Extramedullary plasmacytoma in the stomach

Case contributed by Dr Adriana Dubbeldam

Presentation

Patient with history of plasma cell dyscrasia a decade ago requiring repeated stem cell transplants; no known bone lesions. Now presents with upper GI-bleeding. Gastroscopy reveals large ulcerating stomach tumor.

Patient Data

Age: 65 years old
Gender: Male
CT

The first CT scan was performed the day after admission for staging of the gastroscopically discovered ulcerated gastric tumour. The tumour was then still believed to be a primary carcinoma of the stomach.

CT scan in portovenous phase shows a large submucosal tumour in the greater curvature with no obvious transmural growth and no local adenopathy.

CT

The upper gastro-intestinal bleeding was initially managed endoscopically, however, rebleeding occured and a second, arterial phase CT was performed two weeks later to prepare for angiographic embolisation.

Scan shows extensive involvement of the greater curvature, however involvement of the smaller curvature could now also be appreciated. Vascularity was shown to be primarily from the gastrica sinistra (celiac trunk) and gastrica dextra artery (left hepatic artery). Embolisation was considered successful with soon decreased need for transfusion.

Case Discussion

Plasma cell dyscrasia is a spectrum of diseases characterized by monoclonal proliferation of plasma cells, secreting one type of Ig-antibody (heavy or light chain). Best known in this spectrum is multiple myeloma, although the most common is MGUS (monoclonal gammopathy of undetermined significance). Many lesions in the spectrum can actually evolve to multiple myeloma.

Extramedullary plasmacytomas are rare and usually affect the head and neck region, mainly in the upper aerodigestive tract. Involvement of the stomach as in this case, is more rare.

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Case information

rID: 22200
Case created: 19th Mar 2013
Last edited: 19th Feb 2016
Inclusion in quiz mode: Included

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