Secondary extramedullary plasmacytoma involving the pancreas

Abstract

Extramedullary plasmacytoma is a rare variant of plasma cell tumor involving organs outside the bone marrow. The vast majority of extramedullary plasmacytomas present as a secondary tumor of systemic myelomatosis of the bone marrow. We experienced a patient with extramedullary plasmacytomas of the head and tail of the pancreas presenting as secondary masses from extramedullary plasmacytoma of the maxillary sinus that had been treated 5 years previously. A 38-year-old Japanese man had undergone radiation therapy for an extramedullary plasmacytoma of the maxillary sinus 5 years before the current presentation. He experienced severe upper abdominal pain in November 1999, when laboratory data showed elevation of the serum amylase level. Computed tomography showed two isodensity masses, in the head and tail of the pancreas. Angiography showed two hypervascular masses, one in the head and the other in the tail of the pancreas, and encasement of the portal vein trunk junction. Laparotomy was performed, with the tentative diagnosis of extramedullary plasmacytoma of the pancreas, in order to obtain a definite diagnosis. Intraoperative biopsy revealed that the two pancreatic masses were extramedullary plasmacytomas. External radiation therapy was performed after the operation. When a pancreatic mass is noticed in patients with a history of plasmacytoma, secondary extramedullary plasmacytoma of the pancreas should be considered as a differential diagnosis.

Plasmacytoma of the pancreas: an unusual manifestation of multiple myeloma

“…(3)(4)(5) They are commonly identified after the diagnosis of multiple myeloma, typically as a form of secondary involvement of extraskeletal organs. Rarely, there may be no evidence of bone marrow involvement (i.e.…”

Biliary Obstruction Secondary to an Extramedullary Plasmacytoma of the Pancreas

“…Chemotherapeutic agents are commonly used, particularly when plasmacytomas are secondary in nature (1). In the patients who underwent radiotherapy or chemotherapy, the resolution of biliary obstruction was noted in the majority, thus avoiding the need for surgical bypass or stenting (1,10). In our patient, the resolution of obstructive jaundice was achieved with the use of radiotherapy and chemotherapy.…”

“…They are typically identified after the diagnosis of multiple myeloma (MM) (1). The most common sites for EMP are the upper respiratory tract, followed by the spleen, lymph nodes, and liver.…”

Pancreatic Involvement by Plasma Cell Neoplasms

“…ERCP may demonstrate smooth strictures, dilated common bile duct and proximal pancreatic duct. The demonstration of a smooth stenosis of the biliary tree is more suggestive of an EMP than adenocarcinoma where irregular stenosis is classical [37,41,65].…”

“…Most are single lesions; in some cases, two or more concurrent lesions may occur, and even more rarely, the lesion has its epicentre in another abdominal organ but is large enough to affect the pancreas too, mainly the pancreatic tail [32,41,42] (Fig. 1a, b).…”