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Extramedullary Plasmacytoma of the Stomach Associated With Gastric Amyloidosis


Khalil, Basmah MD; Alastal, Yaseen MD; Nawras, Ali MD, FACP, FACG, FASGE; Heif, Muhannad MD

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S1392-S1394
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Introduction: Extramedullary plasmacytoma (EMP) is a rare disease accounts for approximately 2-4% of all plasmacytomas. Gastric involvement is extremely rare, accounting for less than 5% of all EMPs. The association between gastric plasmacytoma and gastric amyloidosis was reported only in handful of cases in the literature. Herein we present a very rare case of plasmacytoma involving the stomach resulting in gastric amyloidosis.

Case presentation: 69-year-old male patient presented to outpatient clinic for evaluation of intermittent dysphagia to solid food for 3 years. Patient reported 5 kg weight loss over the last 6 months. He denied nausea, vomiting, abdominal pain and heartburn. No fever or night sweating. He never had EGD before. His past medical history was significant for chronic lymphocytic leukemia (CLL) which has been stable for many years. Physical examination was unremarkable, no evidence of lymphadenopathy. Laboratory work up showed WBC of 25 ×109/L, hemoglobin of 13 g/dL, platelets of 188 ×109/L. Creatinine was 1.2 mg/dL and calcium was 8.9 mg/dL. The patient was sent for EGD. Examination of esophagus revealed Schatzki ring at the gastroesophageal junction which was dilated. Endoscopic examination of the stomach revealed diffuse erythema with ulcerations and mucosal nodularity involving the whole stomach (Image 1-3); multiple biopsies were taken. Microscopic examination showed low grade neoplasm with extensive plasma cell differentiation at the gastric mucosa. In situ hybridization showed lambda light chain restriction. Congo Red stain revealed focal apple-green birefringence mucosal deposits consistent with amyloidosis. Immunohistochemical stain was negative for H pylori. The patient had abdomen and pelvic CT scan which was unremarkable, no organomegaly. Bone marrow biopsy showed previously documented CLL which was positive for kappa light chain with no evidence of multiple myeloma or amyloidosis, suggesting that the gastric neoplasm is a second separate neoplasm. The patient was referred to oncology clinic for further treatment of gastric plasmacytoma.

Conclusion: Primary gastric plasmacytoma is a very rare disease that can lead to amyloid deposits in the stomach. Endoscopic features include infiltrative, nodular, ulcerative, or polypoid lesions. It should be considered in the differential diagnosis of malignant infiltration of gastric mucosa.

severe diffuse gastric mucosal erythema, congestion and ulcerations.
retroflection view demonstrates mucosal friability at the fundus and cardia.
erythema and superficial ulcerations of gastric mucosa.
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