Department of Internal Medicine, University of Tennessee Health Science Center Nashville, Nashville, TN, USA.
Postgrad Med. 2022 Jan;134(1):122-123. doi: 10.1080/00325481.2021.2008726. Epub 2021 Nov 29.
Plasma cell neoplasms are a group of diseases involving the malignant proliferation of plasma cells. One common type of plasma cell neoplasm is multiple myeloma, which typically occurs diffusely in the bone marrow. It can manifest with a variety of presentations, including bone pain, fractures, anemia, infection, hypercalcemia, and renal failure. A less common type of plasma cell neoplasm is the solitary plasmacytoma, which is a local proliferation of plasma cells in the bone or extramedullary tissues. They rarely recur after local radiation therapy.An 83-year-old woman was noted on routine labwork to have elevated total serum protein, and serum immunofixation confirmed IgG/Kappa paraprotein. There was no evidence of end-organ damage characteristic of myeloma: hypercalcemia, renal dysfunction, anemia, or bone lesions. She was diagnosed with monoclonal gammopathy of undetermined significance and placed on observation. Seven years later, she developed mild anemia and an increasing M spike. No abnormalities were found on bone marrow biopsy apart from mildly increased plasma cell proliferation (7-10% of total cells). A PET scan showed increased gastric uptake, concerning for possible gastric malignancy. Upper gastrointestinal endoscopic ultrasound revealed extrinsic compression of the stomach fundus and body due to a 40 mm mass and associated adenopathy. Pathology revealed a kappa-restricted plasma cell neoplasm positive for CD138.The patient underwent radiation therapy localized to the gastric area. Subsequent evaluation revealed a persistent gastric mass. Attempted biopsy resulted in a gastrointestinal bleed, rendering her unable to undergo treatment with lenalidomide and aspirin. She is currently undergoing chemotherapy with bortezomib, cyclophosphamide, and dexamethasone. The case illustrates the potential diversity of plasma cell dyscrasia clinical manifestations. Gastric plasmacytomas are an uncommon type of extramedullary plasmacytoma, particularly rare when resistant to radiation therapy.
浆细胞肿瘤是一组涉及浆细胞恶性增殖的疾病。浆细胞肿瘤的一种常见类型是多发性骨髓瘤，通常弥漫性累及骨髓。它可以表现出多种症状，包括骨痛、骨折、贫血、感染、高钙血症和肾衰竭。浆细胞肿瘤的另一种较少见的类型是孤立性浆细胞瘤，即骨髓或骨髓外组织中浆细胞的局部增殖。局部放射治疗后很少复发。
一名 83 岁女性在常规实验室检查中发现总血清蛋白升高，血清免疫固定电泳证实存在 IgG/Kappa 型单克隆丙种球蛋白。没有骨髓瘤特征性的终末器官损伤的证据：高钙血症、肾功能不全、贫血或骨病变。她被诊断为意义未明的单克隆丙种球蛋白血症，并接受观察。七年后，她出现轻度贫血和 M 峰增加。骨髓活检除浆细胞轻度增殖（占总细胞的 7-10%）外无异常。PET 扫描显示胃摄取增加，提示可能存在胃恶性肿瘤。上消化道超声内镜显示胃底和体部因 40mm 肿块和相关淋巴结肿大而受到外压。病理显示kappa 限制的浆细胞肿瘤，CD138 阳性。
患者接受了胃区域的局部放射治疗。随后的评估显示胃内仍有肿块。尝试活检导致胃肠道出血，使她无法接受来那度胺和阿司匹林治疗。她目前正在接受硼替佐米、环磷酰胺和地塞米松化疗。该病例说明了浆细胞异常临床表现的潜在多样性。胃浆细胞瘤是一种罕见的骨髓外浆细胞瘤类型，尤其是对放射治疗耐药的浆细胞瘤更为罕见。
