Carneiro Fabiana Pirani, Sobreira Maria Nazareth Machado, Maia Lívia Bravo, Sartorelli Alesso Cervantes, Franceschi Luiz Eduardo de Almeida Prado, Brandão Mauro Brito, Calaça Bárbara Wosnjuk, Lustosa Fernando Silva, Lopes João Vieira
Department of Pathology, University Hospital of Brasília, UNB, Via L2 Norte, SGAN 604/605, Módulo C, Brasília DF, Brasil.
World J Gastroenterol. 2009 Jul 28;15(28):3565-8. doi: 10.3748/wjg.15.3565.
We report a rare case of extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. A 72-year-old Japanese man was admitted to our hospital presenting with a 3-mo history of epigastric pain, vomiting and weight loss. On computed tomography (CT) a wall thickening of the fourth part of the duodenum was observed. Multiple biopsies obtained from the lesion showed infiltration of plasma cells and lymphocytes, but they were not conclusive. The patient underwent resection of the lesion and, on histopathological examination, the lesion consisted of a dense and diffuse infiltrate of plasma cells and a few admixed lymphocytes with reactive follicles extending to the muscular propria. An extensive deposition of amyloid was also observed. Immunohistochemical stains revealed that a few plasmacytoid cells showed lambda light chain staining, though most were kappa light chain positive. These cells also were positive for CD138 and CD56 but negative for CD20 and CD79. The findings were consistent with extramedullary plasmocytoma associated with a massive deposit of amyloid in duodenum. A subsequent workup for multiple myeloma was completely negative. The patient showed no signs of local recurrence or dissemination of the disease after 12 mo follow-up. Because of the association of plasmocytoma and amyloidosis, the patient must be followed up because of the possible systemic involvement of the neoplasm and amyloidosis in future.
我们报告一例罕见的十二指肠髓外浆细胞瘤伴大量淀粉样物质沉积。一名72岁的日本男性因上腹部疼痛、呕吐和体重减轻3个月入院。计算机断层扫描（CT）显示十二指肠第四部分肠壁增厚。从病变处获取的多次活检显示有浆细胞和淋巴细胞浸润，但诊断不明确。患者接受了病变切除，组织病理学检查显示，病变由密集弥漫的浆细胞浸润以及少量混合淋巴细胞组成，反应性滤泡延伸至固有肌层。还观察到广泛的淀粉样物质沉积。免疫组织化学染色显示，少数浆细胞样细胞呈λ轻链染色，而大多数为κ轻链阳性。这些细胞CD138和CD56也呈阳性，但CD20和CD79呈阴性。这些发现符合十二指肠髓外浆细胞瘤伴大量淀粉样物质沉积。随后对多发性骨髓瘤的检查结果完全为阴性。随访12个月后，患者未出现疾病局部复发或播散迹象。由于浆细胞瘤与淀粉样变性相关，鉴于未来肿瘤和淀粉样变性可能出现全身累及，必须对患者进行随访。
