Gastrointestinal Plasmacytoma Causing Anemia in a Patient With Multiple Myeloma

Tuba Esfandyari; Susan C Abraham; Amindra S Arora

Disclosures

Nat Clin Pract Gastroenterol Hepatol. 2007;4(2):111-115. 

In This Article

Discussion of Diagnosis

Uncontrolled proliferation of monoclonal plasma cells in multiple myeloma can result in overproduction of monoclonal gammopathy, osteolytic lesions, hypercalcemia and cytopenia.[1] Plasmacytomas are extramedullary accumulations of plasma cells that occur in up to 20% of patients with multiple myeloma.[2] The most common site for extramedullary involvement is the upper aerodigestive tract, which includes the oronasopharynx, nasal cavities, sinuses and larynx. Extramedullary involvement in this region presents with epistaxis, nasal discharge, and nasal obstruction.[2] Plasma cell infiltration can involve any segment of the gastrointestinal tract, but gastrointestinal involvement occurs in only 5% of patients with extramedullary involvement.[2] The most common site of gastrointestinal tract involvement is the small bowel, in which region involvement presents as intestinal obstruction and malabsorption.[3,4] Other gastrointestinal sites are the stomach, colon and esophagus, in order of frequency of involvement.[4,5] The endoscopic appearance of gastric plasmacytoma can vary from thickened folds, polyposis and ulcers, to ulcerated masses.[7] Plaque-like involvement of the stomach body and duodenum, which was the endoscopic finding in this patient, has not previously been reported.

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