A case of multiple myeloma with plasmacytoma in the gallbladder and pancreas

• Published in: Tando Vol. 37; no. 1; pp. 83 - 90
• Main Authors: Gibo, Noriaki, Nonogaki, Koji, Ohno, Eizaburo, Aoki, Toshinori, Yashika, Jun, Uetsuki, Kota, Iida, Tadashi, Mizutani, Yasuyuki, Yamao, Kentaro, Ishikawa, Takuya, Uno, Yusuke, Kawashima, Hiroki
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 31.03.2023
• Subjects: contrast enhanced ultrasonography; gallbladder tumor; myeloma; pancreatic tumor; plasmacytoma
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando.37.83

An 84-year-old man presented to our hospital with back pain and loss of appetite, and was noted to have hypercalcemia, renal failure, and hyperproteinemia. The patient was diagnosed with multiple myeloma following bone marrow aspiration. Contrast-enhanced computed tomography revealed an irregular mass that was slightly contrast-enhanced in the gallbladder neck. A round mass with the same contrast effect was also noted in the pancreatic tail, right thoracic cavity, and abdominal cavity. Endoscopic ultrasonography showed that the gallbladder lesion was irregular hypoechoic mass combined with high and low echoes and the pancreatic tail lesions was irregular hypoechoic mass with clear contours. Fine needle aspiration under endoscopic ultrasonography was conducted on both lesions and showed plasma cells with atypia in both samples and were ultimately diagnosed as plasmacytoma. First-line bortezomib-melphalan-prednisone therapy had no response, and an obstructive jaundice associated with the growth of the gallbladder mass developed. However, second-line lenalidomide-dexamethasone therapy that was initiated after bile duct stenting showed a decrease in the M protein and improvement in hypercalcemia. Moreover, the gallbladder lesion and pancreatic lesion were reduced in size, which were consistent with the clinical course of plasmacytoma.