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Successful treatment of a gastric plasmacytoma using a combination of endoscopic submucosal dissection and oral thalidomide.

Park SY, Moon HS, Seong JK, Jeong HY, Yoon BY, Hwang SW, Song KS - Clin Endosc (2014)

Bottom Line: He had no specific medical history and unremarkable laboratory results.Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring.The patient's condition was found to be stable.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.

ABSTRACT
We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.

No MeSH data available.


Related in: MedlinePlus

(A) The lesion was resected using endoscopic submucosal dissection with an insulation-tipped knife. (B) The resected tumor was 40×35 mm in size.
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Figure 2: (A) The lesion was resected using endoscopic submucosal dissection with an insulation-tipped knife. (B) The resected tumor was 40×35 mm in size.

Mentions: A 70-year-old man was admitted to our hospital with the complaint of dyspepsia. He had no previous specific medical history and unremarkable laboratory results. We performed gastroscopy and observed a flat lesion with focal erythematous changes in the anterior wall of the antrum (Fig. 1). There were no specific serum and urine immunoelectrophoresis or immunofixation findings. A biopsy revealed poorly differentiated neoplastic cells and atypical lymphocytes, consistent with metastatic carcinoma. A Giemsa stain indicated Helicobacter pylori negativity. To rule out cancer and systemic diseases such as lymphoma, we performed a bone marrow aspiration, biopsy, and peripheral blood smear. There was no evidence of clonal marrow or peripheral plasmacytosis. We also performed abdominal and pelvic computed tomography (CT) and positron emission tomography/CT scans; these yielded unremarkable results, particularly with regard to lymph node and bone lesions. Regarding the gastric focal lesion, we performed an endoscopic procedure to confirm the previous endoscopic biopsy result as well as for therapeutic reasons using an insulation-tipped knife (KD-610L; Olympus, Tokyo, Japan) (Fig. 2). After successful ESD, the acquired specimen revealed plasma cell infiltration into the lamina propria; however, these cells did not extend deeply into the submucosal layer. The lesion was confined to the mucosa and had a clear resection margin. Numerous plasma cells with atypical hyperchromatic nuclei were observed to infiltrate the gastric mucosa. The neoplastic cells were positive for CD138 (Fig. 3).


Successful treatment of a gastric plasmacytoma using a combination of endoscopic submucosal dissection and oral thalidomide.

Park SY, Moon HS, Seong JK, Jeong HY, Yoon BY, Hwang SW, Song KS - Clin Endosc (2014)

(A) The lesion was resected using endoscopic submucosal dissection with an insulation-tipped knife. (B) The resected tumor was 40×35 mm in size.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260106&req=5

Figure 2: (A) The lesion was resected using endoscopic submucosal dissection with an insulation-tipped knife. (B) The resected tumor was 40×35 mm in size.
Mentions: A 70-year-old man was admitted to our hospital with the complaint of dyspepsia. He had no previous specific medical history and unremarkable laboratory results. We performed gastroscopy and observed a flat lesion with focal erythematous changes in the anterior wall of the antrum (Fig. 1). There were no specific serum and urine immunoelectrophoresis or immunofixation findings. A biopsy revealed poorly differentiated neoplastic cells and atypical lymphocytes, consistent with metastatic carcinoma. A Giemsa stain indicated Helicobacter pylori negativity. To rule out cancer and systemic diseases such as lymphoma, we performed a bone marrow aspiration, biopsy, and peripheral blood smear. There was no evidence of clonal marrow or peripheral plasmacytosis. We also performed abdominal and pelvic computed tomography (CT) and positron emission tomography/CT scans; these yielded unremarkable results, particularly with regard to lymph node and bone lesions. Regarding the gastric focal lesion, we performed an endoscopic procedure to confirm the previous endoscopic biopsy result as well as for therapeutic reasons using an insulation-tipped knife (KD-610L; Olympus, Tokyo, Japan) (Fig. 2). After successful ESD, the acquired specimen revealed plasma cell infiltration into the lamina propria; however, these cells did not extend deeply into the submucosal layer. The lesion was confined to the mucosa and had a clear resection margin. Numerous plasma cells with atypical hyperchromatic nuclei were observed to infiltrate the gastric mucosa. The neoplastic cells were positive for CD138 (Fig. 3).

Bottom Line: He had no specific medical history and unremarkable laboratory results.Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring.The patient's condition was found to be stable.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.

ABSTRACT
We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.

No MeSH data available.


Related in: MedlinePlus