Duodenal localization of plasmablastic myeloma

Abstract

Gastrointestinal involvement in plasma cell neoplasms, either as primary localizations (extramedullary plasmacytomas) or as secondary involvement in systemic multiple myeloma, is a well-known event. Accurate histological examination is crucial in defining the diagnosis. In this report, an uncommon case of duodenal localization of myeloma with plasmablastic features is described, with emphasis on the role of clinical data and findings from ancillary immunostaining techniques to avoid misdiagnosis.

Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature

“…The average age on diagnosis was 62.7 years. In regards to the location of the EMPs, the most common site of presentation was the stomach (41%)[7-17], followed by the duodenum (15%)[18-21], but noticeable is the presence of concurrent lesions in stomach and duodenum (22%)[2,3,22-25]. Jejunal EMPs were less common (11%)[26-28], whereas ileal presentation was the rarest and was mentioned only in one more case report apart from our case (7%)[29].…”

“…Gastrointestinal bleeding in these cases had different presentations. The most common presenting complaint was melena (44%)[7,9,10,13-16,18,19,23,24,29] and four patients (15%) had melena associated with anaemia[21,27,28]. In five cases (19%), the gastrointestinal bleeding was reported as Upper gastrointestinal bleeding with no further clarification[11,12,20,22,30].…”

“…In the majority of the cases analysed the EMPs were a secondary manifestation (63%) at the background of either multiple myeloma (26%)[3,8,14,16,18,25] or more rarely plasmablastic myeloma (7%)[28] or high-grade plasma cell myeloma (4%)[21]. However, there were ten cases (37%)[9-12,19,20,23,26,27,29] of primary EMPs not associated with systemic disease (Figure 7).…”

“…Unfortunately, we were unable to retrieve any data about the treatment eleven of the cases had because there was no information on the reports. For the remaining sixteen case reports there were ten cases of secondary EMP, eight of which received chemotherapy[2,15,17,21,25,28,30], only one radiotherapy due to patient’s co-morbid status[18] and three had surgical treatment[7,18]. The treatment modality selected for the remaining six cases of primary EMP varied between surgery in three cases[26,27,29], chemotherapy in one case[12], radiotherapy in one case[23] and embolization of gastroduodenal artery in one case[19].…”