상복부 통증을 주소로 내원한 46 세 여자 환 자 연세대학교 원주의과대학 원주기독병원 소화기내과, 1 병리과 석기태, 김재우, 조미연 1, 김현수

Present Illness & Past History 46 세 여자 C.C : epigastric pain 외부 병원에서 시행한 내시경에 이상소견이 발 견되어 전원됨 (bx: granular cell tumor) No known Hx of DM, Hepatitis, Pul Tbc, HTN

ROS, P/Ex, and Lab findings Epigastric pain (+), Indigestion (+) 활력 징후 : 130/90 mmHg – 62/min - 18/min – 36.6ºC Hb 13.1 g/dL, Plt 401 X10 9 /L, 혈청 총 단백 7.3 g/dL, 알부민 4.1 g/dL U/A (-) Tumor marker: all negative

EGD AB C D

Pathology

Immunohistochemical stains CD45 (+) CK (-)CD 68 (-) S-100 (-)

Immunohistochemical stains Kappa (+) Lamda (-)

Monoclonal Gammopathy 는 관찰되지 않음 Urine Serum

BM Aspiration x400 BM Biopsy x400

Final Diagnosis  Biopsy : Plasma cell tumor  Rule out Multiple myeloma  Absence of osteolytic lesion  Negative urine analysis: Bence Jones protein  Negative findings of BM biopsy  Serum electrophoresis 정상  Absence of other tissue involvement Gastric Plasmacytoma

Follow-up

Gastric plasmacytoma Immunoproliferative monoclonal disorder of plasma cells 1 ST gastric plasmacytoma : 5% of all extramedullary plasmacytoma Not detected until the disease progresses to advanced stage. Tx: surgery, irradiation, chemotherapy (almost all cases) Multiple myeloma → complete resection of the lesion