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Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 278-279

Endoscopic ultrasound-guided fine needle aspiration and diagnosis of omental plasmacytoma


1 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
2 Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA

Date of Submission02-Jun-2015
Date of Acceptance04-Jan-2016
Date of Web Publication20-Sep-2016

Correspondence Address:
Prabhleen Chahal
Digestive Disease Institute/A30, Cleveland Clinic, 9500 Euclid Avenue, Cleveland - 44195, Ohio
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.190920

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How to cite this article:
Muddana V, Goyal A, Chahal P. Endoscopic ultrasound-guided fine needle aspiration and diagnosis of omental plasmacytoma. Endosc Ultrasound 2017;6:278-9

How to cite this URL:
Muddana V, Goyal A, Chahal P. Endoscopic ultrasound-guided fine needle aspiration and diagnosis of omental plasmacytoma. Endosc Ultrasound [serial online] 2017 [cited 2019 Dec 8];6:278-9. Available from: http://www.eusjournal.com/text.asp?2017/6/4/278/190920



Extramedullary plasmacytomas (EP) are rare and they can occur either as isolated tumors or in concordance with multiple myeloma (MM).[1] The most frequent extramedullary site involved is the upper respiratory tract.[2] Other sites involved are mesenteric, pulmonary, testicular, urinary tract, thyroid, and ovarian, and these are published in case reports.[3],[4] We present the first case report of omental EP diagnosed with endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA).

A 63-year-old female with MM immunoglobulin (Ig) G lambda type, diagnosed 6 months prior, presented with abdominal pain. Computed tomography (CT) scan of the abdomen and the pelvis showed multiple peritoneal lesions and she was referred for EUS. EUS showed several subcentimeter hypoechoic lesions with echogenic foci in the omentum [Figure 1]a and [Figure 1]b. FNA was performed from these lesions. There were no procedure-related complications. The cytology showed atypical plasmacytoid cells with eccentrically placed nuclei and prominent nucleoli [Figure 2]a. Flow cytometry showed a mixture of cluster of differentiation (CD) 45 positive cells and a subset of CD45 negative, dual CD138, and CD38 positive cells. The dual CD38 and CD138 positive cells additionally showed cytoplasmic lambda restriction. The immunophenotype was consistent with a plasma cell neoplasm. These findings were further confirmed by a peritoneal biopsy that revealed a plasma cell neoplasm [Figure 2]b.
Figure 1: (a and b) FNA of hypoechoic omental lesions with scattered echogenic foci

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Figure 2: (a) Atypical plasmacytoid cells with eccentrically placed nuclei and prominent nucleoli (Diff-Quik, 400×) (b) Peritoneal biopsy revealing a plasma cell neoplasm. The cells show eccentrically placed nuclei with clumped-fine nuclear chromatin. Some cells exhibit prominent nucleoli (H&E, 200×)

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In conclusion, this is the first report of omental EP diagnosed with EUS-guided FNA in a patient with known MM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen HF, Wu TQ, Li ZY, et al. Extramedullary plasmacytoma in the presence of multiple myeloma: Clinical correlates and prognostic relevance. Onco Targets Ther 2012;5:329-34.   Back to cited text no. 1
    
2.
Dimopoulos MA, Kiamouris C, Moulopoulos LA. Solitary plasmacytoma of bone and extramedullary plasmacytoma. Hematol Oncol Clic North Am 1999;13:1249-57.  Back to cited text no. 2
    
3.
Yoshida T, Soda K, Yamada S, et al. Biclonal extramedullary plasmacytoma arising in the peritoneal cavity. Report of a case. Surg Today 2004;34:379-82.  Back to cited text no. 3
    
4.
Jarry J. Solitary mesenteric plasmacytoma revelaed by an acute intestinal obstruction. Gastroenterol Clin Biol 2009;33:432-4.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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