University of Oklahoma Health Sciences Center Oklahoma City, OK, United States
Award: Presidential Poster Award
Caleb W. St. Laurent, MD1, Karl F. Mareth, MD1, Carrie H. Yuen, MD2, Amir Rumman, MD, FRCPC1 1University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2University of Oklahoma Health Sciences Center, Oklahoma coty, OK
Introduction: Primary gastric plasmacytoma (PGP) is a rare subtype of extramedullary plasmacytoma (EP). Surgical resection and radiation therapy are historically the mainstay of therapy. Resection by endoscopic submucosal dissection (ESD) has been reported as effective alternative to surgery or radiation therapy. Herein, we report the first known case of using a novel endoscopic full-thickness resection device (FTRD) to curatively treat PGP.
Case Description/Methods: : A 56 year-old African American man with a past medical history of hypertension and H pylori infection eradicated with quadruple therapy was referred for assessment of a gastric mass noted on esophagogastroduodenoscopy (EGD) performed for investigation of dyspepsia. The lesion measured 20mm and was located in the proximal gastric body, along the greater curvature. Endosonographic (EUS) evaluation revealed a heterogenous lesion arising from the submucosa and intimately adherent to the muscularis propria (MP). Biopsies of the mass were obtained. This revealed extensive infiltration of the submucosa with atypical large mononuclear cells. Immunohistochemical staining was positive for CD38, CD138 and negative for CD20 consistent with plasma cells. An extensive hematologic work-up did not identify any extra-gastric disease, confirming the diagnosis of PGP. We elected to proceed with endoscopic therapy. Given that the lesion was adherent to the MP on EUS, we felt that ESD will not be sufficient to obtain a negative deep margin. We performed full-thickness endoscopic resection using the OVESCO gastroduodenal FTRD system. The resected specimen measured 25 x 17 x 11mm. Pathologic examination revealed a kappa-restricted B-lineage neoplasm with extensive plasmacytic differentiation consistent with PGP. The inked resection margins were free of tumor. EGD performed five months after resection revealed a healthy-appearing scar and no evidence of residual or recurrent mass. Scar biopsies were negative.
Discussion: We report the first successful en bloc curative resection of a PGP using a novel endoscopic FTRD. This technique should be considered for PGPs measuring < 20mm, particularly if MP involvement is suspected on EUS, precluding a curative ESD.
Figure: Figure I: A) 20mm primary gastric plasmacytoma noted in the proximal corpus on EGD. B) EUS evaluation of the lesion demonstrating submucosal origin and adherence to the muscularis propria. C) Gross specimen after R0 resection with Full Thickness Resection Device. D) Resection scar 5 months after resection with no indication of recurrence.
Caleb St. Laurent indicated no relevant financial relationships.
Karl Mareth indicated no relevant financial relationships.
Carrie Yuen indicated no relevant financial relationships.
Amir Rumman indicated no relevant financial relationships.
Caleb W. St. Laurent, MD1, Karl F. Mareth, MD1, Carrie H. Yuen, MD2, Amir Rumman, MD, FRCPC1. P1733 - Primary Gastric Plasmacytoma Cured With Endoscopic Full-Thickness Resection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.