JOP. J Pancreas (Online) 2009 Mar 9; 10(2):187-188. JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 10, No. 2 - March 2009. [ISSN 1590-8577] 187 CASE REPORT Pancreatic Plasmacytoma Presenting as Variceal Hemorrhage: Life Threatening Complication of a Rare Entity Muslim Atiq 1 , Syed Abbas Ali 2 , Shyam Dang 1 , Somashekhar G Krishna 1 , Elias Anaisse 2 , Kevin W Olden 1 , Farshad Aduli 1 1 Division of Gastroenterology and Hepatology, 2 Myeloma Institute of Research and Therapy; University of Arkansas for Medical Sciences. Little Rock, AR, USA ABSTRACT Context Pancreatic plasmacytoma is a rare entity and presents with features of mass lesion of pancreas. Case report We present an interesting case of pancreatic plasmacytoma with life threatening gastrointestinal bleeding secondary to isolated gastric varices. Conclusion This case highlights the importance of considering it in differential diagnosis of patients with anemia, recurrent pancreatitis or jaundice and isolated gastric varices, prompting a CT scan to evaluate for any pancreatic mass lesions. INTRODUCTION Extramedullary plasmacytomas are neoplastic plasma cell proliferation outside the bone marrow [1, 2]. Pancreatic plasmacytomas are rare, with only a few case reports in the literature [3, 4, 5]. We describe a case of pancreatic plasmacytoma presenting as gastric variceal hemorrhage secondary to splenic vein thrombosis. The purpose of this report is to highlight this rare manifestation of multiple myeloma especially with regards to gastrointestinal manifestations of the disease. CASE REPORT A 49-year-old Caucasian female with history of diabetes type II, hypertension and congestive heart failure underwent work up for recurrent episodes of acute pancreatitis and was found to have a pancreatic mass. The first episode of acute pancreatitis was at an outside facility around 3 months prior to presentation at our institution. Imaging results at our institution revealed a pancreatic mass. Fine needle aspiration of the lesion was consistent with monoclonal plasma cell dyscrasia. Bone marrow biopsy confirmed the diagnosis of multiple myeloma. She smoked one pack of cigarettes per day; however she denied any alcohol use. Chemotherapy was being contemplated when she started to have acute onset of hematemesis with drop in hemoglobin requiring transfusion of packed red blood cells. After hemodynamic resuscitation an esophagogastro- duodenoscopy was performed. It showed normal esophagus, without esophageal varices. The gastroesophageal junction appeared normal. Retro- flexion in the stomach showed presence of prominent gastric varices with active bleeding. Endoscopic sclerotherapy with sodium morrhuate was performed with control of bleeding. Repeat CT scan of abdomen revealed a 3.9 cm mass in the body of the pancreas (Figure 1). The tumor resulted in the invasion and occlusion of the splenic artery and vein. Multiple collateral vessels were visible near the splenic hilum and along the lesser and greater curvatures of the stomach. Received September 27 th , 2008 - Accepted December 4 th , 2008 Key words Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Pancreatitis; Plasmacytoma Correspondence Farshad Aduli Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR, USA Phone: +1-501.686.5175; Fax: +1-501.686.6248 E-mail: faduli@uams.edu Document URL http://www.joplink.net/prev/200903/07.html Figure 1. A 3.9x3.4 cm mass is noted associated with the posterior aspect of the body of the pancreas, with the loss of fat plane between pancreas and retroperitoneum.