The Journal of Radiology Case Reports - interactive Radiology case reports and Radiology review articles

Journal of Radiology Case Reports

Extramedullary duodenal plasmacytoma presenting with gastric outlet obstruction and painless jaundice

Case Report

Adib R. Karam¹*, Rita J. Semaan², Karen Buch³, Sridhar Shankar4

Radiology Case. 2010 Aug; 4(8):22-28 :: DOI: 10.3941/jrcr.v4i8.487

Cite this paper

1. Radiology Department, University of Massachusetts Medical School, Worcester, MA, USA
2. Department of Medicine, Roger Williams Medical Center, Providence, RI, USA
3. University of Massachusetts Medical School, Worcester, MA, USA
4. Radiology Department, University of Tennessee Regional Medical Center, Memphis, TN, USA

Bookmark and Share


         



  ABSTRACT
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

Malignant plasma cells in multiple myeloma are predominantly confined to the medullary space of the skeletal system, therefore the disease course will be dominated by signs and symptoms related to bone marrow infiltration and destructive bone lesions with their consequences as well as abnormal protein production. Visceral extramedullary plasmacytoma involving the gastrointestinal system and particularly the duodenum is a rare manifestation of the disease. We report a case of duodenal extramedullary plasmacytoma presenting with gastric outlet obstruction and painless jaundice, in a patient treated for multiple myeloma. Diagnosis was first suggested on imaging, and proved by endoscopic biopsy. The duodenal mass resolved following chemotherapy.

  CASE REPORT
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

A 66-year-old gentleman presented to the emergency department of our institution complaining of severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. The patient was known to have a history of multiple myeloma (MM) and had had bone marrow transplants twice, six and three years prior to presentation. He had recent evidence of recurrent disease based on the results of a bone marrow biopsy, obtained three weeks prior to presentation, and was started on Bortezomib (Velcade®). Patient was also known to have a personal history of cholelithiasis, hepatic steatosis, diabetes mellitus type II, and a history of benign esophageal stricture successfully treated using endoscopic dilation. On physical examination the patient was afebrile, and his vital signs were within normal limits; he had prominent scleral icterus and had mild abdominal distention with significant tenderness to deep palpation, and a palpable liver edge. Laboratory testing revealed abnormal liver function tests, with elevated total bilirubin of 12.7 mg/dl (Normal: 0.3-1.2 mg/dl), elevated alkaline phosphatase of 238 IU/L (Normal: 30-115 IU/L), elevated AST of 61 IU/L (Normal: 10-40 IU/L) and a normal ALT level, low calcium of 7.6 mg/dl (Normal: 8.7-10.7 mg/dl), and a low sodium of 126 mg/dl (Normal: 136-145 mg/dl). Results of routine hematologic tests were remarkable for hemoglobin of 7.4 g/dl (Normal: 14-18 g/dl) and hematocrit of 20.4 % (Normal: 42-52 %). Renal function tests were normal.

Given the patient`s history, physical examination, and laboratory findings a CT scan of the abdomen and pelvis with intravenous and oral contrast was ordered for evaluation of possible biliary obstruction, hepatic pathology, and to rule out other gastrointestinal diseases and particularly bowel obstruction. CT scan demonstrated the presence of a 4.4cm x 6.0cm x 5.8cm irregular, soft tissue mass involving the second portion of the duodenum which was significantly narrowed, in close contact with the pancreatic head, with significant intrahepatic and extrahepatic biliary ductal dilation along with pancreatic ductal dilation; in addition there was associated mesenteric lymphadenopathy (Fig. 1 Preview this figure

Figure 1: Computed Tomography
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase show a large solid enhancing soft tissue tumor, measuring approximately 4.4 x 6.0 x 5.8 cm. It appears originating from the medial wall of the descending portion of the duodenum narrowing its lumen (asterisk), involving the medial aspect of the common bile duct and pancreatic head, resulting in significant dilatation of the intrahepatic (thin white arrows) and extrahepatic (thick white arrows) biliary tree; the pancreatic duct is also dilated (not shown). Enlarged regional mesenteric lymph nodes were noted (black cursor). Note significant fluid residue in the stomach. GB: gallbladder; T: tumor; P: pancreatic head; S: stomach. [Technique: KVp = 120; mA = 356; Slice Thickness = 4.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].
).

A Magnetic Resonance Cholangiopancreatography (MRCP) was then performed to further characterize the tumor and its relationship to the biliary tree and pancreas; MRCP demonstrated a 7cm x 5.5cm x 3.5 cm soft tissue mass arising from the medial wall of the second portion of the duodenum, significantly narrowing its lumen (Fig. 2 Preview this figure
Figure 2: Magnetic Resonance Imaging
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Single three-dimensional Radial MRCP Breath Hold image (TR/TE = 2857.85 msec./1027.58 msec. flip angle = 90.0 degrees) demonstrates significant intra- and extrahepatic biliary ductal dilatation as well as main pancreatic duct dilatation. There is a large, non-cystic, space occupying mass (orthogonal white arrows) impinging on the duodenal lumen. Noted is significant fluid residue in the stomach. B: biliary tree; PD: pancreatic duct; D: duodenum; S: stomach.
, Fig. 3 Preview this figure
Figure 3: Magnetic Resonance Imaging
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a: Transverse noncontrast, T2-weighted, fat-suppressed image (TR/TE = 2600 msec./160 msec.) demonstrates the duodenal tumor showing homogenous high signal intensity. b: Transverse noncontrast, T1-weighted, 2D fat-suppressed spoiled gradient-echo sequence (TR/TE = 177 msec./4.3 msec.; flip angle = 80 degrees) demonstrates the duodenal tumor showing homogenous signal intensity isointense to the paraspinal muscles. c-f: Transverse, T1-weighted, fast-suppressed, 3D spoiled gradient echo (LAVA) sequences (TR/TE = 4.216 msec./2.02 msec. flip angle = 12 degrees), before and after intravenous contrast (20 ml gadobenate dimeglumine, Multihance). Duodenal tumor demonstrates mild enhancement during the hepatic arterial-dominant phase (d), which becomes homogenous and more intense after one minute (e), and two-minute delay (f). T: duodeal tumor.
). The medial aspect of the mass was involving the region of the ampulla of Vater and impinging on the head of the pancreas resulting in severe dilation of the pancreatic duct as well as dilation of the intrahepatic and extrahepatic biliary tree.

No focal liver or pancreatic lesions were visualized. The patient subsequently underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) where areas of ulcerated duodenal mucosa and submucosal mass were biopsied (Fig. 4 Preview this figure
Figure 4: Clinical image
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a, b: endoscopic images from the first and second segments of the duodenum showing an extrinsic compression on the medial wall of the duodenum (T) slightly narrowing the duodenal lumen (curved white arrows). c: Endoscopic image from the periampullary region showing mucosal ulceration (asterisks) and bleeding (B), overlying the extrinsic impression from the tumor (T).
) and a biliary stent was placed (Fig. 5 Preview this figure
Figure 5: Computed Tomography
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase, six weeks following chemotherapy, show resolution of the duodenal soft tissue tumor; there remains minimal circumferential duodenal wall thickening (white cursors). Noted is a biliary stent (asterisks) seen from the level of the porta hepatis across the ampulla of Vater, its distal tip formed in the fourth segment of the duodenum. [Technique: KVp = 120; mA = 275; Slice Thickness = 5.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].
). The pathologic specimens showed evidence of tumor cells with prominent nucleoli staining positive for CD138 and kappa immunostains leading to the final pathologic diagnosis of plasmacytoma.

Subsequently, the decision was made by the patient and his care team to continue treating his MM with a modified VTD-PACE regimen (bortezomib, thalidomide, dexamethasone and 4-days continuous infusions of cis-platin, doxorubicin, cyclophosphamide, etoposide). The patient had significant improvement following chemotherapy; a 1-month follow-up CT revealed significant decrease in the intrahepatic ductal dilation, near complete resolution of the duodenal mass close to the pancreatic head, and absence of lymphadenopathy (Fig. 5 Preview this figure
Figure 5: Computed Tomography
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase, six weeks following chemotherapy, show resolution of the duodenal soft tissue tumor; there remains minimal circumferential duodenal wall thickening (white cursors). Noted is a biliary stent (asterisks) seen from the level of the porta hepatis across the ampulla of Vater, its distal tip formed in the fourth segment of the duodenum. [Technique: KVp = 120; mA = 275; Slice Thickness = 5.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].
).

Six months later the patient was admitted to the hospital for an autologous stem cell transplant from an unrelated donor. The patient experienced Tacrolimus-induced encephalopathy fourteen days after the procedure and his course was further complicated by aspiration pneumonia. The patient passed away eight weeks following his third stem cell transplant.

  DISCUSSION
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

B-cell lymphocytes, part of the immune system, derive from hematopoietic stem cells in the bone marrow. In response to foreign antigens, B-cells will mature and transform into plasma cells. The role of plasma cells is to produce millions of copies of the same antibody called immunoglobulin that recognize the antigens and mark them for destruction by complement activation and phagocytosis. When the transformation of a stem cell to a B-cell is altered, it results in an abnormal or malignant plasma cell called plasmablast, a developmentally early form of plasma cell. These cells can proliferate in the bone marrow to form MM or, extramedullary in the soft tissues, to form plasmacytoma. Plasmacytoma can be either primary without evidence of bone marrow involvement or may occur simultaneously with MM, representing extramedullary spread of the disease (Table. 1, Fig. 6 Preview this figure

Figure 6: Table
Summary table of plasmacytoma
).

Primary extramedullary plasmacytoma is a rare form of the disease accounting for 20% of cases [1,2] with 7% only manifesting in the gastrointestinal tract [3,4]. Goldstein and Poker noted in a review of thirty six patients that the stomach was the most commonly involved gastrointestinal site followed by the jejunum, ileum, colon, rectum and finally rarely the duodenum [5]. Gastrointestinal plasmacytoma in the course of MM is extremely rare accounting for approximately 0.9% as Talamo et al. showed in a large retrospective study conducted on 2,584 recruited MM patients [6]. Duodenal involvement manifests usually as an obstructing mass or as upper gastrointestinal bleeding [7-11]. Our patient presented with gastric outlet obstruction secondary to a large duodenal mass significantly narrowing the duodenal lumen; he also had painless jaundice secondary to common bile duct obstruction by the tumor at the level of the ampulla of Vater. The imaging of duodenal MM is not reported in the literature since most of the published cases appeared in gastroenterology journals. The case we are presenting appeared as a large homogenous solid soft tissue mass arising from the duodenal wall, showing a CT density similar to liver, with homogeneous enhancement following intravenous contrast administration. On MRI, it appeared hyperintense on T2-weighted images and isointense on T1-weighted images compared to skeletal muscle, and demonstrated homogeneous enhancement on the equilibrium phase; the radiological diagnosis of duodenal plasmacytoma was suggested based on the patient`s clinical history. The radiological differential diagnosis would obviously include more prevalent diseases such as duodenal adenocarcinoma and lymphoma (Table. 2, Fig. 7 Preview this figure
Figure 7: Table
Differential diagnosis of duodenal plasmacytoma
). Endoscopically, it may appear as a discrete ulcer, an ulcerated mass, thickened mucosal folds, or polyp [13]. In our patient, due to its location along the medial wall of the duodenum, the endoscopic appearance of the tumor simulated a pancreatic head mass invading the duodenal wall. As the endoscopic appearance of duodenal plasmacytoma is non specific, resembling more common conditions such as duodenal adenocarcinoma or like in our case pancreatic head tumor, pathological and immunohistological diagnosis are crucial in making the final diagnosis.

The treatment of duodenal plasmacytoma, as a primary disease or as extramedullary spread, will be to first address the local complications caused by the mass itself such as relief of biliary obstruction or control of bleeding if significant, followed by surgical resection if necessary [8]. Reports on management of solitary plasmacytoma favor radiation therapy over chemotherapy; however in cases of extramedullary spread, as in our patient, high-dose chemotherapy followed by stem-cell transplantation is the standard treatment [8,14]. Of note is that even with aggressive treatment, once there is gastrointestinal involvement the prognosis will be very poor [6].

  TEACHING POINT
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

Although very rare, duodenal involvement by multiple myeloma should be considered as differential diagnosis in the proper clinical settings; pathology will establish the final diagnosis. The prognosis of MM with evidence of gastrointestinal involvement is poor despite aggressive management.








  FIGURES
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

Display figure 1 in original size

Figure 1: 66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase show a large solid enhancing soft tissue tumor, measuring approximately 4.4 x 6.0 x 5.8 cm. It appears originating from the medial wall of the descending portion of the duodenum narrowing its lumen (asterisk), involving the medial aspect of the common bile duct and pancreatic head, resulting in significant dilatation of the intrahepatic (thin white arrows) and extrahepatic (thick white arrows) biliary tree; the pancreatic duct is also dilated (not shown). Enlarged regional mesenteric lymph nodes were noted (black cursor). Note significant fluid residue in the stomach. GB: gallbladder; T: tumor; P: pancreatic head; S: stomach. [Technique: KVp = 120; mA = 356; Slice Thickness = 4.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].

Figure 1: Computed Tomography (Open in original size)
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase show a large solid enhancing soft tissue tumor, measuring approximately 4.4 x 6.0 x 5.8 cm. It appears originating from the medial wall of the descending portion of the duodenum narrowing its lumen (asterisk), involving the medial aspect of the common bile duct and pancreatic head, resulting in significant dilatation of the intrahepatic (thin white arrows) and extrahepatic (thick white arrows) biliary tree; the pancreatic duct is also dilated (not shown). Enlarged regional mesenteric lymph nodes were noted (black cursor). Note significant fluid residue in the stomach. GB: gallbladder; T: tumor; P: pancreatic head; S: stomach. [Technique: KVp = 120; mA = 356; Slice Thickness = 4.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].

Back Back


Display figure 2 in original size
Figure 2: 66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Single three-dimensional Radial MRCP Breath Hold image (TR/TE = 2857.85 msec./1027.58 msec. flip angle = 90.0 degrees) demonstrates significant intra- and extrahepatic biliary ductal dilatation as well as main pancreatic duct dilatation. There is a large, non-cystic, space occupying mass (orthogonal white arrows) impinging on the duodenal lumen. Noted is significant fluid residue in the stomach. B: biliary tree; PD: pancreatic duct; D: duodenum; S: stomach.

Figure 2: Magnetic Resonance Imaging (Open in original size)
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Single three-dimensional Radial MRCP Breath Hold image (TR/TE = 2857.85 msec./1027.58 msec. flip angle = 90.0 degrees) demonstrates significant intra- and extrahepatic biliary ductal dilatation as well as main pancreatic duct dilatation. There is a large, non-cystic, space occupying mass (orthogonal white arrows) impinging on the duodenal lumen. Noted is significant fluid residue in the stomach. B: biliary tree; PD: pancreatic duct; D: duodenum; S: stomach.

Back Back


Display figure 3 in original size
Figure 3: 66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a: Transverse noncontrast, T2-weighted, fat-suppressed image (TR/TE = 2600 msec./160 msec.) demonstrates the duodenal tumor showing homogenous high signal intensity. b: Transverse noncontrast, T1-weighted, 2D fat-suppressed spoiled gradient-echo sequence (TR/TE = 177 msec./4.3 msec.; flip angle = 80 degrees) demonstrates the duodenal tumor showing homogenous signal intensity isointense to the paraspinal muscles. c-f: Transverse, T1-weighted, fast-suppressed, 3D spoiled gradient echo (LAVA) sequences (TR/TE = 4.216 msec./2.02 msec. flip angle = 12 degrees), before and after intravenous contrast (20 ml gadobenate dimeglumine, Multihance). Duodenal tumor demonstrates mild enhancement during the hepatic arterial-dominant phase (d), which becomes homogenous and more intense after one minute (e), and two-minute delay (f). T: duodeal tumor.

Figure 3: Magnetic Resonance Imaging (Open in original size)
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a: Transverse noncontrast, T2-weighted, fat-suppressed image (TR/TE = 2600 msec./160 msec.) demonstrates the duodenal tumor showing homogenous high signal intensity. b: Transverse noncontrast, T1-weighted, 2D fat-suppressed spoiled gradient-echo sequence (TR/TE = 177 msec./4.3 msec.; flip angle = 80 degrees) demonstrates the duodenal tumor showing homogenous signal intensity isointense to the paraspinal muscles. c-f: Transverse, T1-weighted, fast-suppressed, 3D spoiled gradient echo (LAVA) sequences (TR/TE = 4.216 msec./2.02 msec. flip angle = 12 degrees), before and after intravenous contrast (20 ml gadobenate dimeglumine, Multihance). Duodenal tumor demonstrates mild enhancement during the hepatic arterial-dominant phase (d), which becomes homogenous and more intense after one minute (e), and two-minute delay (f). T: duodeal tumor.

Back Back


Display figure 4 in original size
Figure 4: 66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a, b: endoscopic images from the first and second segments of the duodenum showing an extrinsic compression on the medial wall of the duodenum (T) slightly narrowing the duodenal lumen (curved white arrows). c: Endoscopic image from the periampullary region showing mucosal ulceration (asterisks) and bleeding (B), overlying the extrinsic impression from the tumor (T).

Figure 4: Clinical image (Open in original size)
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. a, b: endoscopic images from the first and second segments of the duodenum showing an extrinsic compression on the medial wall of the duodenum (T) slightly narrowing the duodenal lumen (curved white arrows). c: Endoscopic image from the periampullary region showing mucosal ulceration (asterisks) and bleeding (B), overlying the extrinsic impression from the tumor (T).

Back Back


Display figure 5 in original size
Figure 5: 66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase, six weeks following chemotherapy, show resolution of the duodenal soft tissue tumor; there remains minimal circumferential duodenal wall thickening (white cursors). Noted is a biliary stent (asterisks) seen from the level of the porta hepatis across the ampulla of Vater, its distal tip formed in the fourth segment of the duodenum. [Technique: KVp = 120; mA = 275; Slice Thickness = 5.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].

Figure 5: Computed Tomography (Open in original size)
66-year-old male patient presented with severe nausea and vomiting in the setting of a two-week history of worsening fatigue, pruritus, and jaundice. Axial (a) and coronal (b) contrast enhanced (IV and PO) CT images through the mid abdomen obtained in the equilibrium phase, six weeks following chemotherapy, show resolution of the duodenal soft tissue tumor; there remains minimal circumferential duodenal wall thickening (white cursors). Noted is a biliary stent (asterisks) seen from the level of the porta hepatis across the ampulla of Vater, its distal tip formed in the fourth segment of the duodenum. [Technique: KVp = 120; mA = 275; Slice Thickness = 5.00 mm; Dose of intravenous contrast: Iopamidol (Isovue-300), 100 ml].

Back Back


Display figure 6 in original size
Figure 6: Summary table of plasmacytoma

Figure 6: Table (Open in original size)
Summary table of plasmacytoma

Back Back


Display figure 7 in original size
Figure 7: Differential diagnosis of duodenal plasmacytoma

Figure 7: Table (Open in original size)
Differential diagnosis of duodenal plasmacytoma

Back Back


  REFERENCES
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion



1. Pimmental R, Vanstolk R. Gastric plasmacytoma: A rare cause of massive gastrointestinal bleeding. Am J Gastroenterol 1993; 88:1963-1964. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

2. Chim CS, Wong WM, Nicholls J, Chung LP, Liang R. Extramedullary sites of invovelment in hematologic malignancies: case3. Hemorrhagic gastric plasmacytoma as the primary presentation in multiple myeloma J Clin Oncol 2002; 20:344-347. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

3. Alexiou C, Kau RJ, Dietzfelbinger H. Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. Cancer 1999; 85:2305-2314. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

4. Dolin S, Dewer J. Extramedullary plasmacytoma. Am J Pathol 1955; 32:83-103. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

5. Goldstein WB, Poker N. Multiple myeloma involving the gastrointestinal tract. Gastroenterology 1966; 51: 87-93. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

6. Talamo G, Cavallo F, Zangari M. Barlogie B, Lee CK, Pineda-Roman M et al. Clinical and biological features of multiple myeloma involving the gastrointestinal system Haematologica 2006; 91:964-967. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

7. Pentimone F, Camici M, Cini G, Levorato D. Duodenal plasmacytoma. A rare Primary Extramedullary Localization Simulating a Carcinoma Acta Haemat 1979; 61: 155-160. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

8. Telakis E, Tsironi E, Tavoularis G, Papatheodorou K, Tzaida O, Nikolaou A. Gastrointestinal involvement in a patient with multiple myeloma: A case report. Annals Gastro 2009; 22(4):287-290. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

9. Gradshir W, Recant W, Shapiro C. Obstructing Plasmacytoma of the Duodenum: First Manifestation of Relapsed Multiple Myeloma. Am J Gastroenterol 1988; 83(1):77-91. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

10. Schoretsanitis G, Livingstone JI., El-Japourl JN, Watkins N, Wastell C. Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas. Postgrad Med J 1994; 70, 378-379. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

11. Siddique I, Papadakis KA, Weber DM, Glober G. Recurrent bleeding from a duodenal plasmacytoma treated successfully with embolization of the gastroduodenal artery. Am J Gastroenterol 1999; 94,1691-1692. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

12. Hefferman A. Plasmacytoma of pancreas and duodenum causing acute intestinal obstruction. Lancet 1947; 1:910. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

13. Esfandyari T, Abraham SC, Arora AS. Gastrointestinal plasmacytoma that caused anemia in a patient with multiple myeloma. Nat Clin Pract Gastroenterol Hepatol 2007; 4:111-115. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

14. West RL, Sonneveld P, de Jonge V, Hordijk ML, K uipers EJ. Gastrointestinal plasmacytomas: a rare finding with important consequences. Am J Gastroenterol 2008; 103:2413-2414. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

Back Back

  ABBREVIATIONS
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

IU: International units
ALT: Alanine aminotransferase
AST: Aspartate aminotransferase
CT: Computed tomography
MRI: Magnetic resonance imaging
cm: Centimeters
MM: Multiple Myeloma
ERCP: Endoscopic Retrograde Cholangiopancreatography
MRCP: Magnetic Resonance Cholangiopancreatography
GI: Gastrointestinal









  MORE IMAGES
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

Find more cases and images for:

Multiple myeloma at Radiolopolis or Radiology Search
Duodenal plasmacytoma at Radiolopolis or Radiology Search
Gastrointestinal involvement at Radiolopolis or Radiology Search
Extramedullary multiple myeloma at Radiolopolis or Radiology Search
Painless jaundice at Radiolopolis or Radiology Search
Gastric outlet obstruction at Radiolopolis or Radiology Search









  YOUR OPINION
Top
Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
Your opinion

Let us know what you think!












Cite this paper


©2021 Journal of Radiology Case Reports :: www.RadiologyCases.com :: Published by EduRad