Primary gastric plasmacytoma and Helicobacter pylori infection

18 F-FAPI-04 PET/CT in a Case of Primary Gastric Plasmacytoma

ABSTRACT

Primary plasmacytoma of the stomach is very rare. We describe contrast-enhanced CT and 18 F-FAPI-04 PET/CT findings in a patient with primary gastric plasmacytoma and Helicobacter pylori infection. The gastric tumor appeared as a large hypervascular polypoid mass on contrast-enhanced CT and showed intense 18 F-FAPI-04 uptake with SUV max of 11.8 on 18 F-FAPI-04 PET/CT.

Emerging Roles for the Gut Microbiome in Lymphoid Neoplasms

Lymphoid neoplasms encompass a heterogeneous group of malignancies with a predilection for immunocompromised individuals, and the disease burden of lymphoid neoplasms has been rising globally over the last decade. At the same time, mounting studies delineated a crucial role of the gut microbiome in the aetiopathogenesis of various diseases. Orchestrated interactions between myriad microorganisms and the gastrointestinal mucosa establish a defensive barrier for a range of physiological processes, especially immunity and metabolism. These findings provide new perspectives to harness our knowledge of the gut microbiota for preclinical and clinical studies of lymphoma. Here, we review recent findings that support a role for the gut microbiota in the development of lymphoid neoplasms and pinpoint relevant molecular mechanisms. Accordingly, we propose the microbiota-gut-lymphoma axis as a promising target for clinical translation, including auxiliary diagnosis, novel prevention and treatment strategies, and predicting clinical outcomes and treatment-related adverse effects of the disease in the future. This review will reveal a fascinating avenue of research in the microbiota-mediated lymphoma field.

Recent advances upper gastrointestinal lymphomas: molecular updates and diagnostic implications

Approximately one-third of extranodal non-Hodgkin lymphomas involve the gastrointestinal (GI) tract, with the vast majority being diagnosed in the stomach, duodenum, or proximal small intestine. A few entities, especially diffuse large B-cell lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, represent the majority of cases. In addition, there are diseases specific to or characteristic of the GI tract, and any type of systemic lymphoma can present in or disseminate to these organs. The recent advances in the genetic and molecular characterisation of lymphoid neoplasms have translated into notable changes in the classification of primary GI T-cell neoplasms and the recommended diagnostic approach to aggressive B-cell tumours. In many instances, diagnoses rely on morphology and immunophenotype, but there is an increasing need to incorporate molecular genetic markers. Moreover, it is also important to take into consideration the endoscopic and clinical presentations. This review gives an update on the most recent developments in the pathology and molecular pathology of upper GI lymphoproliferative diseases.

Primary plasmablastic plasmacytoma in the stomach of an immunocompetent adult: A case report

RATIONALE

Extramedullary plasmacytomas (EMP) are tumors composed by a monoclonal population of plasma cells that arise in extraosseus tissues, occupying <5% of all plasma cell neoplasms. Gastrointestinal solitary extramedullary plasmacytoma is rare, just comprises about 5% of all EMPs. The most common site is small intestine. The gastric incidence is much rare and especially the plasmablastic plasmacytoma in the stomach.

PATIENT CONCERNS

A 65-year-old man had an epigastric discomfort and mass for about 2 months. Gastroscopy revealed a malignant tumor in the gastric body. Abdomen computed tomography (CT) showed that the gastric cavity was filled, and the irregular soft tissue shadow was seen in the greater curvature, and the enhancement was obvious. To get more tissue, we conducted stomach puncture biopsy. Pathology showed small-round cell malignant tumors. And immunohistochemical examinations revealed that the tumor tend to be a plasma cell tumor.

DIAGNOSIS

Gastric plasma cell tumor.

INTERVENTIONS

Distal gastrectomy was performed to treat the tumor.

OUTCOMES

In addition to ascites caused by hypoproteinemia, there were no postoperative complications. Postoperative pathologic report showed plasmablastic plasmacytoma. Histopathologic examination of the specimen revealed plasmablastic plasmacytoma originating in the stomach with transmural extension, but without lymph node metastasis. The patient is regularly followed up at a postoperative clinic and is doing well, and at present there is no plan for adjuvant treatment.

LESSONS

Surgical resection is good option for gastrointestinal EMP.

Extramedullary plasmacytoma occuring in ileocecum: A case report and literature review

RATIONALE

Gastrointestinal solitary extramedullary plasmacytoma (EMP) is rare, just occupies about 5% of all EMPs. The most common site is small intestine followed by stomach. The colorectal incidence is much rare.

PATIENT CONCERNS

A 63-year-old female had an episodic pain around the umbilicus for about one week. The hyperemia and edema in the ileocecal mucosa were found in colonoscopy, and the endoscopy could not cross the ileocecal valve. The pathology specimens showed a high index suspicion of plasmacytoma.

DIAGNOSES

The patient was diagnosed with extramedullary plasmacytoma.

INTERVENTIONS

A right hemicolectomy surgery was performed to treat the disease.

OUTCOMES

Post surgery pathologic report showed low grade malignant mucosa associated marginal zone B cell lymphoma.

LESSONS

We report a case of an extramedullary plasmacytoma in ileocecum with abdominal pain and a review of extramedullary plasmacytoma.

Primary gastric plasmacytoma: a rare entity

Extramedullary plasmacytomas (EP) are tumours composed by a monoclonal population of plasma cells that arise in extraosseus tissues, comprising <5% of all plasma cell neoplasms. Usually, EP arise in the head and neck region, and the stomach is the second most common location-gastric plasmacytoma (GP). Clinical and radiological manifestations are unspecific and may mimic other tumours like gastric adenocarcinomas, gastric stromal tumours and lymphomas, mainly marginal cell lymphoma (MALT lymphoma) and usually definitive diagnosis is provided by pathological evaluation. We present a case of primary GP, discovered incidentally as a polypoid lesion. Tumour was composed by sheets of mature and immature plasmocytes positive for CD138 on immunohistochemistry, without Helicobacter pylori identification. The patient is alive 6 years later and without tumour relapse.

Double Extramedullary Plasmacytoma of the Stomach with a Long-term Endoscopic Follow-up

A 56-year-old woman was referred to our hospital with a growing gastric submucosal tumor. An upper endoscopic examination revealed two gastric tumors, an original polypoid tumor and a newly diagnosed superficial tumor. Boring biopsied specimens of the submucosal tumor showed gastric plasmacytoma; however, the other specimens showed no malignancy. Blood diseases were ruled out using various examinations; therefore, we diagnosed the tumor as extramedullary gastric plasmacytoma. The patient underwent laparoscopic distal gastrectomy, and both tumors were thus revealed to be plasmacytomas. We experienced a rare case with two differently shaped extramedullary gastric plasmacytomas without significant morphologic change during the follow-up.

Imaging findings of primary gastric plasmacytoma: A case report

Primary gastric plasmacytoma (GP) is a rare extramedullary plasmacytoma with clinical and imaging features that are common among other gastric tumors, such as gastric adenocarcinomas, gastric stromal tumors, and lymphomas. Here, we present a histologically confirmed case of primary GP examined with biphasic computed tomography (CT), magnetic resonance imaging (MRI), and endosonography. A well-circumscribed extraluminal mass appearing as homogeneous attenuation/intensity with gradual enhancement was identified on biphasic enhancement CT and MRI. This mass was hyperintense on diffusion-weighted imaging and hypointense on the apparent diffusion coefficient map, implying that water diffusion in the mass was restricted. In addition, endosonography indicated a low echogenic mass in the gastric wall. These imaging findings increase the available knowledge about imaging of this disease and provide valuable information for differentiating primary GP from common gastric tumors.

Primary submucosal nodular plasmacytoma of the stomach: a poorly recognized variant of gastric lymphoma

Abstract

Gastric plasmacytoma (GP) is a rare variant of gastric lymphomas. In the exceptional event that a patient presents with GP, the lesion occupies the mucosal layer in the vast majority of cases. Here we report a case of nodular plasmacytoma confined to the submucosa with no evidence of Helicobacter pylori (Hp) infection. The patient was a 59-year old female presenting with no particular symptoms. The tumor was well-demarcated and consisted of a diffuse monomorphic proliferation of plasma cells with numerous lymphoid follicles scattered throughout the tumor. The mucosal surface was intact and not associated with any tumor nodules. The cells were diffusely positive for CD79a, Bob1, EMA and IgA and consistently negative for CD3, CD19, CD20, PAX5, CD56, IgM and IgG. Additionally, in situ hybridization demonstrated clonality in the form of λ light-chain restriction. This submucosal nodular proliferation pattern of plasmacytoma is poorly recognized and considered to be a novel variant of lymphoma.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3489998708673079

Complete remission of localised gastric plasmacytomas following definitive radiotherapy

AIMS

Primary gastric extramedullary plasmacytoma is an extremely rare condition and there is scant information in the literature concerning its natural history or therapy. There have been anecdotal reports of surgical resection, with or without Helicobacter pylori eradication, but there are no useful reports of the role of radiotherapy. We report the clinicopathologic outcome of radical radiotherapy as a primary treatment modality.

METHODS

We identified two patients with biopsy-proven primary gastric extramedullary plasmacytoma. Routine staging investigations were performed and H. pylori status was determined. Radical radiotherapy to 41.4 Gy in 23 fractions was delivered using conformal techniques. The target volume was the stomach with a 1-cm margin. Prophylactic anti-emetic was administered prior to each fraction. Post-treatment endoscopies and biopsies were performed at 3-monthly intervals to assess clinicopathological response. Treatment-related toxicities were documented.

RESULTS

Both patients achieved durable (>12 months) pathologically confirmed complete remissions without significant toxicities.

CONCLUSION

Radical radiotherapy offers the potential for cure and organ preservation with low toxicity. It should be considered a favourable alternative to surgery in the management of this rare disease entity.

Complete remission of gastric plasmacytoma following eradication of "Candidatus Helicobacter heilmannii"

This is the first case report of gastric plasmacytoma associated with "Candidatus Helicobacter heilmannii" ('H. heilmannii') infection. The patient was a 40-year-old woman with epigastric discomfort. Upper gastrointestinal endoscopy demonstrated a white granular lesion on the wall of the gastric body. Histological studies showed numerous eosinophilic globules expanding the lamina propria mucosae. Immunohistochemically, the cells with these globules stained positive for CD138, CD79a, immunoglobulin (Ig) M, and kappa light chain, but negative for CD20, IgG, IgA, and lambda light chain. A diagnosis of plasmacytoma was made. Although a Helicobacter pylori infection was not detected, the patient received H. pylori eradication treatment. Two months after H. pylori eradication treatment, an upper gastrointestinal endoscopy showed a reduction of the white granular lesion. Eighteen months after eradication treatment, endoscopy, endoscopic ultrasonography and histological studies revealed complete remission of the lesion. No relapse has been documented 30 months after the initial diagnosis of plasmacytoma. Retrospectively, analysis of biopsy specimens removed before eradication treatment demonstrated that this patient had 'H. heilmannii' infection. Therefore, H. pylori eradication therapy should be considered as a potential first-line therapy for early-stage gastric plasmacytoma with or without H. pylori infection.

Complete endoscopic resection of very early stage gastric plasmacytoma

Gastric plasmacytomas are very rare, and most are not detected until the disease has progressed to an advanced stage. However, there have been recent reports of cases of early-stage gastric plasmacytoma, in which neoplastic cells are confined to the mucosa or submucosa. Here we report a case of a very early stage gastric plasmacytoma that was confined to the lamina propria of the gastric mucosa. The lesion was successfully and completely removed by endoscopic submucosal dissection, and the surveillance endoscopy showed no recurrence during the follow-up of 40 months. This report appears to be the first documented case of complete endoscopic removal of a primary gastric plasmacytoma.