Use of Endoscopic Ultrasound in Diagnosing Plasmacytoma of the Pancreas

Milos Miljkovic’; Viplove Senadhi

doi:10.6092/1590-8577/578

Milos Miljkovic’
Viplove Senadhi Division of Gastroenterol¬ogy and Hepatology and Brater Scholar, Indiana Institute for Personalized Medicine, Indiana University School of Medicine 1050 Wishard Blvd, Suite 4100, Indianapolis, IN 46202, United States. Office: + 1-317-948-0414 Fax: +1-678-623-5999

DOI: https://doi.org/10.6092/1590-8577/578

Keywords: Diagnosis, Endosonography, Multiple Myeoloma, Pancreas, Plasmacytoma, Tomography

Abstract

Context An extramedullary plasmacytoma is a discrete collection of monoclonal plasmocytes arising in tissues other than the bone. Gastrointestinal involvement has been reported in approximately 10% of cases and usually involves the liver; however, there have been a number of cases involving the pancreas. Discussion Although helical CT can be used to diagnose pancreatic plasmacytomas based on a typical radiological appearance, there are a number of pitfalls with CT including similar radiologic appearances of other pancreatic tumors, malignant seeding induced by CT biopsy, and creation of multiple secondary plasmacytomas precipitated by CT biopsy. Tissue diagnosis is critical to management in pancreatic lesions as the decision to pursue surgery (pancreatic adenocarcinoma) versus chemotherapy (lymphoma) or radiation (extramedullary plasmacytoma) is dependent on a correct tissue diagnosis. Tissue diagnosis can change morbidity and mortality with respect to specific treatment of pancreatic lesions in the milieu of pancreatic tumor variance. In the confirmed tissue diagnosis of pancreatic plasmacytoma, radiation and chemotherapy can be preferentially chosen over high risk surgery. EUS-FNA has a lower risk of malignant seeding, complications, and a high sensitivity in the diagnosis of pancreatic plasmacytomas, especially with an increased number of passes and bedside cytopathologists. Conclusion It is important for physicians to have a high index of suspicion for diagnosing pancreatic plasmacytomas in the appropriate clinical setting (i.e., a previously diagnosed multiple myeloma, extramedullary plasmacytoma or any other plasma cell neoplasm). EUS-FNA is now an indispensable imaging modality to achieve the diagnosis of pancreatic extramedullary plasmacytomas with an inherently lower rate of complications, and should be the first choice for tissue evaluation.

Downloads

Download data is not yet available.

References

Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 2011; 117(19):5019-32.

Akiyama H, Krigel RL. Metastatic extramedullary plasmacytoma: a case report and review of the literature of a rare pseudocarcinoma. Am J Hepatol 1988; 27(2):115-7.

Woodruff RK, Whittle JM, Malpas JS. Solitary plasmacytoma. I: Extramedullary soft tissue plasmacytoma. Cancer 1979; 43(6):2340-3.

Moreau P, Bataille R, Mahé B, Milpied N, Harousseau JL. High-dose melphalan is not associated with extramedullary relapses in high-risk multiple myeloma. J Clin Oncol 1993; 11(9):1832.

Lorsbach RB, Hsi ED, Dogan A, Fend F. Plasma cell myeloma and related neoplasms. Am J Clin Pathol 2011; 136(2):168-82.

Schabel SI, Rogers CI, Rittenberg GM, Bubanj R. Extramedullary plasmacytoma. Radiology 1978; 128(3):625-8.

Fischer A, Suhrland MJ, Vogl SE. Myeloma of the head of the pancreas. A case report. Cancer 1991; 67(3):681-3.

Abu-Hammour AM, Venu RP, Etzkorn KP, Showel JL, Zaytsev PM, Brown RD. Common bile duct obstruction caused by multiple myeloma of the pancreas. Gastrointest Endosc 1996; 44(5):606-8.

Lopes da Silva R. Pancreatic Involvement by Plasma Cell Neoplasms. J Gastrointest Cancer 2011; Aug 16;

Hefferman A. Plasmacytoma of pancreas and duodenum causing acute intestinal obstruction. Lancet 1947; 1(6461):910.

Hirata S, Yamaguchi K, Bandai S, Izumo A, Chijiiwa K, Tanaka M. Secondary extramedullary plasmacytoma involving the pancreas. J Hepatobiliary Pancreat Surg 2002; 9(1):111-5.

Gaba RC, Kenny JP, Gundavaram P, Katz JR, Escuadro LRA, Gaitonde S. Subcutaneous plasmacytoma metastasis precipitated by tunneled central venous catheter insertion. Case Rep Gastroenterol 2011 May;4(2):315-22.

Jaubert D, Hauteville D, Verdier M, Houdelette P, Gisserot D, Dupin-Nizard B, et al. Plasmacytoma of the head of the pancreas: a rare cause of cholestatic jaundice. Gastroenterol Clin Biol 1985; 9(6-7):532-4.

Hiller N, Goitein O, Ashkenazi YJ. Plasmacytoma of the pancreas. Isr Med Assoc J 2004; 6(11):704-5.

Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992;38(2):172-3.

Hara K, Yamao K, Mizuno N, Hijioka S, Sawaki A, Tajika M, et al. Interventional endoscopic ultrasonography for pancreatic cancer. World J Clin Oncol 2011; 2(2):108-14.

Hawes RH. Indications for EUS-directed FNA. Endoscopy 1998; 30(Suppl 1):A155-7.

Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc 2003 Nov;58(5):690-5.

Hirooka Y, Goto H, Itoh A, Hashimoto S, Niwa K, Ishikawa H, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol 2003; 18(11):1323-4.

Erickson RA. EUS-guided FNA. Gastrointest Endosc 2004 Aug;60(2):267-79.

Matsumoto K, Yamao K, Ohashi K, Watanabe Y, Sawaki A, Nakamura T, et al. Acute portal vein thrombosis after EUS-guided FNA of pancreatic cancer: case report. Gastrointest Endosc 2003 Feb;57(2):269-71.

Yoshinaga S, Suzuki H, Oda I, Saito Y. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 2011;23 Suppl 1:29-33.

Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000 Feb;51(2):184-90.

Klapman JB, Logrono R, Dye CE, Waxman I. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003; 98(6):1289-94.

Alsohaibani F, Girgis S, Sandha GS. Does onsite cytotechnology evaluation improve the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy? Can J Gastroeterol 2009; 23(1):26-30.

Cherian PT, Mohan P, Douiri A, Taniere P, Hejmadi RK, Mahon BS. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary? HPB (Oxford) 2010; 12(6):389-95.

Senadhi V, Dunbar K, Jagannath S. Diagnosis of a Pancreatic Plasmacytoma by Endoscopic Ultrasound with Fine Needle Aspiration: A Case Report. Am J Gastroenterol 2009; 104(Suppl 3):S234.

Padda MS, Milless T, Adeniran AJ, Mahooti S, Aslanian HR. Pancreatic and Gastric Plasmacytoma Presenting with Obstructive Jaundice, Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration. Case Rep Gastroenterol 2010; 4(3):410-415.

Artifon EL a, Okawa L, Baba ER, Siqueira S a, Moura EGH, Sakai P, et al. Diagnosis of pancreatic plasmacytoma by endoscopic ultrasound-guided fine-needle aspiration. Endoscopy 2011; 43(Suppl 2):E79-80.

Balliu E, Casas JD, Barluenga E, Guasch I. Multifocal involvement of the pancreas in multiple myeloma: sonographic, CT, and MR imaging findings. AJR. Am J Roentgenol 2003; 180(2):545-6.

Pääkkö E, Autio R, Lähde S. Plasmacytoma of the pancreas: CT and MRI appearance. Rofo 1998; 169(6):673-5.

Bredella MA, Steinbach L, Caputo G, Segall G, Hawkins R. Value of FDG PET in the assessment of patients with multiple myeloma. AJR. Am J Roentgenol 2005; 184(4):1199-204.