A Rare Case of Extramedullary Plasmacytoma Presenting as Massive Upper Gastrointestinal Bleeding

Comba, Isin Yagmur; Luna, Nancy E Torres; Cooper, Christopher J.; Crespo, Maria W.; Carilli, Allison

doi:10.7759/cureus.3993

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…We identified 76 patients with MM who developed gastrointestinal perforations between January 1997 and February 2020. Forty‐six were excluded due to the following reasons: perforations due to colonic carcinoma, 7 concomitant AL amyloidosis, 16 graft versus host disease (GVHD) involving the GI tract, 8 bowel perforations in the thirty days posttransplant period with neutropenic colitis diagnosed per CT, 9 clostridium colitis, 2 and invasive cytomegalovirus (CMV) of the colon 2 . Overall, 30 patients with MM with GI perforations were included in the analysis and are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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Colon perforation in multiple myeloma patients – A complication of high‐dose steroid treatment

et al. 2020

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Gastrointestinal complications of multiple myeloma (MM) treatment are common and include nausea, constipation, and diarrhea. However, acute gastrointestinal events like perforations are rare. We aimed to describe the characteristics and outcomes of patients with MM that had colonic perforations during their treatment. This is a retrospective study that included patients from all three Mayo Clinic sites who had MM and developed a colonic perforation. All patients were diagnosed with colonic perforations based on CT scans and were surgically treated. Patients diagnosed with AL amyloidosis, a perforated colon complicating neutropenic colitis during ASCT and those with perforation due to colonic cancer were excluded. A high dose of dexamethasone was defined as ≥40 mg dexamethasone once a week. Thirty patients met inclusion criteria. All patients received steroids at doses ≥10 mg once weekly prior to the perforation, while four (11%) were on high‐dose dexamethasone without chemotherapy. Fourteen patients were given high doses of dexamethasone. Twenty‐five patients required ostomies with all surviving surgery. Twenty‐four perforations (80%) were associated with diverticulitis. Treatment with steroids was resumed in 23 patients with no further gastrointestinal complications. The median OS was 20 months following perforation (IQR 8–59). Within the same timeframe 5854 patients were treated at Mayo Clinic for MM, making the risk of bowel perforation 0.5%. Intestinal perforations in MM are rare and, in our series, always occurred with dexamethasone ≥10 mg per week. Urgent surgery is lifesaving and resumption of anti‐myeloma treatment appears to be safe.

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Section: Resultsmentioning

confidence: 99%

“…[2][3][4] All therapeutic agents used to treat MM can cause gastrointestinal (GI) side effects, including anorexia, nausea, constipation, and diarrhea. 5,6 However, acute GI events such as hemorrhage 7,8 or perforation 9,10 are rare and have been reported only in case reports and small case series.…”

Section: Introductionmentioning

confidence: 99%

Colon perforation in multiple myeloma patients – A complication of high‐dose steroid treatment

et al. 2020

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“…First, the deposition of amyloid proteins in the GI wall leads to increased capillary fragility. Additionally, myeloma cells may directly infiltrate the GI tract in the form of plasmacytoma, and subsequently cause mucosal hyperplasia, edema, erosion, and repair dysfunction [4,5]. Furthermore, defective primary hemostasis was observed in patients with high serum β2-microglobulin and serum-free light chains, suggestive of a very active disease, which may be reflective of increased bleeding tendencies, as explained by Hinterleitner et al [6].…”

Section: Discussionmentioning

confidence: 99%

Duodenal Ulcer with Massive Gastrointestinal Hemorrhage as an Initial Manifestation in Multiple Myeloma with Extramedullary Disease: A Case Report

et al. 2022

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Plasma cell neoplasms are characterized by dysregulated proliferation of mature B cells, which can present with either single (solitary plasmacytoma) or systemic (multiple myeloma (MM)) involvement. MM with extramedullary plasmacytoma (EMP) is a rare disease that accounts for approximately 3–5% of all plasmacytomas. EMP with gastrointestinal (GI) system involvement is an even rarer entity, accounting for <1% of MM cases. We present a case of aggressive MM with EMP invading the duodenum, initially presented with massive upper GI hemorrhage and small bowel obstruction. A 67-year-old woman was admitted to our hospital owing to a lack of either gas or feces passage for 3 days. Abdominal distention and vomit with a high coffee ground content were observed for 24 h. The patient’s condition was initially diagnosed as small bowel obstruction, upper gastrointestinal bleeding, severe anemia, acute renal failure, and hypercalcemia. Furthermore, an analysis of immunoelectrophoresis in the blood, bone marrow aspiration, and tissue biopsy supported the diagnosis of MM and EMP invading the duodenum, upper GI hemorrhage, and small bowel obstruction. Our study provided the possible involvement of MM and EMP in the differential diagnosis of patients with unexplained GI hemorrhage and small bowel obstruction. A thorough review of the literature regarding the association between MM, GI hemorrhage, and small bowel obstruction is presented in this study.

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“…The common clinical presentation of a gastrointestinal EMP is abdominal pain, change of bowel habit, and bowel obstruction. In addition, gastrointestinal bleeding has also been reported [4 , 5] . The average age of onset is 55 years old, with a male predilection [6] .…”

Section: Introductionmentioning

confidence: 97%

“…It is extremely rare to occur in the large intestine. Clinical manifestations are variable depending on the location and invasive depth of tumor [4] . The common clinical presentation of a gastrointestinal EMP is abdominal pain, change of bowel habit, and bowel obstruction.…”

Section: Introductionmentioning

confidence: 99%

Extramedullary plasmacytoma involving rectum: A case report and literature review

Lin

Cai

2021

Radiology Case Reports

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Extramedullary plasmacytoma (EMP) of the gastrointestinal tract is an extreme rarity. Clinical manifestations of EMPs are varied, depending on the position and progress of tumor. Here we report a case of an EMP involving rectum in an 80-year-old, male patient with a change of bowel habit. Computed tomography scanning confirmed a circumscribed, iso-attenuating mass with the obvious heterogeneous enhancement. Patient received the surgical resection by laparoscope and the plasmacytoma was finally confirmed by the pathology. Furthermore, we made a literature review about the EMP of gastrointestinal tract to get the further study. Finally, we found out there is no specificity in imaging examination. Diagnosis of EMP still depends on the histopathology.

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A Rare Case of Extramedullary Plasmacytoma Presenting as Massive Upper Gastrointestinal Bleeding

Cited by 5 publications

References 18 publications

Colon perforation in multiple myeloma patients – A complication of high‐dose steroid treatment

Colon perforation in multiple myeloma patients – A complication of high‐dose steroid treatment

Duodenal Ulcer with Massive Gastrointestinal Hemorrhage as an Initial Manifestation in Multiple Myeloma with Extramedullary Disease: A Case Report

Extramedullary plasmacytoma involving rectum: A case report and literature review

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