Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report

Abstract

Background Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7–17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. Case presentation We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. Conclusions Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.

Multiple Myeloma Presenting as Chronic Diarrhea

“…Symptoms depend on the organ involved, but reports include obstruction, diarrhea, and abdominal pain. 10,11 GI infections may also occur in patients with MM because of compromised immune systems, which may explain our patient's initial recurrent C. difficile infection. 12 Other plasma cell dyscrasias, such as WM, amyloid light-chain amyloidosis, light chain deposition disease, and heavy chain deposition disease, can also have GI involvement.…”

Rare case of anaplastic plasmacytoma in the sinonasal tract

“…Oertel et al report that a radiation dose of 45 Gy or higher is correlated with significantly longer median survival in patients with extramedullary plasmacytomas of the head and neck compared to patients who receive a lesser dose 17 . However, when MM is present, patients typically proceed with systemic therapy such as thalidomide, bortezomib, and lenalidomide 16,18,19 …”

“…17 However, when MM is present, patients typically proceed with systemic therapy such as thalidomide, bortezomib, and lenalidomide. 16,18,19 Extramedullary plasmacytomas with anaplastic features are a rare type of plasma cell malignancy that resembles high-grade lymphoma. There is a paucity of information in the literature regarding the clinical characteristics, diagnosis, and treatment of this particular malignancy.…”