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Extramedullary plasmacytoma of the pancreas diagnosed using endoscopic ultrasonography-guided fine needle aspiration.

Roh YH, Hwang SY, Lee SM, Im JW, Kim JS, Kwon KA, Song JY, Jeong SY - Clin Endosc (2014)

Bottom Line: Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare.We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA).EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Cancer Center, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea. ; Department of Internal Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.

ABSTRACT
Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare. We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis. We report a case of extramedullary plasmacytoma of the pancreas diagnosed using EUS-FNA.

No MeSH data available.


Related in: MedlinePlus

Endoscopic ultrasonography-guided fine needle aspiration cytology (×400) shows (A) a predominantly monomorphic population of plasma cells with (B) positivity for CD138.
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Figure 5: Endoscopic ultrasonography-guided fine needle aspiration cytology (×400) shows (A) a predominantly monomorphic population of plasma cells with (B) positivity for CD138.

Mentions: A 58-year-old woman was transferred to our hospital for further evaluation of pelvic pain that was aggravated by walking and began approximately 2 months before admission. The initial laboratory tests showed a hemoglobin level of 10.6 g/dL, and blood urea nitrogen was 12.0 mg/dL. The results of liver function tests were within normal limits. The level of total protein level was 9.7 g/dL and the albumin level was 3.3 g/dL. A peripheral blood cell smear revealed mild lymphopenia. Skeletal surveys detected a small osteolytic lesion without a sclerotic rim in the left parietal bone and a large bone destructive osteolytic lesion in the right inferior pelvic bone (Fig. 1). Incisional biopsy of the right pelvic bone suggested a malignant bone tumor. The lesion was diagnosed as a plasmacytoma. Further evaluation showed a serum free light chain lambda level of 3,475.3 mg/L and a β2-microglobulin level of 4.6 mg/L. Immunoelectrophoresis showed the presence of an abnormal band of immunoglobulin G and lambda lanes. Plasma cells were 14.2% on bone marrow biopsy. Contrast-enhanced abdominal computed tomography (CT) revealed a suspicious ill-defined marginated mass in the body of the pancreas (Fig. 2). To further characterize the lesion, magnetic resonance imaging (MRI) of the pancreas was performed. T2-weighted MRI indicated that the pancreatic proximal body contained a mass of subtle high signal intensity (Fig. 3A) with marked diffusion restriction (Fig. 3B). For the histopathologic diagnosis, EUS-FNA was planned. Linear EUS (EU-ME1 Ultrasound System; Olympus, Tokyo, Japan) (GF-UCT 240; Olympus) revealed a 1.2×1.0-cm sized, hypoechoic, heterogeneous, well-defined round mass in the pancreatic body (Fig. 4A); FNA was performed via a transgastric approach and five passages were made with a 22-gauge needle (EchoTip Ultra, ECHO-22; Cook Endoscopy, Winston-Salem, NC, USA) (Fig. 4B). The cytopatholgy results showed a small cell neoplasm and the immunohistochemical profile was compatible with plasmacytoma (Fig. 5). The patient began combination therapy consisting of bortezomib, mephalan, and prednisolone with local radiation therapy for the right pelvic bone lesion. The patient was followed up carefully.


Extramedullary plasmacytoma of the pancreas diagnosed using endoscopic ultrasonography-guided fine needle aspiration.

Roh YH, Hwang SY, Lee SM, Im JW, Kim JS, Kwon KA, Song JY, Jeong SY - Clin Endosc (2014)

Endoscopic ultrasonography-guided fine needle aspiration cytology (×400) shows (A) a predominantly monomorphic population of plasma cells with (B) positivity for CD138.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928484&req=5

Figure 5: Endoscopic ultrasonography-guided fine needle aspiration cytology (×400) shows (A) a predominantly monomorphic population of plasma cells with (B) positivity for CD138.
Mentions: A 58-year-old woman was transferred to our hospital for further evaluation of pelvic pain that was aggravated by walking and began approximately 2 months before admission. The initial laboratory tests showed a hemoglobin level of 10.6 g/dL, and blood urea nitrogen was 12.0 mg/dL. The results of liver function tests were within normal limits. The level of total protein level was 9.7 g/dL and the albumin level was 3.3 g/dL. A peripheral blood cell smear revealed mild lymphopenia. Skeletal surveys detected a small osteolytic lesion without a sclerotic rim in the left parietal bone and a large bone destructive osteolytic lesion in the right inferior pelvic bone (Fig. 1). Incisional biopsy of the right pelvic bone suggested a malignant bone tumor. The lesion was diagnosed as a plasmacytoma. Further evaluation showed a serum free light chain lambda level of 3,475.3 mg/L and a β2-microglobulin level of 4.6 mg/L. Immunoelectrophoresis showed the presence of an abnormal band of immunoglobulin G and lambda lanes. Plasma cells were 14.2% on bone marrow biopsy. Contrast-enhanced abdominal computed tomography (CT) revealed a suspicious ill-defined marginated mass in the body of the pancreas (Fig. 2). To further characterize the lesion, magnetic resonance imaging (MRI) of the pancreas was performed. T2-weighted MRI indicated that the pancreatic proximal body contained a mass of subtle high signal intensity (Fig. 3A) with marked diffusion restriction (Fig. 3B). For the histopathologic diagnosis, EUS-FNA was planned. Linear EUS (EU-ME1 Ultrasound System; Olympus, Tokyo, Japan) (GF-UCT 240; Olympus) revealed a 1.2×1.0-cm sized, hypoechoic, heterogeneous, well-defined round mass in the pancreatic body (Fig. 4A); FNA was performed via a transgastric approach and five passages were made with a 22-gauge needle (EchoTip Ultra, ECHO-22; Cook Endoscopy, Winston-Salem, NC, USA) (Fig. 4B). The cytopatholgy results showed a small cell neoplasm and the immunohistochemical profile was compatible with plasmacytoma (Fig. 5). The patient began combination therapy consisting of bortezomib, mephalan, and prednisolone with local radiation therapy for the right pelvic bone lesion. The patient was followed up carefully.

Bottom Line: Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare.We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA).EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Cancer Center, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea. ; Department of Internal Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.

ABSTRACT
Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare. We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis. We report a case of extramedullary plasmacytoma of the pancreas diagnosed using EUS-FNA.

No MeSH data available.


Related in: MedlinePlus