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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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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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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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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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Carneiro FP, Sobreira MDNM, Maia LB, Sartorelli AC, Franceschi LEDAP, Brandão MB, Calaça BW, Lustosa FS, Lopes JV. Extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. World J Gastroenterol 2009; 15:3565-8. [PMID: 19630116 PMCID: PMC2715987 DOI: 10.3748/wjg.15.3565] [Citation(s) in RCA: 6] [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] [Indexed: 02/06/2023] Open
Abstract
We report a rare case of extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. A 72-year-old Japanese man was admitted to our hospital presenting with a 3-mo history of epigastric pain, vomiting and weight loss. On computed tomography (CT) a wall thickening of the fourth part of the duodenum was observed. Multiple biopsies obtained from the lesion showed infiltration of plasma cells and lymphocytes, but they were not conclusive. The patient underwent resection of the lesion and, on histopathological examination, the lesion consisted of a dense and diffuse infiltrate of plasma cells and a few admixed lymphocytes with reactive follicles extending to the muscular propria. An extensive deposition of amyloid was also observed. Immunohistochemical stains revealed that a few plasmacytoid cells showed λ light chain staining, though most were κ light chain positive. These cells also were positive for CD138 and CD56 but negative for CD20 and CD79. The findings were consistent with extramedullary plasmocytoma associated with a massive deposit of amyloid in duodenum. A subsequent workup for multiple myeloma was completely negative. The patient showed no signs of local recurrence or dissemination of the disease after 12 mo follow-up. Because of the association of plasmocytoma and amyloidosis, the patient must be followed up because of the possible systemic involvement of the neoplasm and amyloidosis in future.
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Karanth NV, Vora A, Mishra B, Karanth P, Prabhash K, Pai VR, Parikh PM, Gujral S. Plasma cell dyscrasia presenting as ascites and omental mass. J Clin Oncol 2008; 26:1379-81. [PMID: 18323560 DOI: 10.1200/jco.2007.12.7738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Narayan V Karanth
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Abstract
An uncommon manifestation of plasma cell neoplasia occurs outside the bone marrow and is designated "extramedullary plasmacytoma." These are usually encountered in mucosal sites of the head and neck region. The gastrointestinal tract may be secondarily involved in multiple myeloma or be the site of primary extramedullary plasmacytomas (PEMPs). The esophagus is the least common site of gastrointestinal PEMP. A 58-year-old man presented with dysphagia for solids over a period of 2 months. Otherwise, he was well and systemic examination did not reveal anything of note. After a nondiagnostic biopsy, the patient was subjected to esophago-gastrectomy. Gross examination of the esophagus revealed a large polypoid tumor. Histologically, it was composed of mature plasma cells, plasmablasts (some of which appeared anaplastic), and a minor admixture of lymphoid cells. Focally, the infiltrate permeated the squamous epithelium simulating lymphoepithelial lesions. The neoplastic cells were positive for epithelial membrane antigen, CD79a, IgG, and kappa, while the lymphoid cells were predominantly B cells. The patient did not have a monoclonal gammopathy. Skeletal x-rays and bone trephine examination were both normal. PEMP is biologically and prognostically different to other plasma cell neoplasms. Although rare, esophageal PEMP should be considered in the differential diagnosis of so-called undifferentiated malignant tumors of the esophagus.
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Affiliation(s)
- Runjan Chetty
- Department of Pathology, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa
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Nakamura S, Matsumoto T, Nakamura S, Kusano Y, Esaki M, Kurahara K, Fukuda T. Duodenal mucosa-associated lymphoid tissue lymphoma treated by eradication of Helicobacter pylori: report of 2 cases including EUS findings. Gastrointest Endosc 2001; 54:772-5. [PMID: 11726860 DOI: 10.1067/mge.2001.119602] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Schoretsanitis G, Livingstone JI, el-Japour JN, Watkins N, Wastell C. Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas. Postgrad Med J 1994; 70:378-9. [PMID: 8016015 PMCID: PMC2397629 DOI: 10.1136/pgmj.70.823.378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Plasmacytomas occurring in extramedullary sites are rare tumours, particularly so when located in the gastrointestinal tract. We report the case of a solitary extramedullary plasmacytoma arising in the duodenum and simulating a carcinoma of the head of the pancreas. Diagnostic and treatment options are discussed.
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Affiliation(s)
- G Schoretsanitis
- Academic Surgical Unit, Chelsea & Westminster Hospital, London, UK
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11
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Ezdinli EZ, Nanus DM. B-lymphoproliferative disorders: a proposed unified pathogenetic pathway. Hematol Oncol 1983; 1:297-319. [PMID: 6429025 DOI: 10.1002/hon.2900010403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The clinical features of lymphoproliferative diseases associated with paraproteinemia are briefly reviewed and correlated with current immunologic concepts in an effort to clarify the pathophysiology of B-lymphocyte disorders. B-lymphocyte maturation proceeds in a predictable manner from the Pre-B cell to the formation of idiotype specific plasma cells and memory B-lymphocytes. The immunoglobulin isotype produced by the mature plasma cell is determined by a site specific process of gene switching which proceeds from mu to alpha production. Lymphoproliferative diseases are the result of disordered B cell maturation and their clinical features can be explained by identifying the locus of the maturational defect.
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MESH Headings
- Adult
- Antibody Diversity
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Cell Differentiation
- Female
- Humans
- Hypergammaglobulinemia/complications
- Hypergammaglobulinemia/immunology
- Hypergammaglobulinemia/pathology
- Immunoglobulin A/analysis
- Immunoglobulin G/analysis
- Immunoglobulin M/analysis
- Immunologic Memory
- Leukemia, Lymphoid/complications
- Leukemia, Lymphoid/immunology
- Leukemia, Lymphoid/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoproliferative Disorders/complications
- Lymphoproliferative Disorders/immunology
- Lymphoproliferative Disorders/pathology
- Male
- Middle Aged
- Multiple Myeloma/complications
- Multiple Myeloma/immunology
- Multiple Myeloma/pathology
- Waldenstrom Macroglobulinemia/complications
- Waldenstrom Macroglobulinemia/immunology
- Waldenstrom Macroglobulinemia/pathology
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Asselah F, Crow J, Slavin G, Sowter G, Sheldon C, Asselah H. Solitary plasmacytoma of the intestine. Histopathology 1982; 6:631-45. [PMID: 6292073 DOI: 10.1111/j.1365-2559.1982.tb02756.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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