Gastrointestinal manifestations of extramedullary plasmacytoma: a narrative review and illustrative case reports

Ann R Coll Surg Engl. 2018 May;100(5):371-376. doi: 10.1308/rcsann.2018.0015. Epub 2018 Apr 25.

Abstract

Introduction Solitary extramedullary plasmacytoma are rare, solid-mass tumours which appear immunophenotypically similar to multiple myeloma. The diagnosis and management of gastrointestinal plasmacytoma is complex and requires multidisciplinary input. This study presents a narrative review of intra-abdominal extramedullary plasmacytoma, illustrated with two case studies. Methods The PubMed database was searched without date restrictions for reports of intra-abdominal extramedullary plasmacytoma to synthesise a narrative review. Electronic records were reviewed at a high-volume, quaternary soft-tissue sarcoma centre to identify patients with histopathologically confirmed extramedullary plasmacytoma affecting the gastrointestinal tract. Results Gastrointestinal extramedullary plasmacytomas can present with mass effect or organ-specific dysfunction. Techniques for tissue diagnosis of extramedullary plasmacytoma vary dependent on location, with a formal diagnosis often being made from a resected specimen. Management can include surgery, radiotherapy, systemic chemotherapy or a combination. No high-quality evidence base exists to guide treatment. Two case studies of operated gastrointestinal extramedullary plasmacytoma are presented at different phases of disease progression, with a resultant impact on survival. Conclusion Intra-abdominal extramedullary plasmacytoma is a rare and heterogeneous condition that lacks consensus guidelines for diagnosis and management. Collaboration between international specialist centres will create better quality evidence for treatment of this cohort.

Keywords: Abdominal; Multiple myeloma; Plasmacytoma; Surgery.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Disease Progression
  • Fatal Outcome
  • Female
  • Gastrointestinal Neoplasms / diagnosis*
  • Gastrointestinal Neoplasms / therapy
  • Humans
  • Male
  • Plasmacytoma / diagnosis*
  • Plasmacytoma / therapy