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Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature.
World J Gastrointest Endosc. 2019 Apr 16; 11(4):308-321.WJ

Abstract

BACKGROUND

Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment.

CASE SUMMARY

Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search (PubMed database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma (EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males (67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach (41%), followed by the duodenum (15%). The most common presenting complaint was melena (44%). In the majority of cases, the EMPs were a secondary manifestation (63%) at the background of multiple myeloma (26%), plasmablastic myeloma (7%) or high-grade plasma cell myeloma (4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs.

CONCLUSION

Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy.

Authors+Show Affiliations

Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom. e.iosif@nhs.net.Department of Haematology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom.Department of Histopathology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom.Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom.Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom.Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31040892

Citation

Iosif, Evangelia, et al. "Gastrointestinal Bleeding as Initial Presentation of Extramedullary Plasma Cell Neoplasms: a Case Report and Review of the Literature." World Journal of Gastrointestinal Endoscopy, vol. 11, no. 4, 2019, pp. 308-321.
Iosif E, Rees C, Beeslaar S, et al. Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature. World journal of gastrointestinal endoscopy. 2019;11(4):308-321.
Iosif, E., Rees, C., Beeslaar, S., Shamali, A., Lauro, R., & Kyriakides, C. (2019). Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature. World Journal of Gastrointestinal Endoscopy, 11(4), 308-321. https://doi.org/10.4253/wjge.v11.i4.308
Iosif E, et al. Gastrointestinal Bleeding as Initial Presentation of Extramedullary Plasma Cell Neoplasms: a Case Report and Review of the Literature. World journal of gastrointestinal endoscopy. 2019 Apr 16;11(4):308-321. PubMed PMID: 31040892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature. AU - Iosif,Evangelia, AU - Rees,Clare, AU - Beeslaar,Salome, AU - Shamali,Awad, AU - Lauro,Roberto, AU - Kyriakides,Charis, PY - 2019/02/17/received PY - 2019/03/27/revised PY - 2019/04/08/accepted PY - 2019/5/2/entrez PY - 2019/5/2/pubmed PY - 2019/5/2/medline KW - Case report KW - Extramedullary plasma cell neoplasm KW - Extramedullary plasmacytoma KW - Gastrointestinal bleeding KW - Multiple myeloma KW - Plasmablastic myeloma SP - 308 EP - 321 JF - World journal of gastrointestinal endoscopy VL - 11 IS - 4 N2 - BACKGROUND: Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment. CASE SUMMARY: Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search (PubMed database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma (EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males (67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach (41%), followed by the duodenum (15%). The most common presenting complaint was melena (44%). In the majority of cases, the EMPs were a secondary manifestation (63%) at the background of multiple myeloma (26%), plasmablastic myeloma (7%) or high-grade plasma cell myeloma (4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs. CONCLUSION: Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy. SN - 1948-5190 UR - https://www.unboundmedicine.com/medline/citation/31040892/Gastrointestinal_bleeding_as_initial_presentation_of_extramedullary_plasma_cell_neoplasms:_A_case_report_and_review_of_the_literature_ L2 - https://www.wjgnet.com/1948-5190/full/v11/i4/308.htm DB - PRIME DP - Unbound Medicine ER -
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