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

Secondary extramedullary plasmacytoma in the absence of active multiple myeloma: a rare cause of small bowel obstruction

A 75-year-old woman with a history of multiple myeloma in remission presented with signs, symptoms and imaging findings consistent with a small bowel obstruction secondary to an intussusception. She underwent operative management, and intraoperative findings were consistent with an intussusception of mid small bowel as the cause of the small bowel obstruction. The offending portion of small bowel was resected, and histopathology confirmed a plasmacytoma deposit in the small bowel at the lead point of the intussusception. Secondary extramedullary plasmacytomas in the gastrointestinal system are rare but can have significant consequences like small bowel obstruction requiring operative management. We present a rare case that emphasizes the need to be highly suspicious for uncommon sequelae of multiple myeloma like secondary extramedullary plasmacytomas when managing patients with history of multiple myeloma in remission with concerning abdominal symptoms.

Multiple Myeloma Presenting as Chronic Diarrhea

Extramedullary gastrointestinal tract involvement in plasma cell dyscrasias is rare and represents a diagnostic challenge. We present a 66-year-old man with an unusual presentation of multiple myeloma. He presented with chronic diarrhea, and extensive biopsies in the jejunum allowed for the presumptive diagnosis of multiple myeloma to be made and the weighted decision to treat without a definitive diagnosis. Plasma cell dyscrasias can have highly varied presentations, unclear differentiation, and require a multidisciplinary approach for diagnosis and management. Adequate tissue sampling of the small bowel is critical in assessing patients with chronic diarrhea.

Rare case of anaplastic plasmacytoma in the sinonasal tract

BACKGROUND

Extramedullary plasmacytomas are tumors that develop from plasma cells and rarely express anaplastic features. To our knowledge, there have only been three reported cases of anaplastic plasmacytomas of the sinonasal tract in the English literature. We detail the fourth case.

METHODS

A 70-year-old male was seen with a 4-month history of nasal congestion, bloody mucous, and left sided nasal obstruction. On positron emission tomography/computed tomography, the lesion was FDG-avid with an SUV_max of 25.1. A biopsy of the lesion and subsequent immunohistochemical staining confirmed the diagnosis of an anaplastic plasmacytoma.

RESULTS

The patient is undergoing a 5-week course of curative-intent radiation therapy.

CONCLUSION

Extramedullary plasmacytomas with anaplastic features are very rare. We highlight the value of thorough histopathological review and detailed immunostains to arrive at a diagnosis of anaplastic extramedullary plasmacytoma.