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Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report. World J Surg Oncol 2023; 21:63. [PMID: 36843105 PMCID: PMC9969680 DOI: 10.1186/s12957-023-02956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/21/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Primary lymphoma of the liver, gallbladder, and extrahepatic bile ducts or secondary involvement of these organs by leukemia is exceedingly rare. Patients with primary lymphoma or leukemic involvement of the biliary tract and liver often present with symptoms and signs of biliary tract obstruction or inflammation. CASE PRESENTATION We present a case of a 24-year-old male with biliary tract symptoms who underwent laparoscopic cholecystectomy. His precholecystectomy complete blood count performed on the same morning showed 72% lymphocytes while peripheral blood smears showed approximately 15% blasts. Surgeon went ahead with the procedure. Imaging done prior to surgery showed thickened gallbladder, while the liver, biliary tract, and pancreas did not show any thickening or mass lesion. However, the liver was enlarged. Grossly, the gallbladder wall did not show any stones or discrete mass involving the wall. Instead, there was subtle thickening of the gallbladder wall due to diffuse infiltration by the leukemic infiltrate. This lymphoid population reacted with PAX-5 and TdT immunohistochemical antibodies in a diffuse manner confirming precursor B-cell origin. This patient was found to have B-lymphoblastic leukemia involving his bone marrow on further clinical and diagnostic workup. Patient responded well to chemotherapy and is currently on maintenance treatment. He is well 1.5 years after his diagnosis. CONCLUSION This case highlights a unique and rare scenario where a previously undiagnosed and unsuspected hematologic malignancy initially presented with clinical features of a chronic inflammatory condition involving an abdominal organ owing to secondary involvement by the malignant infiltrate.
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A Case of Extramedullary Plasmacytoma of the Biliary Tract with a Poor Prognosis. REPORTS 2022. [DOI: 10.3390/reports6010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Extramedullary plasmacytoma (EMP) is a rare disease consisting of the presence of monoclonal plasma cells in tissues other than the bone. Most EMPs are located in the head and neck region. We present an extremely rare case of an EMP originating from the biliary tract in a 76-year-old male. This is the fifth report of a primary EMP arising from the biliary tract. He was diagnosed with jaundice, and he was referred for an additional examination. Abdominal ultrasonography revealed a tumor in the gallbladder and bile ducts, and a bile duct biopsy was performed via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The pathological and immunohistochemical examination revealed that the tumor was a plasmacytoma originating in the biliary tract. Although endoscopic biliary drainage was performed, the bile duct infection was not well controlled due to obstructive jaundice caused by the tumor. Furthermore, the bleeding from the tumor during chemotherapy was uncontrolled. Pancreaticoduodenectomy and cholecystectomy were performed to control the infection and bleeding. Although chemotherapy was continued after surgery, the tumor of the intrahepatic bile duct enlarged. He died seven months after the diagnosis because of the treatment-resistant tumor.
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Ono H, Iwatsu S, Otsuka E, Kato Y. Incidentally Detected Extramedullary Plasmacytoma of the Gallbladder: A Case Report and Literature Review. Intern Med 2022; 62:1145-1149. [PMID: 36104190 PMCID: PMC10183269 DOI: 10.2169/internalmedicine.0035-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Extramedullary plasmacytoma (EMP) can rarely occur in conjunction with multiple myeloma (MM). EMPs are usually detected in the upper aerodigestive tract (UAD) but can also occur along the digestive tract. However, the involvement of gallbladder is uncommon. Gastrointestinal tract symptoms often lead to the diagnosis of EMP in the gallbladder. An 81-year-old man was referred to our hospital with suspected primary gallbladder carcinoma. He was subsequently operated on, and the pathological findings showed EMP of the gallbladder without MM.
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Affiliation(s)
- Hideki Ono
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
| | - Shinichi Iwatsu
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
| | - Eiichi Otsuka
- Department of Hematology, Oita Prefectural Hospital, Japan
| | - Yuji Kato
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
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Sakashita M, Matsuda K, Omizo T, Orita N, Arihara F, Matsuda M, Ogawa K, Okumura H, Nakanishi Y, Sakai A. Bile duct MALT lymphoma diagnosed with direct cholangioscopy: a case report. Clin J Gastroenterol 2022; 15:1145-1150. [DOI: 10.1007/s12328-022-01692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
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Kolagatla S, Jenkins JK, Strunk H, Smith F, Ganti SS, Moka N. Secondary Extramedullary Myeloma of the Gallbladder: A Case Report. J Investig Med High Impact Case Rep 2022; 10:23247096221117809. [PMID: 35968559 PMCID: PMC9379956 DOI: 10.1177/23247096221117809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extramedullary myeloma (EMM) is an infrequent but well-established manifestation
of multiple myeloma (MM), defined as a soft tissue plasma cell neoplasm without
bone marrow involvement. Gallbladder involvement in EMM, however, is a very rare
occurrence, with only 8 cases found in the English medical literature. Here, we
present a case of an older adult male with a gallbladder mass in the presence of
increasing serum kappa light chains after a normal bone marrow biopsy confirmed
the complete remission of a previous MM diagnosis. Histopathologic evaluation of
a biopsied sample confirmed the mass as an atypical plasma cell neoplasm. Later
in his treatment, he developed several firm, smooth, violaceous skin nodules on
the torso, which histopathology confirmed as also being atypical plasma cell
neoplasms. We aim to contribute to the medical literature by expanding the pool
of information regarding EMM of the gallbladder to support future diagnostic and
treatment recommendations.
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Affiliation(s)
| | - Joshua K. Jenkins
- Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Haley Strunk
- Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
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Alyass F, Narh-Martey PN. Multiple Myeloma Plasmacytoid Infiltration of the Gallbladder Presenting as Acute Cholecystitis. CRSLS : MIS CASE REPORTS FROM SLS 2021; 8:CRSLS.2021.00049. [PMID: 36017061 PMCID: PMC9387365 DOI: 10.4293/crsls.2021.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Secondary distal plasmacytoma that arise from multiple myeloma is a common hematological malignancy that manifests in later stages of the disease. These plasmacytomas are known to cause extensive systemic organ damage. When extramedullary plasmacytomas reach the gallbladder or biliary ducts, expansion can mimic acute acalculous cholecystitis or cholangiocarcinoma. We report a case of a 56-year-old female with a history of aggressive course IgA κ chain multiple myeloma who presented with right upper quadrant abdominal pain with nausea and vomiting for one week duration. Her laboratory panel revealed liver function tests consistent with gallbladder etiology. Abdominal ultrasound and CT showed no evidence of cholelithiasis precluding to acute acalculous cholecystitis. Initial medical management did not show any improvement. A robotic cholecystectomy was performed, and a pathology review of the specimen found a neoplastic stricture of the gallbladder fundus, the histological evaluation of which revealed plasmacytoid cells originating from her primary multiple myeloma diagnosis. The patient’s condition declined following surgery, postoperative presentation included metastatic liver thrombosis mimicking cholangiocarcinoma and the patient later expired with palliative care.
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Affiliation(s)
- Fadi Alyass
- Trinity Medical Science University, School of Medicine, (International) Ribishi, St. Vincent and the Grenadines, West Indies, (United States) Roswell, Georgia USA
| | - Patrick N Narh-Martey
- Houston Medical Center, General Surgery, Department of Surgery, Warner Robins, Georgia USA
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Liu Z, Zang Y, Wang X, Li N, Lin D. Primary mucosa-associated lymphoid tissue lymphoma of the hilar bile duct resulting in fluctuant jaundice: A case report. Medicine (Baltimore) 2018; 97:e12830. [PMID: 30313119 PMCID: PMC6203564 DOI: 10.1097/md.0000000000012830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary mucosa-associated lymphoid tissue (MALT) lymphomas rarely originate in the hilar bile duct. Preoperative diagnosis of a primary MALT lymphoma of the hilar bile duct is difficult owing to the rarity of this disease. Differentiating between obstructive jaundice caused by MALT lymphoma of the hilar bile duct and hilar cholangiocarcinoma (the most common form of bile duct cancer) is challenging. PATIENT CONCERNS A 57-year-old man presented to our hospital in August 2012 with fluctuant obstructive jaundice. DIAGNOSES Contrast-enhanced abdominal computed tomography and magnetic resonance cholangiopancreatography showed a hilar liver mass measuring 23 × 28 mm along with intrahepatic biliary dilatation indicating hilar bile duct obstruction with a high index of suspicion for hilar cholangiocarcinoma. INTERVENTIONS AND OUTCOMES Based on frozen section examination, he was intraoperatively diagnosed with chronic nonspecific inflammation. Histopathological and immunohistochemical examinations confirmed a diagnosis of malignant lymphoma, specifically classified as an extranodal marginal zone B-cell lymphoma of MALT type. LESSONS A primary MALT lymphoma of the bile duct should be considered among the differential diagnosis in patients with a hilar tumor who present with fluctuating jaundice and are preoperatively diagnosed with suspected hilar cholangiocarcinoma, and/or an intraoperative diagnosis of chronic nonspecific inflammation (based on frozen section examination) assessed for stenosis or obstruction of the bile duct.
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Affiliation(s)
| | | | - Xinxin Wang
- Department of Pathology, Beijing YouAn Hospital, Capital Medical University, Fengtai District
| | - Ning Li
- General Surgery Center
- Beijing Institute of Hepatology, Beijing, China
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Abughanimeh O, Qasrawi A, Abu Omar M, Bahaj W, Abu Ghanimeh M. A Case of Multiple Myeloma Associated with Extramedullary Plasmacytoma of the Gallbladder Manifesting as Acute Cholecystitis. Cureus 2018; 10:e2688. [PMID: 30050743 PMCID: PMC6059516 DOI: 10.7759/cureus.2688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Multiple myeloma (MM) is a common hematological malignancy that represents 1% of all cancers. MM is distinguished from other plasma cell disorders by prominent bone marrow involvement and systemic organ damage. Extramedullary plasmacytomas of the gall bladder (GB) or biliary ducts, whether solitary or in association with MM, are very rare. We report a case of a 66-year-old female with a history of refractory MM who presented with right upper quadrant abdominal pain. Her laboratory evaluation revealed an abnormal liver panel and lactic acidosis. Abdominal ultrasonography was consistent with acute cholecystitis with no evidence of biliary obstruction or abnormal liver parenchyma. An open cholecystectomy with liver biopsy was performed. The histological evaluation revealed involvement of the GB submucosa and serosa, as well as the liver parenchyma by abnormal plasma cells with lambda light chain restriction. Congo red stain for the GB sample was positive. The patient declined further treatment for MM and was discharged home with comfort measures.
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Affiliation(s)
- Omar Abughanimeh
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Ayman Qasrawi
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mohannad Abu Omar
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Waled Bahaj
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mouhanna Abu Ghanimeh
- Department of Internal Medicine-Gastroenterology, Henry Ford Health System, DETROIT, USA
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St Romain P, Desai S, Bean S, Jiang X, Burbridge RA. Extramedullary plasmacytoma of the gallbladder diagnosed by endoscopic ultrasound fine needle aspiration (EUS-FNA). J Gastrointest Oncol 2015; 6:E7-9. [PMID: 25830051 DOI: 10.3978/j.issn.2078-6891.2014.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/09/2014] [Indexed: 11/14/2022] Open
Abstract
Extramedullary plasmacytoma (EMP) is a rare entity that can exist independently or in conjunction with underlying plasma cell myeloma (PCM). When there is underlying multiple myeloma, the presence of EMP portends a poor prognosis. The most common locations for an EMP include the gastrointestinal tract, pleura, testis, skin, peritoneum, liver, endocrine glands and lymph nodes; involvement of the gallbladder is exceedingly rare with only five other cases reported and only one of which was associated with PCM. EMP of the gallbladder can manifest as acute cholecystitis, biliary obstruction, or may be asymptomatic. Treatment is traditionally surgical resection plus adjuvant chemotherapy or autologous stem cell transplant. We present a case of a 53-year-old man with PCM who was found to have a gallbladder mass on imaging and underwent endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of the mass, which was diagnostic of a plasma cell neoplasm.
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Affiliation(s)
- Paul St Romain
- 1 Department of Internal Medicine, 2 Division of Gastroenterology, Department of Internal Medicine, 3 Department of Pathology and Laboratory Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Svetang Desai
- 1 Department of Internal Medicine, 2 Division of Gastroenterology, Department of Internal Medicine, 3 Department of Pathology and Laboratory Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Sarah Bean
- 1 Department of Internal Medicine, 2 Division of Gastroenterology, Department of Internal Medicine, 3 Department of Pathology and Laboratory Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Xiaoyin Jiang
- 1 Department of Internal Medicine, 2 Division of Gastroenterology, Department of Internal Medicine, 3 Department of Pathology and Laboratory Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Rebecca A Burbridge
- 1 Department of Internal Medicine, 2 Division of Gastroenterology, Department of Internal Medicine, 3 Department of Pathology and Laboratory Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Cho YH, Byun JH, Kim JH, Lee SS, Kim HJ, Lee MG. Primary malt lymphoma of the common bile duct. Korean J Radiol 2013; 14:764-8. [PMID: 24043969 PMCID: PMC3772255 DOI: 10.3348/kjr.2013.14.5.764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 03/27/2013] [Indexed: 11/15/2022] Open
Abstract
Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.
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Affiliation(s)
- Young Hoon Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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