Esophageal Plasmacytoma Revealed by Persistent Hiccups: A Case Report and Literature Review

Abstract

Introduction. Solitary extramedullary plasmacytoma (SEP) is a rare neoplasm that is derived from monoclonal proliferation of plasma cells in the soft tissues or organs arising outside the bone marrow. It is present in about 3% of all plasma cell tumors and originates mainly from the upper respiratory tract and nasopharynx. Involvement of the esophagus is exceptionally seen in cases of SEP. Case Presentation. We report a novel case of a 74-year-old male patient attended with a 6-month history of hiccupping further associated with dysphasia and weight loss all caused by esophageal plasmacytoma. Histological and immunohistochemical examination of the tumor confirmed the diagnosis of plasmacytoma. Workup for the multiple myeloma came out to be negative, thus confirming the diagnosis of SEP. The patient was treated with radiotherapy alone, leading to complete remission (at 30 months of follow-up). Conclusion. Esophageal plasmacytoma, an exceptional presentation of extramedullary plasmacytoma, should be kept in mind while dealing with patients presenting with intractable hiccups.

Endoscopic Diagnosis and Management of Esophageal Extramedullary Plasmacytoma in a Dog

“…Among these five patients who underwent follow-up, one underwent local resection and cyclophosphamide chemotherapy, two underwent esophagogastrectomy, one underwent endoscopic submucosal dissection (ESD), and one underwent radiation therapy. These patients had no recurrence during a median follow-up period of 6 months (range: 5 days to 30 months) (1,6,8,12,15,16,19,25). Although there are no established treatment protocols, owing to the limited number of case reports, considering the positive outcomes in all locally treated human cases, esophageal EMP is suspected to have low local aggression, and local resection with or without adjunctive chemotherapy should be curative; these treatment options could also be considered in veterinary practice.…”

“…The most common locations for EMP in dogs are the cutaneous sites of the limbs and head, mucous membranes of the oral cavity and lips, and the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, and large intestine (24). EMP arising in the esophagus is extremely rare, with only one case having been reported in veterinary medicine and six in human medicine (9,12). Typically, cutaneous and oral EMPs in dogs are benign and respond well to local therapy.…”

“…Immunohistochemical studies directed at detecting im-munoglobulin light and heavy chains, thioflavin-T, or multiple myeloma 1 (MUM1) are helpful in differentiating plasmacytomas from other round cell tumors and in the definitive diagnosis of plasmacytomas (17,24). In veterinary medicine, there are no treatment guidelines for esophageal plasmacytoma; however, surgical management, chemotherapy, radiation therapy, and endoscopic management have been proposed in humans medicine (1,6,8,12,15,16,19,25).…”