PMC6153524_01
Computed tomographic scan of abdomen with contrast-large pancreatic body mass
encasing the portal vein as well as the celiac artery.
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An ultrasound of the abdomen showed a pancreatic mass and a follow-up computed tomographic (CT) scan of the abdomen and pelvis revealed a large pancreatic body mass encasing the portal vein as well as the celiac artery (Figure 1).
Endoscopic ultrasound:well-defined mass arising from the pancreas. Mass on
ultrasonography was hypoechoic and heterogeneous. Mass measured 6 cm on long
axis and 4 cm on short axis. The mass was encasing the celiac artery.
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Endoscopic ultrasound (EUS) revealed a well-defined round mass arising from the body, measuring 6 cm on the long axis and 4 cm on the short axis (Figure 2).
Pancreatic biopsy shows predominant population of atypical plasma cells that
are CD138 positive: Hematoxylin and Eosin staining, magnification x 400.
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CT-guided core biopsy of the pancreatic mass at the discretion of her oncologist for further immunochemistry testing as the FNA biopsy only stated "suspicious" for atypical plasma cells. Computed tomography-guided biopsy of the pancreatic mass was remarkable for atypical plasma cells with positive CD138 (Figure 3).
Bone marrow biopsy shows a mildly hypercellular marrow averaging 50% to 60%.
Cellularity is primarily due to increase in plasma cells which are diffusely
distributed throughout the marrow space and account for approximately 50% of
the nucleated elements: Hematoxylin and Eosin staining.
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She underwent a bone marrow biopsy which revealed mildly hypercellular marrow and 50% to 70% plasma cell (major criteria; Figure 4).
Bone marrow, flow cytometric evaluation shows monotypic lambda light
chain-positive plasma cell population: Hematoxylin and Eosin staining.
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They were monotypic demonstrating lambda chain (Figure 5).
Liver biopsy shows malignant neoplasia that is poorly differentiated but
focally has plasmacytic features: Hematoxylin and Eosin staining,
magnification x 400.
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The biopsy results revealed plasmacytoma with progression to stage 3 metastasis MM (Figures 6 to 8).
Liver biopsy immunostain CD138: diffuse strong positive.
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The biopsy results revealed plasmacytoma with progression to stage 3 metastasis MM (Figures 6 to 8).
Liver biopsy immunostain Ki67: high proliferation rate approaching 100%.
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The biopsy results revealed plasmacytoma with progression to stage 3 metastasis MM (Figures 6 to 8).