Intestinal perforation with abdominal abscess caused by extramedullary plasmacytoma of small intestine: A case report and literature review

Abstract

Background: Extramedullary plasmacytoma (EMP) of the gastrointestinal tract is an extremely rare disease. Clinical manifestations of EMPs are varied and depend on the location and progression of the tumor.

Case summary: Here, we firstly report a case of intestinal perforation with abdominal abscess caused by EMP of the small intestine in a 55-year-old female patient. The patient received emergency surgery immediately after the necessary preoperative procedures. During the operation, EMP was found to have caused the perforation of the small intestine and the formation of multiple abscesses in the abdominal cavity. Partial resection of the small intestine with peritoneal irrigation and drainage was performed. EMP was finally confirmed by postoperative histopathology and laboratory tests. Additionally, we performed a literature review of gastrointestinal EMP to obtain a deeper understanding of this disease.

Conclusion: EMP of the small intestine may have spontaneous perforation, which requires emergency surgery. Surgical resection can obtain good therapeutic effects.

Keywords: Case report; Extramedullary plasmacytoma; Gastrointestinal tract; Perforation; Small intestine; Treatment.

Figure 1

Preoperative computed tomography scan findings. A: There are small air bubbles scattered under the left diaphragm (indicated by white arrow); B: The small intestinal lumen in the upper left abdomen is dilated with gas and fluid accumulation, showing multiple fluid-gas level changes; C: The intestinal wall presents edematous thickening (indicated by white arrow), and the density of local mesentery increases; D: Multiple abscesses can be seen between the intestinal lumen (indicated by white arrow).

Figure 2

Histopathological examination of extramedullary plasmacytoma of small intestine. Microscopic view of the resected extramedullary plasmacytoma originating from small intestine. A: Hematoxylin and eosin staining, magnification × 100; B: Ki67, magnification × 200; C: CD38, magnification × 200; D: CD138, magnification × 200; E: Kappa, magnification × 200; F: Lambda, magnification × 200.

Figure 3

Intra-operative findings. The small intestinal serosa has a dark red polyp-like protrusion (black arrow) with a perforation about 0.5 cm in diameter at the top. The local intestinal wall presents hyperemia, edema and thickening (white arrow). The surface of the surrounding small intestine is covered with a large amount of purulent material (blue arrow).