, Jeong JY, Baek DW, Cho SH, Seo AN. Two cases of extramedullary plasmacytoma of the small intestine presenting with ileus: A case report. Medicine (Baltimore) 2022; 101:e30842. [PMID: 36221423 PMCID: PMC9542664 DOI: 10.1097/md.0000000000030842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Extramedullary (extraosseous) plasmacytoma (EMP) of the small intestine is a rare plasma cell neoplasm (PCN) that presents with abdominal pain, nausea, vomiting, etc. We describe 2 cases of EMP of the small intestine that presented with ileus. METHODS A 78-year-old woman and 68-year-old man visited our clinic with complaints of abdominal discomfort and obstruction. Abdominal computed tomography (CT) revealed a thickened lesion with multiple enlarged mesenteric lymph nodes (LNs) in the ileum and duodenum. The female patient underwent segmental resection in the ileum. The male patient underwent Whipple's operation in the duodenum. RESULTS Histopathological examination and immunohistochemical staining of resected specimens from the 2 patients confirmed a PCN. In the surgical specimens of 2 cases, immunoglobulin heavy-chain rearrangement was confirmed by polymerase chain reaction amplification, but no Epstein-Barr virus (EBV)-infected cells were found by EBV-in situ hybridization. Bone marrow aspirate and trephine biopsies were negative for the type of PCN. Bone marrow cytogenetics and fluorescence in situ hybridization revealed no abnormalities. Serum β2-microglobulin levels were within normal limits. Additionally, none of the patients showed an M-spike in serum or urine protein electrophoresis. Therefore, the patients were diagnosed with a solitary EMP of the small intestine. The female patient refused treatment. At follow-up 3 months postoperatively, her disease progressed and she newly developed multiple LNs and nodular lesions in the right pelvic side wall. She was treated with dexamethasone. The male patient experienced back pain 25 days after Whipple's operation. Spine series magnetic resonance imaging revealed an intermediate signal intensity mass in the posterior epidural space from T8/9 to T10. The mass was removed, and the same histologic features were identified as duodenal masses. He was treated with dexamethasone and radiotherapy. CONCLUSIONS EMPs of the small intestine are easy to overlook because they rarely occur in the small intestine. Although surgery is not required for diagnosis, surgical resection can be a good option for EMPs of the small intestine, instead of local radiation therapy. However, close follow-up is required due to the possibility of relapse or progression to plasma cell myeloma.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hyung Jun Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ji Yun Jeong
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Dong Won Baek
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- *Correspondence: An Na Seo, Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hogukno, Buk-gu, Daegu 41404, South Korea (e-mail: )
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4
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Wang KW, Xiao N. Intestinal perforation with abdominal abscess caused by extramedullary plasmacytoma of small intestine: A case report and literature review. World J Gastrointest Surg 2022; 14:611-620. [PMID: 35979418 PMCID: PMC9258233 DOI: 10.4240/wjgs.v14.i6.611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) of the gastrointestinal tract is an extremely rare disease. Clinical manifestations of EMPs are varied and depend on the location and progression of the tumor.
CASE SUMMARY Here, we firstly report a case of intestinal perforation with abdominal abscess caused by EMP of the small intestine in a 55-year-old female patient. The patient received emergency surgery immediately after the necessary preoperative procedures. During the operation, EMP was found to have caused the perforation of the small intestine and the formation of multiple abscesses in the abdominal cavity. Partial resection of the small intestine with peritoneal irrigation and drainage was performed. EMP was finally confirmed by postoperative histopathology and laboratory tests. Additionally, we performed a literature review of gastrointestinal EMP to obtain a deeper understanding of this disease.
CONCLUSION EMP of the small intestine may have spontaneous perforation, which requires emergency surgery. Surgical resection can obtain good therapeutic effects.
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Affiliation(s)
- Ke-Wei Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Nan Xiao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Rene CG, Achiam MP, Salomo M, Penninga L. Extramedullary relapse in a patient with multiple myeloma: a rare cause of gastrointestinal perforation and massive bleeding. BMJ Case Rep 2021; 14:e243663. [PMID: 34794974 PMCID: PMC8603271 DOI: 10.1136/bcr-2021-243663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/03/2022] Open
Abstract
Multiple myeloma (MM) patients live longer due to more effective treatment, and we now see previously uncommon manifestations of MM, like extramedullary disease. We present a case of a 74-year-old man known with MM that relapsed with extramedullary manifestations at different locations. One of them as a gastric plasmacytoma (GP). He was successfully treated with chemoradiotherapy (Daratumumab, Bortezomib and Dexamethasone), which resulted in clinical response for 8 months, confirmed by biopsy and histopathology. Perforation of the GP occurred, and he underwent partial gastrectomy (Billroth II gastrojejunostomy). The patient's disease progressed again 5 months after surgery, and he did not want any additional treatment. He accepted palliative care and died 10 months after the operation. A lack of knowledge about the characteristics and treatment of extramedullary MM exists, and prospective studies to investigate incidence, prognosis and treatment for extramedullary MM are needed for improving the poor prognosis of this manifestation.
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Affiliation(s)
| | | | - Morten Salomo
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
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Alnimer L, Zakaria A, Alshare B, Samhouri Y, Raphael M. A Rare Case of Small Bowel Extramedullary Plasmacytomas Presenting With Intestinal Obstruction. Cureus 2021; 13:e15704. [PMID: 34277289 PMCID: PMC8285570 DOI: 10.7759/cureus.15704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Extramedullary plasmacytoma (EMP) is a plasma cell disorder involving soft tissues in the absence of clonal bone marrow involvement or destructive bone lesions. When present in the gastrointestinal (GI) tract, and specifically the small intestine, it can cause a wide range of symptoms including GI bleeding, obstruction, and abdominal pain. The diagnosis is challenging, as it can hold an indolent course, and is infrequently encountered in clinical practice. Diagnosis requires biopsy of the involved organ, which can be obtained during surgery or endoscopy, and other workup to rule out systemic disease and bone marrow involvement. Treatment depends on the primary site of disease involvement and the presence of other features of systemic disease. We report a case of multiple small bowel plasmacytomas in a 51-year-old female who presented with small bowel obstruction. She eventually underwent surgical resection and is currently on chemotherapy awaiting stem cell transplant.
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Affiliation(s)
- Lynna Alnimer
- Department of Internal Medicine, Ascension Providence Hospital-Michigan State University/College of Human Medicine, Southfield, USA
| | - Ali Zakaria
- Department of Gastroenterology, Ascension Providence Hospital-Michigan State University/College of Human Medicine, Southfield, USA
| | - Bayan Alshare
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, USA
| | - Yazan Samhouri
- Department of Hematology and Oncology, Allegheny Health Network, Pittsburgh, USA
| | - Michael Raphael
- Department of Gastroenterology, Ascension Providence Hospital-Michigan State University/College of Human Medicine, Southfield, USA
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Abstract
Hematologic malignancies include several lymphoproliferative and myeloproliferative disorders, many of which are frequently encountered in current health care settings. These malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. In fact, the GI tract may represent the most common extranodal site of involvement in many of them, such as lymphoma. Furthermore, in the current era of improved cancer treatment and advanced transplant procedures with increased survival, it has been quite common to encounter GI involvement by these malignancies through the disease course. Post-transplant lymphoproliferative disorder following kidney transplantation, for example, very commonly involves the GI tract. Other conditions that can involve the GI tract include multiple myeloma, plasmacytoma, myeloid sarcoma, mastocytosis, and Castleman disease. Imaging diagnosis of these malignancies can be challenging, since they are much less common than primary GI cancers and both share many common imaging features as well. However, certain imaging features, particularly in combination with a matching clinical scenario, play a pivotal role in diagnosing these conditions and directing further evaluation. In this article, we review common and rare hematologic malignancies of the GI tract and discuss their pathophysiologic, clinical, and imaging features.
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Hanawa Y, Higashiyama M, Horiuchi K, Ayaki K, Ito S, Mizoguchi A, Nishii S, Wada A, Inaba K, Sugihara N, Furuhashi H, Takajo T, Shirakabe K, Watanabe C, Tomita K, Komoto S, Nagao S, Miura S, Shimazaki H, Takeuchi K, Ueno H, Hokari R. Crohn's Disease Accompanied with Small Intestinal Extramedullary Plasmacytoma. Intern Med 2019; 58:2019-2023. [PMID: 30918171 PMCID: PMC6702015 DOI: 10.2169/internalmedicine.1687-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We herein present the case of an immunocompetent 63-year-old man who had previously undergone resection of Crohn's disease (CD)-related small intestinal obstruction more than 30 years ago. He had not been receiving any medication for many years, but had recently started to suffer from ileus. A stenosed site of ileo-cecal anastomosis was identified and therefore was surgically resected, which was diagnosed as CD with small intestinal extramedullary plasmacytoma (EMP). The subsequent progression of CD was successfully controlled by anti-TNFα agents without any recurrence of EMP for over 3 years, implying the clinical benefit and safety of the biological therapy. This was the first known case of a patient who received anti-TNFα agents after a resection of small intestinal EMP accompanied with CD.
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Affiliation(s)
- Yoshinori Hanawa
- Department of Internal Medicine, National Defense Medical College, Japan
| | | | - Kazuki Horiuchi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kana Ayaki
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Suguru Ito
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Akinori Mizoguchi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shin Nishii
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Akinori Wada
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kenichi Inaba
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Nao Sugihara
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hirotaka Furuhashi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Takeshi Takajo
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kazuhiko Shirakabe
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Chikako Watanabe
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kengo Tomita
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shigeaki Nagao
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Soichiro Miura
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hideyuki Shimazaki
- Department of Laboratory Medicine, National Defense Medical College Hospital, Japan
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Japan
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9
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Mwinyogle AA, Bhatt A, Kapisoda K, Somerville J, Cunningham SC. Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report. J Med Case Rep 2019; 13:148. [PMID: 31097019 PMCID: PMC6524270 DOI: 10.1186/s13256-019-2068-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7–17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. Case presentation We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. Conclusions Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.
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Affiliation(s)
| | - Astha Bhatt
- Department of Surgery, St Agnes Hospital, Baltimore, MD, USA
| | | | | | - Steven C Cunningham
- Pancreatic and Hepatobiliary Surgery, St Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD, 21229, USA.
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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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11
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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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12
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Fagkrezos D, Manes K, Paraskeva K, Lenos M, Triantopoulou C, Apessou D, Maniatis P. Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report. J Med Case Rep 2018; 12:379. [PMID: 30583721 PMCID: PMC6305571 DOI: 10.1186/s13256-018-1888-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Involvement of the gastrointestinal tract occurs in approximately 10% of cases. Case presentation A 71-year-old Caucasian woman with known diverticular disease of the colon and multiple myeloma diagnosed 3 years previously, with monoclonal bands of immunoglobulin A, lambda light chains, and multiple osteolytic lesions, presented to our hospital with abdominal pain, abdominal discomfort, and pneumoperitoneum. She underwent left colectomy for diverticulitis with perforation, and an extramedullary secondary colonic plasmacytoma was found in histopathological examination of the sigmoid colon. Conclusions Plasmacytoma is known to occur in extraosseous sites. The stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Secondary extramedullary plasmacytoma of the colon is rare. Colonic plasmacytoma may have varying clinical presentations, such as inflammatory bowel disease and multiple colonic strictures. Although these cases are rare, treating physicians as well as radiologists, pathologists, and surgeons should be aware of this entity.
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Affiliation(s)
- Dimitris Fagkrezos
- Computed Tomography Department, Konstantpouleio General Hospital Nea Ionia, Athens, Greece.
| | - Konstantinos Manes
- Surgery Department, Konstantpouleio General Hospital Nea Ionia, Athens, Greece
| | - Konstantina Paraskeva
- Gastroenterology Department, Konstantpouleio General Hospital Nea Ionia, Athens, Greece
| | - Michalis Lenos
- Pathology Department, Konstantopouleio General Hospital Nea Ionia, Athens, Greece
| | | | - Dimitra Apessou
- Pathology Department, Konstantopouleio General Hospital Nea Ionia, Athens, Greece
| | - Petros Maniatis
- Computed Tomography Department, Konstantpouleio General Hospital Nea Ionia, Athens, Greece
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13
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Glasbey JC, Arshad F, Almond LM, Vydianath B, Desai A, Gourevitch D, Ford SJ. Gastrointestinal manifestations of extramedullary plasmacytoma: a narrative review and illustrative case reports. Ann R Coll Surg Engl 2018; 100:371-376. [PMID: 29692194 DOI: 10.1308/rcsann.2018.0015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Solitary extramedullary plasmacytoma are rare, solid-mass tumours which appear immunophenotypically similar to multiple myeloma. The diagnosis and management of gastrointestinal plasmacytoma is complex and requires multidisciplinary input. This study presents a narrative review of intra-abdominal extramedullary plasmacytoma, illustrated with two case studies. Methods The PubMed database was searched without date restrictions for reports of intra-abdominal extramedullary plasmacytoma to synthesise a narrative review. Electronic records were reviewed at a high-volume, quaternary soft-tissue sarcoma centre to identify patients with histopathologically confirmed extramedullary plasmacytoma affecting the gastrointestinal tract. Results Gastrointestinal extramedullary plasmacytomas can present with mass effect or organ-specific dysfunction. Techniques for tissue diagnosis of extramedullary plasmacytoma vary dependent on location, with a formal diagnosis often being made from a resected specimen. Management can include surgery, radiotherapy, systemic chemotherapy or a combination. No high-quality evidence base exists to guide treatment. Two case studies of operated gastrointestinal extramedullary plasmacytoma are presented at different phases of disease progression, with a resultant impact on survival. Conclusion Intra-abdominal extramedullary plasmacytoma is a rare and heterogeneous condition that lacks consensus guidelines for diagnosis and management. Collaboration between international specialist centres will create better quality evidence for treatment of this cohort.
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Affiliation(s)
- J C Glasbey
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
| | - F Arshad
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
| | - L M Almond
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
| | - B Vydianath
- Department of Histopathology, Queen Elizabeth Hospital , Birmingham , UK
| | - A Desai
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
| | - D Gourevitch
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
| | - S J Ford
- Department of Soft Tissue Sarcoma, Queen Elizabeth Hospital , Birmingham , UK
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14
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Licci S. Duodenal localization of plasmablastic myeloma. World J Gastrointest Pathophysiol 2017; 8:93-95. [PMID: 28573072 PMCID: PMC5437507 DOI: 10.4291/wjgp.v8.i2.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/27/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal involvement in plasma cell neoplasms, either as primary localizations (extramedullary plasmacytomas) or as secondary involvement in systemic multiple myeloma, is a well-known event. Accurate histological examination is crucial in defining the diagnosis. In this report, an uncommon case of duodenal localization of myeloma with plasmablastic features is described, with emphasis on the role of clinical data and findings from ancillary immunostaining techniques to avoid misdiagnosis.
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Han YJ, Park SJ, Park MI, Moon W, Kim SE, Ku KH, Ock SY. Solitary extramedullary plasmacytoma in the gastrointestinal tract: report of two cases and review of literature. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 63:316-20. [PMID: 24870305 DOI: 10.4166/kjg.2014.63.5.316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Solitary extramedullary plasmacytoma (EMP) is a plasma cell neoplasm without bone marrow involvement. EMPs are rare in the gastrointestinal (GI) tract. We report two cases of primary EMP, one in the transverse colon and the other in the stomach. In the first case, a mass on the transverse colon was found on colonoscopy. The patient underwent left hemicolectomy and has been followed-up for 3 years without recurrence postoperatively. The latter case had several masses in the stomach. The patient underwent bypass surgery and has received supportive care for 1 month. Histopathologic specimens of both the cases showed a monoclonal lambda chain EMP. Subsequent investigations included a bone marrow biopsy, serum IgA, IgG, IgM and serum protein electrophoresis, and the results were negative for multiple myeloma in both the cases. Solitary EMP in the GI tract can be mistaken for colon cancer or stomach cancer on endoscopy; therefore, a sufficient number of biopsy specimens can help diagnose solitary EMPs. Surgical resection alone or with radiation therapy in cases with positive surgical margin is currently the only treatment for solitary EMP in the GI tract. Further study is necessary to determine disease prognosis and to investigate other treatment methods.
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Affiliation(s)
- You Jin Han
- Division of Gastroenterology, Department of Internal Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea
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Vetro C, Bonanno G, Giulietti G, Romano A, Conticello C, Chiarenza A, Spina P, Coppolino F, Cunsolo R, Raimondo FD. Rare gastrointestinal lymphomas: The endoscopic investigation. World J Gastrointest Endosc 2015; 7:928-949. [PMID: 26265987 PMCID: PMC4530327 DOI: 10.4253/wjge.v7.i10.928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 07/09/2015] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease.
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Eck DL, Dortch JD, Bowers SP. Extramedullary Plasmacytoma of the Small Intestine. Am Surg 2015. [DOI: 10.1177/000313481508100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dustin L. Eck
- Department of Surgery Mayo Clinic Jacksonville, Florida
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Light Chain Escape Multiple Myeloma Complicated with Catastrophic Extramedullary Plasmacytoma Following Novel Agent Treatment. JOURNAL OF CANCER RESEARCH AND PRACTICE 2014. [DOI: 10.1016/s2311-3006(16)30022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Here we report the discovery of an extramedullary ileocecal plasmacytoma, a rare entity reported only ∼60 times in the literature. This finding occurred during management of a patient who had sustained an occult perforation during diagnostic colonoscopy. We explored the patient finding a large ileocecal perforation, and thus a right hemicolectomy was performed. Interestingly, the pathology of the mass was consistent with an extramedullary plasmacytoma, which is a very rare gastrointestinal diagnosis. We end by summarizing the presentation and work-up of extramedullary plasmacytoma.
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Affiliation(s)
- Emmanuel M Gabriel
- Department of Surgery, University of Texas Health Science Center, San Antonio, TX 78229, USA Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX 78229, USA
| | - Michelle Savu
- Department of Surgery, University of Texas Health Science Center, San Antonio, TX 78229, USA Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX 78229, USA
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Gravina AG, Federico A, Sica A, D'Armiento FP, Ferrara MG, Falcone U, Dallio M, Cozzolino D, Guastafierro S, Loguercio C, Romano M. Secondary Extramedullary Plasmacytoma of the Duodenum: An Unusual Endoscopic Presentation. Gastroenterology Res 2013; 6:110-111. [PMID: 27785239 PMCID: PMC5051155 DOI: 10.4021/gr547w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 12/22/2022] Open
Abstract
We describe an unusual case (a 79-year-old woman) of secondary extramedullary plasmacytoma (EMP) involving the duodenum. While all the previously reported cases of duodenal involvement by EMP (namely 20 cases) were characterized by the presence of ulcerative masses or ischemic necrotic lesions, in our case EMP led to the unusual finding of several non-polypoid lesions with a depressed central area. The final diagnosis was multiple myeloma IgA lambda, stage II A, with secondary duodenal EMP. To our knowledge this is the first report showing duodenal involvement by EMP with the aspect of multiple non-polypoid lesions.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy; These authors contributed equally to this work
| | - Alessandro Federico
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy; These authors contributed equally to this work
| | - Antonello Sica
- Onco-Hematology Units, Second University of Naples, Italy
| | | | | | | | - Marcello Dallio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy
| | | | | | - Carmela Loguercio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy
| | - Marco Romano
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy
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Ariyarathenam A, Galvin N, Akoh JA. Secondary extramedullary plasmacytoma causing small bowel intussusception in a patient with multiple myeloma - A case report. Int J Surg Case Rep 2013; 4:486-8. [PMID: 23562898 DOI: 10.1016/j.ijscr.2013.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/17/2013] [Accepted: 02/21/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Multiple myeloma is a monoclonal, immunoproliferative plasma-cell neoplasm of the B lymphoid cells. Extramedullary plasmacytoma is a type of plasma-cell neoplasm that can present as a primary tumour or secondary to another plasma-cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease with ileum involvement being very rare. PRESENTATION OF CASE We report a rare case of a 58-year-old man, with known multiple myeloma, re-presenting with evidence of small bowel obstruction, secondary to an intussusception due to a malignant plasma cell deposit, which was successfully resected at laparotomy. Previous two similar admissions, prior to this index admission, failed to arrive at this difficult rare diagnosis. DISCUSSION Primary and secondary extramedullary plasmacytoma mainly affects the upper aero-digestive tract. Involvement of the ileum, as in this case, is a rare complication. Prognosis of secondary extramedullary plasmacytoma affecting the gastrointestinal tracts is unknown, due to the small number of cases reported in the literature, but suggestive of a poor prognosis. The role of surgery is often palliative to deal with resolvable life-threatening emergencies and where possible to prolong life. CONCLUSION The case adds to the current literature of the rare event of visceral secondary extramedullary plasmacytoma involving the gastrointestinal tract, in the course of multiple myeloma and highlights the need for a high index of suspicion for such uncommon complications, to avoid delay in diagnosis and treatment.
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Affiliation(s)
- Arun Ariyarathenam
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
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