Extramedullary plasmacytoma in the stomach

Case contributed by Dr Adriana Dubbeldam


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

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

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 embolization.

Two weeks later


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). Embolization 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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