Aggressive Extramedullary Multiple Myeloma Presenting as Small Bowel Obstruction

Authors

  • Paul J. Wurtz
  • Kevin McGovern
  • Jamie Shah
  • Kristin E. Stoll
  • Devin Moore

DOI:

https://doi.org/10.14740/jh2031

Keywords:

Extramedullary multiple myeloma, Plasmacytoma, Small bowel obstruction, Hepatic plasmacytoma, Iron deficiency anemia

Abstract

De novo extramedullary multiple myeloma (EMM) is a rare subset of multiple myeloma (MM) defined by the presence of clonal plasma cells (PC) outside of the bone marrow. It is associated with refractory disease and adverse outcomes. Even in EMM, plasmacytomas within the duodenum, jejunum, and ileum are uncommon, with fewer than 70 cases reported in the literature. Here, we present a particularly aggressive case of EMM resulting in a small bowel obstruction secondary to an intraluminal plasmacytoma while on myeloma-directed therapy. The patient underwent surgical resection with anastomosis and was transitioned to more definitive cytotoxic chemotherapy followed by autologous stem cell rescue. This case highlights challenges in the management of EMM over standard MM and argues that dedicated clinical trials for patients with aggressive EMM are warranted to further understand the unique pathophysiology and improve overall survival.

Author Biographies

  • Paul J. Wurtz, Brooke Army Medical Center

    Department of Internal Medicine, CPT, US Army

  • Kevin McGovern, Brooke Army Medical Center

    Department of General Surgery, MAJ, US Army

  • Jamie Shah, Brooke Army Medical Center

    Department of Pathology, Capt, US Air Force

  • Kristin E. Stoll, Brooke Army Medical Center

    Department of Hematology and Oncology, Maj, US Air Force

  • Devin Moore, Brooke Army Medical Center

    Department of Internal Medicine, Capt, US Air Force

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Published

2025-02-25

Issue

Section

Case Report

How to Cite

1.
Wurtz PJ, McGovern K, Shah J, Stoll KE, Moore D. Aggressive Extramedullary Multiple Myeloma Presenting as Small Bowel Obstruction. J Hematol. Published online February 25, 2025. doi:10.14740/jh2031