Plasmacytoma Of Colon Research Articles

A Durable Response of Primary Advanced Colonic Plasmacytoma Using a Combination of Surgical Resection and Adjuvant Bortezomib: A Case Report and Literature Review

Primary isolated extra-medullary plasmacytoma (EMP) is a rare entity that most commonly involves the nasopharynx or upper respiratory tract. Only 10% of cases involve the gastrointestinal tract, mainly the small intestine and the stomach. Involvement of the colon is extremely rare with less than 40 reported cases worldwide. We report a case of a 57-year-old man who was presented with a 3-week history of fresh bleeding from the rectum. Colonoscopy showed a polypoidal mass arising from the ascending colon; biopsy showed clonal plasmacytosis and a primary colonic solitary EMP diagnosis was made after exclusion of multiple myeloma (MM). Accordingly, the patient underwent a right hemicolectomy, followed by 6 cycles of bortezomib, cyclophosphamide, and dexamethasone (VCD). The patient continued to be disease-free 30 months after the completion of his chemotherapy. To our knowledge, this is the first reported case of primary colonic plasmacytoma managed with surgical resection followed by an adjuvant bortezomib-based regimen with a durable response.

1621 Extramedullary Plasmacytoma of the Colon

INTRODUCTION: Plasma cell tumors can be categorized into multiple myeloma or plasmacytomas. Plasmacytoma is the proliferation of neoplastic monoclonal plasma cells in sites other than the bone marrow. This case illustrates a rare case of plasmacytoma in the colon. CASE DESCRIPTION/METHODS: A 49-year-old man with medical history of type 1 DM and GERD presented for average risk screening colonoscopy. Colonoscopy showed a 12mm transverse colon polyp that was resected via hot snare polypectomy. Pathology of the 12mm polyp showed lamina propria expansion with large sheets of plasma cells. On immunohistochemistry (IHC), the plasma cells showed kappa light chain restriction. IHC gene rearrangement studies showed a low level of immunoglobulin heavy chain amplification. Pathology was consistent with plasmacytoma associated with tubular adenoma without high grade dysplasia. Margins were negative. A complete blood count obtained by primary care physician demonstrated Hgb of 14.1 g/dl. Complete metabolic panel was normal. Serum protein electrophoresis, urine Bence Jones protein, bone marrow biopsy, skeletal bone survey and PET CT scan were recommended to exclude multiple myeloma and involvement at other sites. DISCUSSION: Plasmacytoma can be either be solitary bone plasmacytoma or solitary extramedullary plasmacytoma. The diagnosis of solitary plasmacytoma depends on the exclusion of multiple myeloma via normal bone marrow biopsy, normal skeletal survey and absence of end organ damage. If multiple myeloma is present, the lesion is characterized as an extramedullary manifestation of multiple myeloma. Solitary bone plasmacytoma occurs most commonly in the vertebrae. Solitary extramedullary plasmacytoma involves sites other than bone or bone marrow. It most commonly involves the nasopharynx or upper respiratory tract and is observed in 3-5% of plasma cell tumors. Colonic extramedullary plasmacytoma is rare and occurs in approximately 10% of extramedullary cases. Clinical presentations of extramedullary plasmacytoma are variable and depend on site of involvement. There are no current guidelines for the treatment of patients with colonic plasmacytoma. It is unclear whether endoscopic or surgical resection alone suffices as conclusive management or additional treatment modalities like radiotherapy or chemotherapy is necessary.

Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report

BackgroundExtramedullary 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 presentationA 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.ConclusionsPlasmacytoma 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.

Primary extramedullary plasmacytoma of the sigmoid colon with perforation: a case report

BackgroundExtramedullary plasmacytomas account for 4% of all plasma cell tumors and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. Extramedullary plasmacytoma of the colon with perforation has not been reported.Case presentationA 77-year-old woman with a 1-year history of lower abdominal pain and nausea was admitted to our hospital. An abdominal computed tomography scan revealed a sigmoid tumor with perforation. The patient underwent emergency surgery. Pathological examination led to a diagnosis of plasmacytoma of the colon. The patient did not undergo postoperative adjuvant chemotherapy. She has had no recurrence in 14 months of regular follow-up.ConclusionsWe have herein described a rare case of extramedullary plasmacytoma of the gastrointestinal tract with perforation involving the sigmoid colon.

Extramedullary Plasmacytoma of the Cecum: A Rare Cause of Iron Deficiency Anemia

Introduction: Plasmacytomas are solid myelomatous tumors composed of atypical plasma cells, which can be formed within bone or less commonly within soft tissue. Plasmacytomas are commonly associated with multiple myeloma (MM), however they may manifest outside the context of MM as solitary plasmacytomas. Extramedullary plasmacytomas are most commonly found in the aerodigestive tract, however they may present anywhere in the body. Here we present a rare case of a woman with iron deficiency anemia secondary to a cecal plasmacytoma not associated with MM. Case Report: A 73-year-old woman presented with iron deficiency anemia. Two years prior she had been diagnosed with a solitary extramedullary plasmacytoma in her right posterior mediastinum with intraspinal extension to T3. She underwent curative T2-T5 laminectomy and radiotherapy. Her disease was considered in remission at the time of presentation. After treatment of her profound iron deficiency anemia with intravenous iron, a single contrast barium enema was performed. It showed a large polypoid lesion in the lateral proximal ascending colon below the level of the ileocecal valve. These findings were indicative of colonic neoplasm and she was referred for colonoscopy. Colonoscopy confirmed the presence of a 4 cm fungating tumor at this location. This tumor was not amenable to endoscopic removal. Biopsies were taken for pathology which demonstrated plasmacytic infiltrate with frequent mitotic activity consistent with extramedullary plasmacytomas. Her β2 microglobulin level was elevated (282.5 nmol/L). She was referred back to oncology services where she was treated with concurrent prednisone and radiotherapy - 45 gray in 25 fractions. Discussion: Colonic extramedullary plasmacytomas are exceedingly rare with fewer than 25 cases reported in the literature. Any area of the gastrointestinal tract may be involved; however the most common site of involvement is the sigmoid colon. The most common presenting symptom of colonic plasmacytoma is abdominal pain; other symptoms have also been reported including overt bleeding, large bowel obstruction, and intussusception. We report a rare diagnosis of colonic extramedullary plasmacytoma from a history of iron deficiency anemia without presentation of the aforementioned symptoms. Treatment of plasmacytomas of the colon most commonly involve surgical resection. Radiotherapy and chemotherapy have only played a modest role in treatment. In our case the patient was felt to be a poor surgical candidate, and successful radiotherapy was performed.

Extensive Extramedullary Disease Involving the Colon in Multiple Myeloma: A Case Report and Review of Literature

Organ involvement in multiple myeloma (MM) is characterized by infiltrative disease or by a myelomatous mass known as a plasmacytoma. We present a patient with MM who had extensive extramedullary involvement of the colon and a review of the literature on colon plasmacytomas. A 57-year-old male with MM presented with disease relapse in 2007, workup showing biopsy confirmed left perinephric extra-medullary disease involving the adjacent colon. Positron emission-tomography (PET) exhibited intense pan-colonic fluoro-deoxyglucose (FDG) uptake and computed-tomography confirmed extensive infiltrating soft tissue thickening in the ascending, transverse, and descending colon representing plasmacytomas. The patient underwent an autologous hematopoietic stem cell transplantation after conditioning with high-dose melphalan. Restaging PET-scan showed complete resolution of colonic extra-medullary plasmacytomas. Extramedullary plasmacytomas (EMP) are rare and constitute 4% of all plasma cell tumors. Colonic plasmacytoma is an extremely rare site, with fewer than 25 cases reported in the literature. Colonic plasmacytomas have different presentations depending on the size and location. Treatment options for primary EMPs include surgical resection, radiotherapy, and chemotherapy. The primary treatment option for secondary EMP is systemic chemotherapy. This rare pan-colonic plasmacytoma, as a part of extramedullary myeloma, showed an impressive response to chemotherapy.

Sigmoid Plasmacytoma Mimicking Colon Cancer in a Multiple Myeloma Patient

Purpose: Colonic plasmacytomas are a rare manifestation of a myeloma malignancy, with less than 25 cases reported. We report such a case occurring in the sigmoid colon with the symptoms mimicking colon cancer and review the literature. Awareness of this complication in patients with multiple myeloma is important to provide early diagnosis and treatment. A 52-year-old man presented to the emergency room with intermittent hematochezia for several weeks. He was diagnosed with multiple myeloma two years previously and had been treated with chemotherapy and bone marrow transplantation. The initial response to treatment was favorable, and his disease was in remission at the time of presentation. There was no family history of colorectal cancer and no previous screening colonoscopy. He denied alcohol ingestion, non-steroidal anti-inflammatory drug use, and smoking. His vital signs were normal. Initial hematocrit was 21.7% and he received blood transfusions. Two days after admission, colonoscopy revealed a large fungating, partially obstructing mass in the lower sigmoid colon (Figure A); the remainder of the colon was normal. Biopsied specimens from the mass lesion were consistent with plasmacy-toma, and immunohistochemical stains showed strong expression of CD138 and CD79a by the neoplastic cells (Figure B). At exploratory laparotomy, the mass was large and extended into the sigmoid mesentery, anterior rectum and bladder. Surgical resection included the sigmoid colon, upper rectum, and a portion of the posterior superior bladder. On histologic examination, the 12 cm diameter plasmacytoma invaded through the wall of the colon into the pericolonic fat; seven lymph nodes were all negative. The patient recovered uneventfully and further chemotherapy was planned as an outpatient. Extra-medullary colonic plasmacytoma is a rare manifestation of multiple myeloma. It has many different presentations, including rectal bleeding or bowel obstruction. The endoscopic appearance has no characteristic features to differentiate it from other tumors, and thus biopsy is essential. Though there are no defined treatment guidelines, surgical resection and chemotherapy have been used for localized colonic presentations. Manifestation of these symptoms in myeloma patients should prompt early colonoscopies for effective and early diagnosis and treatment.Figure A: Mass in sigmoid colon seen by colonoscopy. Figure B. Multiple plasmacytoma cells on sigmoid mass biopsy expressing CD138 (H&E, original magnification x40).

Primary isolated extramedullary plasmacytoma of colon

BackgroundExtramedullary plasmacytoma is an uncommon entity that most commonly involves nasopharynx or upper respiratory tract. Involvement of the gastrointestinal tract occurs in approximated 10% of cases. Isolated primary plasmacytoma of colon is rare and only 7 well documented cases have been reported in the literature.Case presentationWe present a case of 42 year male who presented with diarrhea. Multiple colonic strictures were found on investigation. Colonoscopic biopsy was not helpful in making any specific diagnosis. Patient underwent subtotal colectomy. Isolated primary colonic plasmacytoma was found on histopathological examination.ConclusionPlasmacytoma is known to occur in extra osseous sites. Primary colonic plasmacytoma, however, is a rare clinical entity. Primary colonic plasmacytoma may have varying clinical presentations including multiple colonic strictures that may mimic colonic tuberculosis or inflammatory bowel disease. Although these cases are rare, treating physician as well as radiologist, and pathologist should be aware of this entity.

Clinical course of solitary extramedullary plasmacytoma

Background and purpose: Solitary extramedullary plasmacytoma (EMP) represents a rare category of malignant disease on which there are limited data in regard to diagnosis, staging and natural history. This study attempted to clarify the clinical course of solitary extramedullary plasmacytoma after radiation or surgical therapy given with curative intent. Materials and methods: The diagnosis was based on a mass of clonal plasma cells separate from bone or bone marrow without evidence of occult disease elsewhere. Between 1963 and 1996, 22 previously untreated patients with an EMP were diagnosed. Disease presented in the head or neck in 86%, usually in the nasal cavity (NC) or maxillary sinus (MS), and in these areas local bone destruction was found in 10 of 11 patients. Among all patients, serum myeloma protein was present in three patients (14%) and Bence Jones protein alone was found in two patients (9%). Radiation therapy was the sole treatment for 18 of 22 patients, and the median radiotherapy dose was 50 Gy (range, 40–60 Gy); five of seven patients with an EMP of oral cavity (OC), oropharynx (OP), nasopharynx (NP), parotid or larynx also received elective neck irradiation. Two patients underwent surgery plus postoperative irradiation of a plasmacytoma of the sigmoid colon or pleura, and two patients had resection alone of a plasmacytoma of the colon or cervical lymph node. Results: Local control was achieved in 21 of 22 patients (95%), and disease never recurred in regional nodes. Disappearance of myeloma protein occurred in three of five patients with an evaluable abnormality. Multiple myeloma developed in seven patients (32%), all within 5 years. The 5-year rate of freedom from progression to multiple myeloma was 56% and the median survival was 9.5 years. Conclusion: Radiation therapy achieved excellent locoregional control of EMP with an approximate cure fraction of 50%.

Primary colonic plasmacytoma.

A case of extramedullary plasmacytoma of the colon is presented. This rare tumor should be included in the differential diagnosis of space-occupying lesions of the large bowel. Its relationship to multiple myeloma is uncertain. Some extramedullary plasmacytomas are apparently capable of paraprotein production. This was not observed in this case and is an area needing further investigation. Eosinophilic intranuclear inclusions, similar to those previously reported in multiple myeloma and macroglobulinemia of Waldenstrom, were present.