Solitary extramedullary plasmacytoma of the duodenum and pancreas – A case report and review of the literature

Mile Ignjatović; Mihailo Bezmarević; Snežana Cerović

doi:10.2298/7047

Mile Ignjatović Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Mihailo Bezmarević Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Snežana Cerović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia, Institute of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/7047

Keywords: plasmacytoma, duodenum, pancreas, intestinal obstruction, surgical procedures, operative, postoperative period, ascites, treatment outcome,

Abstract

Introduction. The extramedullary plasmacytomas (EMPs) are rare tumors of plasma cell disorders which are rarely found in the duodenum. We presented a case of solitary EMPs involving the duodenum and pancreas successfully treated by surgical resection after failure of chemotherapy. Case report. A 55-year-old female with previously diagnosed solitary EMP of the duodenum was admitted to our institution after failure of three cycles of vincristine, adriablastine, dexamethasone (VAD) chemotherapy regimen with an upper gastrointestinal obstruction. On admission computed tomography of the abdomen showed tumor in the region of the second part of duodenum and uncinate process of the pancreas with a complete duodenal obstruction. Intraoperatively a tumor formation was in the region of the second duodenal part, originated from the wall of duodenum with the total diameter of 7 ´ 5 cm, covering the entire circumference of duodenal wall leaded to a narrowing of duodenal lumen to the thigh gap with an upper gastrointestinal obstruction. Infiltration in the head of the pancreas and uncinate process were also found. The Whipple’s procedure was performed but postoperative course was complicated by rapidly refilling chylous ascites which was resolved 4 days after the surgery. Conclusion. Each patient with gastrointestinal EMPs should be considered separately and in timely manner, thus adequate treatment could provide local disease control.

References

Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: International Agency for Research on Cancer (IARC); 2008.

Yoshida T, Soda K, Yamada S, Nakahara M, Nishida J, Kametaka M, et al. Biclonal extramedullary plasmacytoma arising in the peritoneal cavity: report of a case. Surg Today 2004; 34(4): 379−82.

Nolan KD, Mone MC, Nelson EW. Plasma cell neoplasms. Re-view of disease progression and report of a new variant. Surg Oncol 2005; 14(2): 85−90.

Schoretsanitis G, Livingstone JI, El-Japour JN , Watkins N, Wastell C. Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas. Postgrad Med J 1994; 70(823): 378−9.

Hefferman A. Plasmacytoma of pancreas and duodenum caus-ing acute intestinal obstruction. Lancet 1947; 249(6461): 910.

Derechin MM, Goldberg LS, Herron L. Extraosseous Plasmacy-tomas Causing Extrahepatic Cholestasis and Cardiac Tampo-nade: A Unique Case of Multiple Myeloma. Scand J Haemtol 1970; 7(5): 318−21.

Pentimone F, Camici M, Cini G, Levorato D. Duodenal plasmacy-toma. A rare primary extramedullary localization simulating a carcinoma. Acta Haematol 1979; 61(3): 155−60.

Hirakawa T, Fukuda Y, Tabata M, Hatanaka Y, Aihara K, Su-zuki T, et al. Primary duodenal submucosal plasmacytoma - an autopsy case. Nihon Rinsho 1978; 36(9): 3278−9. (Japanese)

Mannell A. Primary isolated extramedullary plasmacytoma of the duodenum. Aust NZ J Surg 1979; 49(5): 577−80.

Spalding DR, Isla AM, Thompson JN, Williamson RC. Pancreas-sparing distal duodenectomy for infrapapillary neoplasms. Ann R Coll Surg Engl 2007; 89(2): 130−5.

Telakis E, Tsironi E, Tavoularis G, Papatheodorou K, Tzaida O, Ni-kolaou A. Gastrointestinal involvement in a patient with mul-tiple myeloma: A case report. Ann Gastroenterol 2009; 22(4): 287−90.

Gradishar W, Recant W, Shapiro C. Obstructing plasmacytoma of the duodenum: first manifestation of relapsed multiple mye-loma. Am J Gastroenterol 1988; 83(1): 77−9.

Siddique I, Papadakis KA, Weber DM, Glober G. Recurrent bleed-ing from a duodenal plasmacytoma treated successfully with embolization of the gastroduodenal artery. Am J Gastroenterol 1999; 94(6): 1691−2.

Karam AR, Semaan RJ, Buch K, Shankar S. Extramedullary duo-denal plasmacytoma presenting with gastric outlet obstruction and painless jaundice. J Radiol Case Rep 2010; 4(8): 22−8.

Carneiro FP, Sobreira MN, Maia LB, Sartorelli AC, Franceschi LE, Brandão MB, et al. Extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. World J Gastroenterol 2009; 15(28): 3565−8.

Fowell AJ, Poller DN, Ellis RD. Diffuse luminal ulceration re-sulting from duodenal plasmacytoma. Gastrointest Endosc 2007; 65(4): 707−8.

Magagnoli M, Pedicini V, Rahal D, Santoro A. Solitary plasmacy-toma of the duodenum. Am J Hematol 2004; 76(2): 185−6.

Chen CH, Yang CC, Yeh YH, Kuo CL. Duodenal plasmacytoma. Gastrointest Endosc 2001; 54(6): 753.

Ali R, Ozkalemkas F, Ozcelik T, Ozkan A, Ozkocaman V, Ozturk H, et al. Extramedullary plasmacytoma involving the abdomin-al vessels and pancreas. Dig Dis Sci 2007; 52(11): 3199−201.

Bezmarević M, Mirković D, Perisić N, Cerović S, Panisić M, Micković S, et al. Sclerosing mesenteritis as a rare cause of upper ileus. Vojnosanit Pregl 2013; 70(3): 326−30.

Kadokura M, Tanio N, Nonaka M, Yamamoto S, Kataoka D, Ku-shima M, et al. A surgical case of solitary plasmacytoma of rib origin with biclonal gammopathy. Jpn J Clin Oncol 2000; 30(4): 191−5.

Das-Gupta EP, Sidra GM, Bessell EM, Lush RJ, Byrne JL, Russell NH. High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall. Bone Marrow Transplant 2003; 32(8): 759−61.

Damaj G, Mohty M, Vey N, Dincan E, Bouabdallah R, Faucher C, et al. Features of extramedullary and extraosseous multiple myeloma: a report of 19 patients from a single center. Eur J Haematol 2004; 73(6): 402−6.

Liebross RH, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Clinical course of solitary extramedullary plasmacytoma. Ra-diother Oncol 1999; 52(3): 245−9.

Hirata S, Yamaguchi K, Bandai S, Izumo A, Chijiiwa K, Tanaka M. Secondary extramedullary plasmacytoma involving the pan-creas. J Hepatobiliary Pancreat Surg 2002; 9(1): 111−5.

Talamo G, Cavallo F, Zangari M, Barlogie B, Lee C, Pineda-Roman M, et al. Clinical and biological features of multiple myeloma involving the gastrointestinal system. Haematologica 2006; 91(7): 964−7.

Dispenzieri A, Gertz MA. POEMS syndrome. Orphanet encyc-lopedia. Available from: http://www.orpha.net/data/patho/GB/uk-POEMS.pdf. [cited 2005 June 10].

Shakuntala P, Praveen S, Shankaranand B, Rajshekar K, Umadevi K, Bafna U. A rare case of plasmacytoma of the ovary: A case re-port and literature review. Ecancermedicalscience 2013; 7: 288.