Diffuse gastric plasmacytoma involvement in multiple myeloma

Involvement of the gastrointestinal tract in multiple myeloma is rare. It is an aggressive biological sign and is associated with a poor prognosis [1] [2].

A 64-year-old woman with a history of multiple myeloma, diagnosed 3 years earlier, experienced persistent epigastric pain for 1 month. The multiple myeloma was classified as an IgG-k type, stage IIIA according to the Durie–Salmon classification system. The patient had undergone several cycles of chemotherapy with vincristine, doxorubicin, and dexamethasone, followed by high doses of melphalan and lenalidomide.

Based on the symptoms, the patient underwent upper endoscopy, which revealed multiple polypoid red nodules ([Fig. 1]) extending from the fundus to the antrum of the stomach. Immunohistochemical analysis of biopsies from the lesions showed infiltration of the gastric mucosa by CD138-positive, CD56-positive, monoclonal IgG-k-type plasma cells ([Fig. 2]), in accordance with the patient’s multiple myeloma classification. Because of the diffuse involvement of the stomach by plasmacytomas and her clinical condition, neither total gastrectomy nor radiation could be done. The patient died 3 months later.

Fig. 1 Endoscopic view of multiple red, polypoid nodules on the posterior wall of the gastric body.

Fig. 2 Pathological analysis of the stomach biopsies performed during upper endoscopy. a Hematoxylin and eosin stain, × 200 magnification, b Immunohistochemical stain for CD138, × 200. c Immunohistochemical stain for kappa chain, × 200. d Cytokeratin AE1/AE3 stain, × 100.

The endoscopic picture of plasmacytomas in the gastrointestinal tract includes the nodular, ulcerative, polypoid, and infiltrative types, with the nodular being the most commonly seen [3] [4]. The small bowel is the gastrointestinal site most commonly affected, followed by the stomach, colon, and esophagus, in order of frequency of involvement [3].

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

Competing interests: None

• References

• 1 Oriol A. Multiple myeloma with extramedullary disease. Adv Ther 2011; 28: 1-6
• 2 Weinstock M, Ghobrial IM. Extramedullary multiple myeloma. Leuk Lymphoma 2013; 54: 1135-1141
• 3 Talamo G, Cavallo F, Zangari M et al. Clinical and biological features of multiple myeloma involving the gastrointestinal system. Haematologica 2006; 91: 964-967
• 4 Sloyer A, Katz S, Javors FA et al. Gastric involvement with excavated plasmacytoma: case report and review of endoscopic criteria. Endoscopy 1988; 20: 267-269