Difficult endoscopic diagnosis of a pancreatic plasmacytoma: Case report and review of literature

Abstract

A 71-year-old man, with history of plasmacytoma in relapse since one year, was hospitalized for a initial presentation of acute pancreatitis and hepatitis. Although there was a heterogeneous infiltration around the pancreas head, the diagnosis of an extramedullary localization of his plasmacytoma was not made until later. This delayed diagnosis was due to the lack of specific radiologic features and the lack of dilatation of biliary ducts at the admission. A diagnosis was made with a simple ultrasound guided paracentesis of the low abundance ascites after a transjugular hepatic biopsy, an endoscopic ultrasound-guided fine needle aspiration of the pancreatic mass, and a failed attempt of biliary drainage through endoscopic retrograde cholangiopancreatography. In order to document the difficulty of this diagnosis, characteristics of 63 patients suffering from this condition and diagnosis were identified and discussed through a systematic literature search.

Keywords: Plasmacytoma; Pancreas; Diagnosis; Ultrasound endoscopy; Review

Core tip: We wrote an interesting case report about a pancreatic plasmacytoma for which diagnosis, including endoscopic diagnosis, was a challenge. In a second part, a systematic pubmed search was performed from 1950 to June 2016, reporting characteristics and route to diagnosis of 63 similar cases reports! Strengths of our paper are the original route to diagnosis (by a simple ultrasound guided paracentesis, after failed of the endoscopic route) and our literature search which is particularly exhaustive: we are first to identify more 20 case similar reports (63!!) and their characteristics.