Journal of Clinical Oncology, Vol 20, Issue 9
(May), 2002: 2405-2406
© 2002 American Society for Clinical Oncology
Unusual Presentations of Uncommon Tumors
Case 3. Giant Cell Plasmacytoma Presenting as an Intraperitoneal Mass
R. V. Datta,
T. Daskalakis,
H. Adler,
H. Lehman
South Nassau Communities Hospital, Oceanside, and Maimonides Medical Center, Brooklyn, NY
A previously healthy 76-year-old man presented to his primary physician complaining of weakness. On physical examination, a large, nontender, left upper-quadrant abdominal mass was palpated; there were no other significant findings. Routine laboratory tests showed mild anemia with hemoglobin level of 11.0 g/dL and monoclonal gammopathy. Results of all other blood work were normal, including lactate dehydrogenase level. Bone marrow examination showed no abnormal cells. Chest x-ray revealed no intrathoracic lesions. Evaluation of the abdominal mass by computed tomography (CT) scan showed a very large intraperitoneal mass extending from the left paracolic gutter and the spleen to the stomach and transverse colon (Fig 1). CT-guided biopsy was suggestive of a poorly differentiated neoplasm of hematopoietic origin. The specimen was inadequate for conclusive histologic characterization. Subsequent repeat CT-guided biopsy was complicated by intra-abdominal hemorrhage requiring multiple transfusions and emergency exploratory laparotomy. At operation, a large solid intraperitoneal mass was found in the left upper quadrant extending to and incasing the middle mesocolon and displacing the stomach and transverse colon superiorly. The mass was wrapped by the greater omentum. There was an actively bleeding omental artery, which was injured during the CT-guided biopsy. This vessel was suture-ligated, and 2 L of hemoperitoneum were evacuated. Open biopsy of the mass was done. Postoperative recovery of the patient was uneventful.
Microscopic evaluation of the specimen revealed neoplastic tissue composed of a diffuse sheet of cells infiltrating native collagen. The cells were of different sizes, ranging from medium to giant multinucleated cells with plasmacytic features. The nuclei of these cells were eccentric in location, roundish to irregular with clumped chromatin. The cytoplasm was abundant, homogenous, dense, and acidophilic (Fig 2). Numerous mitotic figures were present. Immunohistochemical studies showed that the neoplastic cells were reactive for immunoglobulin G, kappa, CD79a, and BCl-2. The findings were consistent with an anaplastic plasmacytoma. The bone marrow biopsy specimen was normal.
Plasma cell neoplasms are clinically divided into two discrete categories, the diffuse disseminated form known as multiple myeloma and the localized form known as plasmacytoma. Extramedullary plasmacytomas (EMPs) are plasma cell tumors that arise outside the bone marrow and occur either as a solitary plasma cell tumor (primary EMPs) or as manifestations of a previously known or unknown multiple myeloma (secondary EMPs). They can show various degrees of aggressiveness, from an indolent primary EMP to a rapidly progressive multiple myeloma.
Primary EMPs comprise approximately 10% of all EMPs.1,2 Primary EMPs have been reported in the upper respiratory tract, stomach, small and large bowel, thyroid, kidney, spleen, and heart. Primary EMPs most commonly arise in the sixth and seventh decades of life but may develop at any age with a 3:1 male preponderance.3 The diagnosis of primary EMP can only be established histologically, with a normal radiographic survey in the absence of bone marrow infiltration to distinguish it from multiple myeloma and secondary EMP. Detection of a paraprotein does not preclude the diagnosis, although the excretion of large amounts of abnormal immunoglobulin suggests a higher tumor cell mass. Primary EMP is a relatively rare neoplasm most commonly reported in the upper respiratory tract and oral cavity.4 Here we report a very unusual case of primary EMP presenting as a large intraperitoneal mass originating from the omentum.
REFERENCES
1.
Liebross RH, Ha CS, Cox JD, et al: Clinical course of solitary extramedullary plasmacytoma. Radiother Oncol 52: 245-249, 1999[CrossRef][Medline]
2.
Knowling MA, Harwood AR, Bersagel DE: Comparison of extramedullary plasmacytomas with solitary and multiple plasma. J Clin Oncol 1: 255-262, 1983[Abstract]
3.
Wiltshaw E: The natural history of extramedullary plasmacytoma and its relation to solitary myeloma of bone and myelomatosis. Medicine 55: 217-238, 1976[Medline]
4.
Woodruff RK, Whittle JM, Malpas JS: Solitary plasmacytoma I: Extramedullary soft tissue plasmacytoma. Cancer 43: 2340-2343, 1979[CrossRef][Medline]
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