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• W2914868888 abstract "Introduction: Multiple myeloma (MM) is a common hematological malignancy characterized by the malignant proliferation of clonal plasma cells with the overproduction of monoclonal proteins. Solitary plasmacytomas are localized plasma cell tumors that arise in bone or outside the bone in the soft tissues without the systemic manifestations of MM. The involvement of the gall bladder (GB) and biliary ducts by plasma cell neoplasms, whether solitary plasmacytomas or MM with secondary plasmacytomas, is rare. The clinical and radiological manifestations of GB involvement can be confused with many benign and malignant diseases. Thus, GB involvement of MM is rarely considered in the differential diagnosis of GB diseases, and most of the cases are diagnosed post-operatively or post-mortem. Case report: A 66-year-old African American female with a past medical history of refractory immunoglobulin G lambda MM, presented with five days of right upper quadrant pain. The pain was sudden in onset, intermittent, worse with eating, and without radiation. On physical exam, the patient was in distress but remained alert and oriented. Her vital signs were all stable. She exhibited right upper quadrant abdominal tenderness without rebound or guarding. An abdominal ultrasound revealed a distended GB with sludge, thickened GB wall up to 9.5 mm, and the sonographic murphy sign was positive. The patient was diagnosed with acute cholecystitis. She was started on intravenous hydration and intravenous piperacillin-tazobactam, and was made NPO. The patient was referred for open cholecystectomy given her overall condition and lactic acidosis. Intra-operatively, the GB was thickened and firm but not overly distended or perforated. The pathology report from the cholecystectomy revealed chronic cholecystitis with involvement of the GB submucosa and serosa by abnormal plasma cells with lambda light chain restriction. The patient declined any further treatment for MM and decided to proceed with hospice care. She was discharged home with comfort measures. Conclusion: GB and biliary involvement by extramedullary plasmacytoma, whether solitary or as a secondary infiltration associated with MM, is rare and has only been described in case reports (8 cases in English literature). Secondary malignant infiltration of the GB and biliary system should be considered in the differential diagnosis of GB diseases, especially in patients with a history of malignancy or concerning symptoms.Figure: An abdominal ultrasound showing a distended GB with pericholecystic fluid (A) and a thickened GB wall (B).Figure: Hematoxylin and eosin stain (A) and lambda light restriction (B) of the GB showing cholecystitis with involvement of the GB submucosa and serosa by abnormal plasma cells with lambda light chain restriction." @default.
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• W2914868888 date "2017-10-01" @default.
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• W2914868888 title "A Case of Multiple Myeloma Associated With Extramedullary Plasmacytoma of the Gallbladder Manifesting as Acute Cholecystitis" @default.
• W2914868888 doi "https://doi.org/10.14309/00000434-201710001-01389" @default.
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