Gastric Plasmacytoma Research Articles

A Rare Cause of Gastrointestinal Bleeding

She was admitted for pleural biopsy. However, an episode of gastrointestinal bleeding with passage of melena occurred before the biopsy. Laboratory studies revealed normal leucocyte count with lymphocytosis (white blood count, 7460/μL; lymphocyte, 59.1%); hemoglobin, 10.7 g/dL; creatinine, 0.5 mg/dL; alanine aminotransferase, 28 IU/L; serum albumin, 2.9 g/dL; globulin, 4.3 g/dL; lactate dehydrogenase, 311 IU/L; and normal carcinoembryonic antigen (3.62 ng/mL). Esophagogastroduodenoscopy revealed multiple polypoid nodules with overlying ulcers and mucosal friability, extending from the cardia and body to the antrum of stomach (Figure B). Two additional polyps were detected at second portion of duodenum (Figure C). Biopsies were performed.What is the most likely diagnosis?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.Answer to the Clinical Challenges and Images in GI Question: Image 1: Multiple Myeloma With Extramedullary Gastroduodenal PlasmacytomaView Large Image Figure ViewerDownload Hi-res image Download (PPT)Gastrointestinal plasmacytoma had been described in 1966.1Goldstein W.B. Poker N. Multiple myeloma involving the gastrointestinal tract.Gastroenterology. 1996; 51: 87-93Abstract Full Text PDF Google Scholar Endoscopic features of this disease are difficult to differentiate from lymphoma and amyloidosis, so pathology is mandatory for an accurate diagnosis. Solitary extramedullary (gastric) plasmacytomas have less bone marrow involvement and result in better outcomes. However, gastrointestinal involvement of multiple myeloma is a sign of aggressive biological features.2Talamo G. Cavallo F. Zangari M. et al.Clinical and biological features of multiple myeloma involving the gastrointestinal system.Haematologica. 2006; 91: 964-967PubMed Google Scholar Extensive extramedullary involvements of multiple myeloma, as in our patient, are generally fatal.3Liebross R.H. Ha C.S. Cox J.D. et al.Clinical course of solitary extramedullary plasmacytoma.Radiother Oncol. 1999; 52: 245-249Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar She was admitted for pleural biopsy. However, an episode of gastrointestinal bleeding with passage of melena occurred before the biopsy. Laboratory studies revealed normal leucocyte count with lymphocytosis (white blood count, 7460/μL; lymphocyte, 59.1%); hemoglobin, 10.7 g/dL; creatinine, 0.5 mg/dL; alanine aminotransferase, 28 IU/L; serum albumin, 2.9 g/dL; globulin, 4.3 g/dL; lactate dehydrogenase, 311 IU/L; and normal carcinoembryonic antigen (3.62 ng/mL). Esophagogastroduodenoscopy revealed multiple polypoid nodules with overlying ulcers and mucosal friability, extending from the cardia and body to the antrum of stomach (Figure B). Two additional polyps were detected at second portion of duodenum (Figure C). Biopsies were performed. What is the most likely diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Answer to the Clinical Challenges and Images in GI Question: Image 1: Multiple Myeloma With Extramedullary Gastroduodenal PlasmacytomaGastrointestinal plasmacytoma had been described in 1966.1Goldstein W.B. Poker N. Multiple myeloma involving the gastrointestinal tract.Gastroenterology. 1996; 51: 87-93Abstract Full Text PDF Google Scholar Endoscopic features of this disease are difficult to differentiate from lymphoma and amyloidosis, so pathology is mandatory for an accurate diagnosis. Solitary extramedullary (gastric) plasmacytomas have less bone marrow involvement and result in better outcomes. However, gastrointestinal involvement of multiple myeloma is a sign of aggressive biological features.2Talamo G. Cavallo F. Zangari M. et al.Clinical and biological features of multiple myeloma involving the gastrointestinal system.Haematologica. 2006; 91: 964-967PubMed Google Scholar Extensive extramedullary involvements of multiple myeloma, as in our patient, are generally fatal.3Liebross R.H. Ha C.S. Cox J.D. et al.Clinical course of solitary extramedullary plasmacytoma.Radiother Oncol. 1999; 52: 245-249Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar Gastrointestinal plasmacytoma had been described in 1966.1Goldstein W.B. Poker N. Multiple myeloma involving the gastrointestinal tract.Gastroenterology. 1996; 51: 87-93Abstract Full Text PDF Google Scholar Endoscopic features of this disease are difficult to differentiate from lymphoma and amyloidosis, so pathology is mandatory for an accurate diagnosis. Solitary extramedullary (gastric) plasmacytomas have less bone marrow involvement and result in better outcomes. However, gastrointestinal involvement of multiple myeloma is a sign of aggressive biological features.2Talamo G. Cavallo F. Zangari M. et al.Clinical and biological features of multiple myeloma involving the gastrointestinal system.Haematologica. 2006; 91: 964-967PubMed Google Scholar Extensive extramedullary involvements of multiple myeloma, as in our patient, are generally fatal.3Liebross R.H. Ha C.S. Cox J.D. et al.Clinical course of solitary extramedullary plasmacytoma.Radiother Oncol. 1999; 52: 245-249Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar Supplementary MaterialeyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlNDY1MWVmMjIwNDczMzY2ZGRhNDJlMWQyOWI2ZWQ2NiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjY3NzAxMDk5fQ.okWjpkAPWciwWrPy8fsvjnpqyRTzOVPajqd_tMCI-Glgedi9nZApdCAfOeDvWoLV1CY3pV1X0EMbQbqUXvK9XgYaDcaNcBfFFPPj2VgLPuiElDp1n2v79I69s1LpsG68YTDz-DM_hvY4Lw3ZpSbXs9KnStY8IGCDdkhtSv-4ge5o_Js8fVaqARoVqy3glHekmSAU0XeIfAKbSLS4shBHHyrsPHSdBxKjbm2AibdOoDz700gdnzuPN8lKKyEUtykp190bKtgIc_LttaqwFGXMlwPL87V-5evrsFtX6mGwXpoHlTHHgQhy6kovTJ1SoVu6L9Aw1tKP9_ayvPq06D6Zuw Download .mp4 (10.24 MB) Help with .mp4 files Video 1 eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlNDY1MWVmMjIwNDczMzY2ZGRhNDJlMWQyOWI2ZWQ2NiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjY3NzAxMDk5fQ.okWjpkAPWciwWrPy8fsvjnpqyRTzOVPajqd_tMCI-Glgedi9nZApdCAfOeDvWoLV1CY3pV1X0EMbQbqUXvK9XgYaDcaNcBfFFPPj2VgLPuiElDp1n2v79I69s1LpsG68YTDz-DM_hvY4Lw3ZpSbXs9KnStY8IGCDdkhtSv-4ge5o_Js8fVaqARoVqy3glHekmSAU0XeIfAKbSLS4shBHHyrsPHSdBxKjbm2AibdOoDz700gdnzuPN8lKKyEUtykp190bKtgIc_LttaqwFGXMlwPL87V-5evrsFtX6mGwXpoHlTHHgQhy6kovTJ1SoVu6L9Aw1tKP9_ayvPq06D6Zuw Download .mp4 (10.24 MB) Help with .mp4 files Video 1

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

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 SlidesThe 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

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. 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. Both patients achieved durable (>12 months) pathologically confirmed complete remissions without significant toxicities. 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 30months 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.

As Rare As It Gets — Gastric Plasmacytoma Presenting as Jaundice: A Case Report

Purpose: INTRODUCTION: Primary or secondary involvement of the GI tract by plasma cell dyscrasias is exceptionally rare. We hereby present the case report of a gastric plasmacytoma that had a unique and novel presentation of jaundice. CASE DESCRIPTION: A 68 y/o female with h/o HTN, recurrent DVT, and asthma presented with abdominal pain for two weeks. Pain was associated with nausea, occasional vomiting and yellowish discoloration of skin and sclera. She denied any weight loss or itching. Abdominal exam showed mild distension, hepatomegaly and right upper quadrant tenderness. Laboratory results showed creatinine 1.8 mg/dl, Hgb 6.1g/dl, MCV 112.8, platelet count 45000cells/cubic millimeter, albumin 2.5 g/dl, total bilirubin 4.0 umol/l, direct bilirubin 2.9 umol/l, ALP 209 U/L, AST 75 U/L and ALT 36 U/L. Chest X-ray showed an abnormal lesion on the right 6th rib. Abdominal ultrasound showed coarsened echotexture of the liver, gall bladder sludge, perihepatic ascites and no cholecystitis. MRCP showed nodular liver without any significant gallbladder or CBD findings. EGD showed a nodule at the incisura of the stomach and a non bleeding ulcer. Histopathology of the gastric nodule revealed hyperplastic foveolar polyp containing a nodular cluster of plasma cells. Immunohistochemistry was consistent with a nodular collection of predominantly lambda positive cells in the lamina propria diagnostic of gastric plamacytoma. Bone marrow biopsy and flow cytometry analysis were interpreted as marked cell dyscrasia, diffuse marrow infiltration with monoclonal IgG/lambda + plasma cells. Immunohistochemistry showed that 90-95% of the nucleated cells in the biopsy were CD138 positive. DISCUSSION: Multiple Myeloma (MM) involves GI tract only in about <5% of the cases. Gastrointestinal involvement rarely is the first or sole presenting symptom of extramedullary MM. It is either an incidental finding or manifests as a secondary system involvement. Liver is the most commonly involved site followed by the small intestine, pancreas, stomach, peritoneum and colon. Gastric plamacytoma has a varied endoscopic appearance of thickened folds, polyposis, ulcers and multiple nodules. Differential diagnoses include amyloidosis, poorly differentiated neoplasms, MALT lymphoma and GIST. Tissue pathology including flow cytomtery and immunohistochemistry play a vital role in diagnostic differentiation. Complete resection of the gastric lesion is usually recommended with or without combination with irradiation or chemotherapy. Gastric or any extra nodal involvement in a patient with multiple myeloma carries a poor prognosis.

Gastric Plasmacytoma in a Patient Evaluated for Anemia as the Presenting Symptom of Multiple Myeloma

Gastric Plasmacytoma in a Patient Evaluated for Anemia as the Presenting Symptom of Multiple Myeloma

A CKSE of IgM producing gastric plasmacytoma of superficial type

A CKSE of IgM producing gastric plasmacytoma of superficial type

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.

Primary Gastric Plasmacytoma: A Rare Cause of Melena

Purpose: Extramedullary plasmacytomas (EMP) are particularly rare, accounting for less than 3-4% of all plasma cell tumors. Almost 90% of cases with EMP develop in the head and neck area including the sinuses, nasopharynx, and tonsils. We report a case of primary gastric plasmacytoma and its clinical, endoscopic, and histological manifestations. Results: A 52-year-old man with hypertension and dyslipidemia presented with a one week history of melena, fatigue, early satiety, and epigastric discomfort. On upper endoscopy, a 3 cm mass was identified opposite the cardia along the posterior wall of the stomach at the body/fundus junction [Image 1]. On endoscopic ultrasound, a 3.3 cm mass was found in the submucosa of the stomach, with involvement of the muscularis propria [Image 2]. Biopsy specimens of the mass revealed gastric mucosa with a mild to moderate inflammatory infiltrate composed of small lymphocytes with plasma cells. Immunohistochemical stains performed on the neoplastic cells demonstrated the presence of plasma cell marker CD138, monotypic for immunoglobulin kappa light chains. CD20, a B-cell marker, was not expressed by the malignant cells. The morphology of the plasma cells in conjunction with immunohisto-chemistry was consistent with primary gastric plasmacytoma. Marginal zone B-cell lymphoma (MALT) was considered unlikely because of the absence of monocytoid B-cells, CD20 B-cell marker, centrocytes and small lymphoid cells. A bone marrow biopsy showed no evidence of lymphoma or plasma cell neoplasm. Conclusion: Primary gastric plasmacytoma is an extremely rare diagnosis with scattered case reports in the literature. Though no general consensus exists on treatment, radiation therapy and surgical resection are two modalities that have been used.Figure: Mass.Figure: EUS.

Primary gastric plasmacytoma associated with Helicobacter pylori infection: a report of two cases with different prognosis

We describe two cases of primary gastric plasmacytoma (GP) associated with Helicobacter pylori infection. Case 1 was that of a 58-year-old man with epigastric pain. H. pylori was eradicated before surgical resection was performed, and after the therapy, the tumor size was reduced. A postoperative pathological examination revealed that the tumor was in early stage and histological grade was grade 1. After 44 months of operation, the patient was in complete remission with no evidence of local relapse or progression to systemic MM. Case 2 was that of a 70-year-old woman with a history of melena. H. pylori eradication was not presented preoperatively. The resected specimen showed the tumor was in advanced stage and histological grade 3. GP eventually progressed to MM and she died of pulmonary infection. In our opinion, GP cannot be eradicated with H. pylori eradication, but disease progression can be effectively controlled to a certain extent. The prognosis of this disease is relatively fair when treated at an early stage. In addition to the treatment, the difference in prognosis could be associated with age, the stage of the tumor, and histological grade.

A rare case of primary gastric plasmacytoma: An unforeseen surprise

Primary plasmacytoma of the gastrointestinal tract is a rare entity. We report a case of a primary gastric plasmacytoma in a 57-year-old man who presented with upper-gastrointestinal bleeding. Endoscopy showed a nodular gastric mass with central umblication. Histological examination of the gastrectomy specimen revealed a monoclonal lambda-chain extramedullary plasmacytoma. Further staging was found to be negative for multiple myeloma. As other more common pathologic processes at this site may also be endowed with numerous plasma cells, awareness of this entity and distinction using immunohistochemistry are extremely crucial. Because systemic disease ultimately develops in many patients with localized plasmacytoma, such patients should be followed closely for the appearance of clinical, biochemical, and roentgenologic evidence of multiple myeloma.

COEXISTENCE OF THORACIC PLASMACYTOMA AND SARCOIDOSIS

INTRODUCTION: An extensive debate has existed over the association of sarcoidosis with cancer. In patients with certain malignancies like lymphomas, testicular cancer, lung cancer and melanomas an increased incidence of sarcoidosis has been classically reported (1). Only a single case report of coexistence of sarcoidosis with a gastric plasmacytoma has been described in the literature. The authors present, the second reported case of a plasmacytoma presenting concomitantly with sarcoidosis, and the first reported case occurring in a thoracic medullary plasmacytoma.

PRIMARY GASTRIC PLASMACYTOMA REFRACTORY TO HELICOBACTER PYLORI ERADICATION THERAPY

A 49-year-old woman underwent upper gastrointestinal endoscopic examination for epigastric discomfort, revealing giant folds on the greater curvature of the stomach. Histological examinations of biopsy specimens taken from the giant folds showed signs of chronic inflammation, and Helicobacter pylori was also identified. She underwent first-step H. pylori eradication. On follow-up endoscopy, H. pylori was not identified. However, endoscopic findings were unchanged and repeated biopsies showed dense infiltration of atypical plasma cells. No proliferation of centrocyte-like cells was seen. Immunohistochemically, plasma cells were positive for lambda-chain. Primary gastric plasmacytoma was diagnosed. Total gastrectomy was carried out with splenectomy and regional lymph node dissection. The patient remains disease free as of 6 years postoperatively.

Primary Gastric Plasmacytoma and Helicobacter pylori Infection

Primary Gastric Plasmacytoma and <i>Helicobacter pylori</i> Infection

Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma.

Gastrointestinal Bleeding Secondary to Multiple Gastric Plasmacytoma

Gastrointestinal Bleeding Secondary to Multiple Gastric Plasmacytoma

Successful treatment of extramedullary gastric plasmacytoma with the combination of bortezomib and dexamethasone: First reported case

We report a case of a 68-year-old man presented with upper-gastrointestinal bleeding. Endoscopy showed a large ulcerated gastric mass. Histological examination of the gastric biopsies revealed a k monoclonal extramedullary plasmacytoma (EMP). Further staging was negative for multiple myeloma. The patient was managed with bortezomib at a dose of 1.3 mg/m 2 on days 1, 4, 8 and 11 of a 21-day cycle in combination with dexamethasone 20 mg p.o. on days 1, 2, 4, 5, 8, 9 and 11, 12 of each cycle. After 4 cycles of treatment, no endoscopic or histological findings of EMP were found. Thirteen months after diagnosis the patient is in complete remission with no evidence of local relapse or evolution to multiple myeloma. This is the first reported case of EMP successfully managed with the combination of bortezomib and dexamethasone.

Multiple Myeloma Presenting as Pulmonary, Gastric and Epidural Extramedullary Plasmacytomas: Synchronous Presentation.

Plasma cell tumors are lymphoid neoplastic proliferations of B cells that may be classified as multiple myeloma (MM), solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP).The extramedullary plasmacytoma account for 1–2% of the total number of plasma-cell growths of which 80 % are originated on the head and neck and upper airways. Males are more frequently affected at sixth-seventh decade.Herein we are presenting a case of 51 years old male with synchronous multiple extramedullary plasmacytomas involving lung, stomach and spine,Presentation of a case51 years old black male from St. Lucia with no significant past medical history, presented to the local hospital in St. Lucia with hematemesis. Endoscopy was performed and a growth in the stomach was found. He came to the US for treatment.When seen in our hospital, patient complained of black tarry stool, severe right sided chest pain radiating to the back, generalized body aches, fatigue and 10 Lbs. weight loss within the last 2 monthsPhysical examination: revealed tenderness on the right side of chest and back, and decreased breath sound on the righ upper lobe, otherwise unremarkableWork up including CT scan of the chest/abdomen /pelvis showed an irregular right apical mass posteriorly with destruction of the adjacent second and third ribs posteriorly and in T2 and T3 vertebrae, diffuse lytic lesions involving the spines, sacrum, ribs and sternum. There was also a large irregular soft tissue mass the posterior aspect of the fundus of the stomach. Liver, spleen and lymph nodes were normal.Laboratory studies showed WBCs 9.8, Hg 6.9, Platlets 218, BUN 71, Cr. 5.2, Ca 13.4, albumin 3.4, B2 microglobulin 7.5, TP 11.4, LDH 1063, LFT's all normal, Cea 00 ng/ml, AFP 6.0 ng/ml, Ca19-9 9.4 U/ml, PSA.97 ng/ml, iron study, folate, B12 all within normal range, serum protein electropheresis and immunofixation showed monoclonal spike in the Gamma region 53.8% (IgG Kappa and IgA Kappa), IgG 10917 mg/dl, IgA 85 mg/dl, IgM 16 mg/dl, urine protien elctrophersis showed 88 mg/dl M-spike in beta region, 24 hours urine was 2400 mg/24 hBone marrow biopsy showed extensive infiltration with poorly differentiated plasma cells, flow cytometry consistent with plasma cell neoplasm, cytogenetics and FISH did not show any evidence of chromosome 13 deletion or trisomy 11. Gastric mass biopsy and lung mass biopsy showed plasma cells similar to the bone marrow infiltrate consistent with plasmacytoma. Diagnosis of multiple myeloma and multiple extramedullary plasmacytomas were made.Plasmaphersis was started because of worsening renal function despite aggressive hydration. Kidney function and calcium level normalized after 5 sessions of Plasmaphersis. Chemotherapy with Doxil, Vincrestine and dexamethasone (DVd) was started. Because of the persistent drop in hemoglobin from gastric mass bleeding, Radiation therapy to the gastric area was given (2300 cGy in 4 weeks)While on treatment he developed severe bilateral lower extremities weakness, MRI showed 8 cm epidural mass at the T8 level, the field of radiation was increased to include the new lesion along with Decadron.He developed severe oral mucositis, esophagitis pancytopenia, continue to bleed from the gastric mass, and finally developed an overwhelming VRE sepsis and shock. He was transferred to MICU and expired despite aggressive supportive care.Conclusion:MM can present as multiple extramedullary plasmacytomas. The response to chemotherapy is very poor The prognosis is very poor,

Plasma cell neoplasms

Plasma cell neoplasms are generally categorized into four groups; multiple myeloma (MM), solitary plasmacytoma of the bone (SPB), plasma cell leukemias, and extramedullary plasmacytomas (EMP). A plasmacytoma is defined as any discrete, usually solitary mass of neoplastic plasma cells, either in the bone marrow or in various soft tissue sites. Each manifestation of a plasma cell neoplasm differs in terms of tumor recurrence and progression to MM. A gastric plasmacytoma (GP) is a rare presentation of extramedullary plasmacytoma and has not been previously reported as a site of recurrence for a SPB. This pattern of tumor recurrence is unique and the management of gastric plasmacytoma as part of this complex disease is discussed. The continuum of progression between various sites and manifestations of plasma cell manifestations is reviewed including a previously undiscovered sequence of bone disease, gastric disease, and finally multiple myeloma.

EUS Diagnosis of Aberrant Right Subclavian Artery (arsa)

Background: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch occurring in 0.4-2.0% of the general population. Instead of arising from the brachiocephalic artery, the ARSA arises as the last branch from the aortic arch. ARSA is usually asymptomatic and found incidentally on imaging studies as it courses between the esophagus and spine (80%), between the esophagus and trachea (15%) or anterior to the trachea (5%). Aim: Determine the prevalence of ARSA in patients undergoing upper EUS and describe the EUS characteristics of ARSA. Methods: Retrospective review of 6040 upper EUS exams from 07/01/00 to 12/01/04. Results: 26 of 7180 (0.37%: 95% CI [0.22%, 0.50%]) patients (9 males, 17 females; mean age 56 years (range 23-81 years) undergoing upper EUS were found to have an ARSA. The indications for EUS were esophageal or gastric cancer (n=6), biliary disease (n=7), chronic pancreatitis (n=3), pancreatic cancer (n=3), pancreatic cyst (n=1), mediastinal mass (n=3), insulinoma (n=1), plasmacytoma (n=1) and abdominal pain (n=1). In all 26 patients, radial imaging identified a well-defined, anechoic tubular structure originating from the descending thoracic aorta passing between the esophagus and spine. In all 10 patients undergoing linear imaging, the abnormal anatomy was detected and the vascular nature confirmed by Doppler. In the one patient, both radial and linear imaging identified unsuspected aneurysmal dilatation of the ARSA; a rare condition referred to as Kommerell's Diverticulum (KD). The presence of co-morbidities precluded surgical repair despite the presence of dysphagia and risk of severe complications associated with KD. None of the other 23 patients had symptoms to suggest an ARSA. Interestingly, of the 13 patients who had CT prior to EUS, only 4 were initially reported to have ARSA. However, later review of the CTs verified an ARSA in all 13 patients. Of the two patients that underwent a barium swallow, only one suggested an ARSA. Conclusion: This report highlights the utility of both radial and linear EUS imaging in identifying previously unsuspected ARSA and associated anomalies. Background: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch occurring in 0.4-2.0% of the general population. Instead of arising from the brachiocephalic artery, the ARSA arises as the last branch from the aortic arch. ARSA is usually asymptomatic and found incidentally on imaging studies as it courses between the esophagus and spine (80%), between the esophagus and trachea (15%) or anterior to the trachea (5%). Aim: Determine the prevalence of ARSA in patients undergoing upper EUS and describe the EUS characteristics of ARSA. Methods: Retrospective review of 6040 upper EUS exams from 07/01/00 to 12/01/04. Results: 26 of 7180 (0.37%: 95% CI [0.22%, 0.50%]) patients (9 males, 17 females; mean age 56 years (range 23-81 years) undergoing upper EUS were found to have an ARSA. The indications for EUS were esophageal or gastric cancer (n=6), biliary disease (n=7), chronic pancreatitis (n=3), pancreatic cancer (n=3), pancreatic cyst (n=1), mediastinal mass (n=3), insulinoma (n=1), plasmacytoma (n=1) and abdominal pain (n=1). In all 26 patients, radial imaging identified a well-defined, anechoic tubular structure originating from the descending thoracic aorta passing between the esophagus and spine. In all 10 patients undergoing linear imaging, the abnormal anatomy was detected and the vascular nature confirmed by Doppler. In the one patient, both radial and linear imaging identified unsuspected aneurysmal dilatation of the ARSA; a rare condition referred to as Kommerell's Diverticulum (KD). The presence of co-morbidities precluded surgical repair despite the presence of dysphagia and risk of severe complications associated with KD. None of the other 23 patients had symptoms to suggest an ARSA. Interestingly, of the 13 patients who had CT prior to EUS, only 4 were initially reported to have ARSA. However, later review of the CTs verified an ARSA in all 13 patients. Of the two patients that underwent a barium swallow, only one suggested an ARSA. Conclusion: This report highlights the utility of both radial and linear EUS imaging in identifying previously unsuspected ARSA and associated anomalies.