Management of Biliary Complications in Hilar Plasmacytoma: A Case Report

Abstract

Introduction: Plasma cell neoplasms present different clinical forms that can delay or result in erroneous diagnosis. Single plasmacytoma is a rare condition that presents no other symptoms than those derived from the primary lesion and that can result in challenging treatment strategies. Case Presentation: We present a case of a 50-year-old female patient with previous plasma cell leukemia and allogeneic stem cell transplantation who was admitted with obstructive jaundice. An MRI showed a hepatic hilar mass. A PET-CT was performed and showed no recurrence of disease. The patient was submitted to bilateral endoscopic biliary drainage. Following the procedure, the patient presented abdominal pain and was diagnosed of acute cholecystitis that was treated with a cholecystostomy and antibiotic treatment. An endoscopic ultrasound (EUS) was performed and fine needle aspiration (FNA) revealed atypical plasma cells which confirmed biliary extramedullary plasmacytoma. The patient was started on chemotherapy (pomalidomide + dexamethasone and cyclophosphamide) during 8 months. A CT scan was then performed and showed complete radiologic response. The biliary stents were removed and the patient is currently alive and disease-free. Conclusion: Management of extramedullary plasmacytomas can be challenging as they can mimic other conditions. Endoscopic and percutaneous approach should be considered as chemotherapy is the mainstay of treatment.