EXTRAMEDULLARYPLASMOCYTOMA OF THE ANAL CANAL AND RECTUM IN PATIENT WITH ULCERATIVE COLITIS

Aims:

Plasmacytomas are clonal proliferations of plasma cells which are cytologically and immunophenotypically identical as plasma cell myeloma, but manifest a localized osseous or extraosseous growth pattern. Solitary plasmacytoma of bone (P-bone) and solitary extramedullaryplasmacytoma (P-extramedullary) are rare diseases. Extramedullaries rarely occur in the GI tract, stomach, small bowel, colon, or rectum. The lower gastrointestinal EMP represents less than 5% of all cases, and location in the anal canal is exceedingly rare. We found only few cases of common presentation of inflammatory bowel disease and extramedullaryplasmacytoma.

Methods:

A 88-year-old man with diagnosis of ulcerative rectosigmoiditis since 2013 was hospitalized in our hospital due to the presence of liquid stools with blood, urgent for defecation, weakness, loss of weight. He reported last colonoscopy examination from 2015., where there was see one sessile polyp of rectum diamether 6 mm (histology inflammatory pseudopolyp) and remission of ulcerative proctosigmoiditis.

Results:

During hospitalization in our hospital, colonoscopy was performed and showed tumor about 20 cm diameter, starting from anal canal. Immunohistochemical staining of biopsy specimens of rectal tumor yielded a diagnosis of plasmablastic plasmacytoma, gr III (LCA+, EMA -/+, VIM+, CD38+, CD138-, CD20-, kappa+, MUM-1+, Ki 67 about 60%). In sample of serum electrophoresis of proteins and immunofixation monoclonal gammopathy (alpha 1 globulin) were presented. An abdominal computed tomography (CT) scan showed tumor size 10.7X11X16 cm, TNM stadium T4N2 (uriniray bladder, prostate, peritoneum, ascites).

There was no evidence of disease in other locations and these features were consistent with the diagnosis of an extra-osseous plasmacytoma. Within the consultation with haematologist, patient was referred to haematology department for further treatment.

Conclusions:

We presented rare case of plasmablasticplasmocytoma of anal canal and rectum in patient with ulcerative colitis witch could mimic relapse of ulcerative colitis or adenocarcinoma.