A Case of Multiple Myeloma (IgG, κ type) Causing Extrahepatic Obstructive Jaundice by Massive Extramedullary Plamacytoma

Abstract

A 74-year-old male with multiple myeloma (Ig G, κ-type) was treated with cyclophosphomide and prednisolone with a good clinical response. Fourteen months later the same treatment was repeated with moderate response. Sixteen months after the initial therapy, the patient developed cramping abdominal pain, nausea and vomiting. Physical examination revealed a hard, tender mass in the right costal margin which developed rapidly in size. The patient developed severe jaundice and died of massive hematemesis seventeen months after the initial presentation.
At autopsy, there was a huge tumour mass around the omentum (18×13×9cm), which extended directly to the duodenum, pancreas, bile ducts, gallbladder, and stomach. The common bile duct was encased and compressed by the surrounding tumour, causing complete obstructive jaundice, although the duct was anatomically patent. In the stomach there wer two ulcers (2×2cm, 3×4cm), the basis of which was infiltrated by plasma cells.
Histologically, the myeloma cells were characterized by small and middle-sized plasma cells which showed considerable pleomorphism with many atypical and giantnucleated cells, especially in the extraskeletal lesion.