A Case of Concurrent Gastric and Pancreatic Plasmacytomas in a Patient With Multiple Myeloma: An Extremely Rare Entity.

Tagore Sunkara,Ghulamullah Shahzad,Santosh R Sharma,Madhavi Reddy,Andrew Ofosu,Vinaya Gaduputi

doi:10.1177/2324709618777003

Abstract

Multiple myeloma (MM), a plasma cell tumor, is primarily a disease of the bone marrow. Extramedullary plasmacytoma, also a plasma cell tumor, is very rare in the gastrointestinal tract and the pancreas, and only a handful cases have been documented till now. Gastric and pancreatic plasmacytomas are usually seen in elderly patients; however, cases in patients as young as 32 years of age have been reported. Commonly, patients with gastric plasmacytoma present with nonspecific symptoms like epigastric pain, abdominal fullness, anorexia, and weight loss, or serious conditions like massive upper gastrointestinal bleeding and gastric outlet obstruction. Patients with pancreatic plasmacytoma commonly present with obstructive jaundice. In this article, we present the case of a 79-year-old man with a history of MM for 3 years, diagnosed with gastric and pancreatic masses, which turned out to be plasmacytomas. To our knowledge, simultaneous occurrence of gastric and pancreatic plasmacytomas is extremely uncommon with less than 5 cases reported in the literature. We also compiled all the individual cases of gastric and pancreatic MM that have been reported in literature till now.

Highlights

Multiple myeloma (MM) is primarily the disease of the bone marrow characterized by abnormal proliferation of plasma cells.[1]
Multiple myeloma is a malignancy of the hematopoietic system characterized by an abnormal proliferation of plasma cells with overproduction of immunoglobulins in the bone marrow.[1]
We compiled all the cases of gastric plasmacytoma (Table 1) and pancreatic plasmacytoma (Table 2) that have been reported in the literature

Summary

Introduction

Multiple myeloma (MM) is primarily the disease of the bone marrow characterized by abnormal proliferation of plasma cells.[1]. Physical examination was significant for epigastric tenderness on palpation, but otherwise unremarkable His laboratory test values including liver function tests were within normal limits. The patient underwent esophagogastroduodenoscopy, which revealed a large polypoid mass with central ulceration in the gastric cardia (Figure 1). The EUS revealed an irregular, well-defined, and heterogeneous solid mass with cystic components in the body of the pancreas (Figure 2B). It measured 33.2 × 39.8 mm on its long axis and 39.2 × 33.2 mm on it short axis. The cells showed clusters of Kappa-restricted monoclonal plasma cells, positive for CD138 (Figure 4A) and κ (Figure 4B), which was consistent with plasma cell neoplasm.

Discussion

Findings

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