Plasmacytoma of the duodenum associated with idiopathic thrombocytopenic purpura

초록

Extramedullary plasmacytoma (EMP) are rare tumors and they occupy 5% of all plasma cell neoplasms. Primary EMP of duodenum is very rare and only 9 cases were previously reported. Primary EMP is not associated with bone marrow plasmacytosis, Bence Jones proteinuria, or radiological changes in bone. We have experienced a case of primary EMP of duodenum associated with idiopathic thrombocytopenic purpura (ITP). The patient was 54 year old male. He had suffered form epigastric discomfort and pain in the right upper \quadrant for 10 days. Duodenal endoscopic ultrasonogram revealed well demarced 2cm sized mass in the ampulla of vater. Under the impression of peiampullary cancer, the patient was taken Whipple's operation. On the gross examination, the common bile duct (CBD) was markedly dilated and distal CBD showed tumor infiltration with severe mural thickening. However, the mucosal surface in intact. Whole thickness of duodenal wall was invaded by tumor showing gray white and homogeneous cut surface. The tumor extended to the pancreas parenchyma, grossly. Microscopically, diffuse infiltration of palsmal cells was noted in the duodenal wall. The mucosal layer is relatively intact. The CBD and pancreas were invaded by the tumor. The plasma cells showed mild to moderated atypia with mitoses. The section of bone marrow showed compatible features of ITP without evidence of myeloma. There was neither bony abnormalities nor monoclonal gammopathy in the serum electrophoresis.