Int J Colorectal Dis (2004) 19:289–291 DOI 10.1007/s00384-003-0560-6 LETTER TO THE EDITOR Arturo Lattuneddu Fulvio Farneti Enrico Lucci Domenico Garcea Sonia Ronconi Luca Saragoni A case of primary extramedullary plasmacytoma of the colon Accepted: 21 October 2003 Published online: 19 December 2003  Springer-Verlag 2003 A. Lattuneddu ( ) ) · F. Farneti · E. Lucci · D. Garcea Department of General Surgery, Morgagni Hospital, Piazza Solieri 1, 47100 Forlì, Italy e-mail: a.lattuneddu@ausl.fo.it Tel.: +39-0543-731214 Fax: +39-0543-731214 S. Ronconi Oncohematology Unit, Division of Oncology and Diagnostics, Pierantoni Hospital, Forlì, Italy L. Saragoni Pathology Unit, Division of Oncology and Diagnostics, Pierantoni Hospital, Forlì, Italy Dear Editor: An 86-year-old man was admitted to our department with a 4-month his- tory of intermittent crampy abdomi- nal pain, occasional rectal bleeding and asthenia. Past medical history was remark- able for chronic obstructive pulmo- nary disease and a serious arterioschlerotic vasculopathy that had required, about 4 years previ- ously, an aorto-iliac bifemoral bypass to treat a rupturing aneurism of the sub-renal abdominal aorta. At physical examination the pa- tient was noted to have a core tem- perature of 37.4C, with a pulse rate of 70 beats/min, sinus rhythm and a blood pressure of 135/95 mm Hg; no palpable abdominal or rectal masses were detected. Laboratory examina- tions, comprehensive of tumor mark- ers, were within normal range except for Hb 8.7 g/dl, MCV 85.9 fl, and MCH 28.3 pg. ECG confirmed the sinus rhythm, but identified a spo- radic supraventricular extrasystole with left ventricular hypertrophy with low functional capacity. The chest roentgenogram was normal. Abdom- inal ultrasound showed cholelithiasis and a mass occupying space in the left iliac fossa, probably originating from the colon. A barium enema study, technically inadequate due to the partial inconti- nence of the patient, was not com- pleted but nevertheless revealed a consistent reduction in size with irregular borders of the medial distal tract of the sigma. Colonoscopy showed a severe stricture about 18 cm from the anal verge, which prevented the advancement of the endoscope. Biopsies identified an epitheliomorphic malignant tumor which was poorly differentiated due to diffuse necrobiotic-ulcerative phe- nomena of specimens. At explorative laparotomy, a large mass involving the sigmoid colon was found and a segmental resection of the left colon was performed, with a complementary colecystectomy. There was no evidence of intra- abdominal tumor spread. Surgical tissue was fixed in 10% formalin, processed for light microscopy and stained with hematoxylin-eosin and Giemsa. Histopathological examination identified a plasmacytoma of 13 cm in diameter, with full-thickness infil- tration of the colonic wall and re- gional lymph node involvement (13/ 18 positive). Microscopically, the lesion had a solid-type expansive growth pattern, with evidence of neoplastic thrombosis. Most of the tumor sample was composed of a diffuse proliferation of plasma cells, with a predominance of blastic ele- ments and numerous mitoses. Immu- nohistochemical staining was focally and intensely positive for CD38 only in the mature plasma cells. Neoplas- tic proliferation presented a mono- clonal restriction for IgG-K. IgA and