Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2019; 11(4): 308-321
Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.308
Gastrointestinal bleeding as initial presentation of extramedullary plasma cell neoplasms: A case report and review of the literature
Evangelia Iosif, Clare Rees, Salome Beeslaar, Awad Shamali, Roberto Lauro, Charis Kyriakides
Evangelia Iosif, Awad Shamali, Roberto Lauro, Charis Kyriakides, Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
Clare Rees, Department of Haematology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
Salome Beeslaar, Department of Histopathology, Frimley Park Hospital, Frimley, Camberley GU16 7UJ, United Kingdom
Author contributions: Iosif E, Shamali A, Kyriakides C and Lauro R designed the study; Iosif E, Rees C, Beeslar S contributed to data acquisition and interpretation; Iosif E, Rees C and Kyriakides C wrote the manuscript. The final manuscript was approved by all authors. Rees C and Kyriakides C were the supervising consultants.
Informed consent statement: Informed consent obtained from the patient in the form of pre-operative written consent.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Evangelia Iosif, MD, MSc, Surgeon, Department of Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Road, Frimley, Camberley GU16 7UJ, United Kingdom. e.iosif@nhs.net
Telephone: +44-125-2649406
Received: February 17, 2019
Peer-review started: February 17, 2019
First decision: March 11, 2019
Revised: March 27, 2019
Accepted: April 8, 2019
Article in press: April 9, 2019
Published online: April 16, 2019
Processing time: 60 Days and 11.1 Hours
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.

Keywords: Gastrointestinal bleeding; Extramedullary plasma cell neoplasm; Plasmablastic myeloma; Multiple myeloma; Extramedullary plasmacytoma; Case report

Core tip: The involvement of gastrointestinal tract by plasma cell neoplasms and the manifestation as gastrointestinal bleeding is very rare. However, patients can be profoundly unstable on presentation requiring immediate diagnosis and intervention. As the existing literature is very scattered and it mainly consists of case reports, we are aiming with our present work not only to describe our experience but also to review, consolidate and discuss information about diagnosis and management of this rare cause of gastrointestinal bleeding. The management these patients requires a multidisciplinary team approach and should involve not only the gastroenterology and surgical teams but also haematology and oncology teams for achievement of the best possible outcomes.