Endoscopy 2011; 43: E298-E299
DOI: 10.1055/s-0030-1256451
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Successful endoscopic mucosal resection of a solitary extramedullary plasmacytoma in the sigmoid colon

T.  Kodani1 , T.  Osada1 , T.  Terai1 , T.  Ohkusa2 , T.  Shibuya1 , N.  Sakamoto1 , K.  Beppu1 , J.  Kato1 , A.  Nagahara1 , H.  Watanabe3 , S.  Watanabe1
  • 1Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
  • 2Department of Gastroenterology and Hepatology, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan
  • 3Pathology and Cytology Laboratories, BML Inc. PCL Japan, Tokyo, Japan
Further Information

T. Osada

Department of Gastroenterology
Juntendo University School of Medicine

2-1-1 Hongo
Bunkyo-ku
Tokyo 113-8421
Japan

Fax: +3-81-388621060

Email: otaro@juntendo.ac.jp

Publication History

Publication Date:
13 September 2011 (online)

Table of Contents

A 42-year-old man was referred to our hospital as he was found to be positive for faecal occult blood at a routine checkup. Colonoscopy revealed a submucosal tumor (SMT), 9 mm in size, at the distal end of the sigmoid colon ([Fig. 1]).

Zoom Image

Fig. 1 A submucosal tumor (9 mm) in the sigmoid colon as revealed by colonoscopy and removed by endoscopic submucosal resection.

Carcinoid tumor was suspected and successfully removed using endoscopic mucosal resection (EMR). Histological examinations showed diffuse infiltration of atypical plasma cells mainly in the submucosal layer ([Fig. 2]).

Zoom Image

Fig. 2 Hematoxylin and eosin stained section showing diffuse infiltration of atypical plasma cells, mainly in the submucosal layer.

Immunophenotyping involving monoclonal antibodies to immunoglobulin revealed expression of IgG with kappa light chain restriction by the proliferating plasma cells, indicating monoclonality ([Fig. 3]).

Zoom Image

Fig. 3 Immunophenotypic analysis showing proliferating plasma cells expressing IgG with kappa light chain restriction.

The lesion showed local accumulation of amyloid with Congo red staining ([Fig. 4]).

Zoom Image

Fig. 4 Submucosal amyloid deposit revealed by Congo red staining.

There was no lymphovascular invasion. Further, serum electrophoresis, bone marrow biopsy, and urinary levels of Bence Jones proteins were within normal limits. A full digestive tract survey with double-balloon enteroscopy, gallium scintigraphy, and enhanced computed tomography revealed no mass or lymphadenopathy. Therefore, a histopathological diagnosis of solitary extramedullary plasmacytoma (EMP) with a submucosal amyloid deposit (9 × 6 × 5 mm) of AL amyloidosis in the sigmoid colon was made. Following total tumor EMR, there has been no recurrence during a 36-month follow-up.

EMPs account for only 3 % – 5 % of all plasma cell tumors, occurring in the upper air passage, nasal cavity, and paranasal sinuses in about 80 % of cases; only 7.2 % cases occur in the gastrointestinal tract [1]. The small intestine is the most common gastrointestinal site, followed by the stomach. It is extremely rare in the colon. Historically, EMPs have been treated by surgical resection because of gastrointestinal obstruction [2] [3], but to our knowledge, there has been no published report of an EMP being eradicated by EMR [4]. It is our impression that the endoscopic and histopathological findings of early-stage solitary EMP that we have presented here will be significant in guiding the management of similar manifestations of EMP in other patients.

Endoscopy_UCTN_Code_CCL_1AD_2AC

Competing interests: None

#

References

  • 1 Alexiou C, Kau R J, Dietzfelbinger H et al. Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts.  Cancer. 1999;  85 2305-2314
  • 2 Wing E J, Perchick J, Hubbard J. Solitary obstructing plasmacytoma of the colon.  JAMA. 1975;  233 1298-1299
  • 3 Islam S R, Attaya M N, Parupudi S et al. Sigmoid plasmacytoma mimicking colon cancer in a patient with multiple myeloma: case report and review of literature.  Gastrointest Endosc. 2010;  71 655-657
  • 4 Pais J R, García-Segovia J, Rodríguez-Garcia J L et al. Solitary plasmacytoma of the rectum: report of a case treated by endoscopic polypectomy and radiotherapy.  Eur J Surg Oncol. 1994;  20 592-594

T. Osada

Department of Gastroenterology
Juntendo University School of Medicine

2-1-1 Hongo
Bunkyo-ku
Tokyo 113-8421
Japan

Fax: +3-81-388621060

Email: otaro@juntendo.ac.jp

#

References

  • 1 Alexiou C, Kau R J, Dietzfelbinger H et al. Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts.  Cancer. 1999;  85 2305-2314
  • 2 Wing E J, Perchick J, Hubbard J. Solitary obstructing plasmacytoma of the colon.  JAMA. 1975;  233 1298-1299
  • 3 Islam S R, Attaya M N, Parupudi S et al. Sigmoid plasmacytoma mimicking colon cancer in a patient with multiple myeloma: case report and review of literature.  Gastrointest Endosc. 2010;  71 655-657
  • 4 Pais J R, García-Segovia J, Rodríguez-Garcia J L et al. Solitary plasmacytoma of the rectum: report of a case treated by endoscopic polypectomy and radiotherapy.  Eur J Surg Oncol. 1994;  20 592-594

T. Osada

Department of Gastroenterology
Juntendo University School of Medicine

2-1-1 Hongo
Bunkyo-ku
Tokyo 113-8421
Japan

Fax: +3-81-388621060

Email: otaro@juntendo.ac.jp

Zoom Image

Fig. 1 A submucosal tumor (9 mm) in the sigmoid colon as revealed by colonoscopy and removed by endoscopic submucosal resection.

Zoom Image

Fig. 2 Hematoxylin and eosin stained section showing diffuse infiltration of atypical plasma cells, mainly in the submucosal layer.

Zoom Image

Fig. 3 Immunophenotypic analysis showing proliferating plasma cells expressing IgG with kappa light chain restriction.

Zoom Image

Fig. 4 Submucosal amyloid deposit revealed by Congo red staining.