case_images: PMC6142722_01
case_images: MRI of abdomen T2 sequence showed a moderately T2 hyperintense, round, well-circumscribed homogeneous mass, measuring approximately 6.3 x 5.9 x 8.2 cm, arising off the head of the pancreas (yellow arrow). There was also a mild thickening of gallbladder wall (red arrow).
case_images: CRIGM2018-9017617.001.jpg
case_images: PMC6142722_01_CRIGM2018-9017617.001.jpg
case_images: fig1
case_images: MRI of the abdomen showed a well-circumscribed homogenous mass at the head of pancreas obstructing the biliary system (Figure 1).
case_images: Endosonographic image demonstrating a well-defined round, hypoechoic mass, measuring 65 mm x 64 mm in maximal cross-sectional diameter.
case_images: CRIGM2018-9017617.002.jpg
case_images: PMC6142722_01_CRIGM2018-9017617.002.jpg
case_images: fig2
case_images: EUS showed a hypoechoic mass (Figure 2) and smear of the FNA sampling with a 22G needle revealed numerous atypical plasma cells displaying increased cell size, fine nuclear chromatin, and prominent nucleoli (Figure 3).
case_images: Cytology smear (Diff-Quick stain) of the FNA sample on the left showed numerous plasma cells with atypical nucleoli under 400x magnification. Hematoxylin and eosin staining of the FNA sample showed abundant lymphocytes under 400x magnification.
case_images: CRIGM2018-9017617.003.jpg
case_images: PMC6142722_01_CRIGM2018-9017617.003.jpg
case_images: fig3
case_images: EUS showed a hypoechoic mass (Figure 2) and smear of the FNA sampling with a 22G needle revealed numerous atypical plasma cells displaying increased cell size, fine nuclear chromatin, and prominent nucleoli (Figure 3). Hematoxylin and eosin stain showed basophilic stained plasma cells (Figure 3).
case_images: Immunohistochemistry of the FNA sample showed positive staining for CD138 under 400x magnification on the left side and positive staining for Lambda light chain under 400x magnification on the right side.
case_images: CRIGM2018-9017617.004.jpg
case_images: PMC6142722_01_CRIGM2018-9017617.004.jpg
case_images: fig4
case_images: Immunohistochemistry was positive for CD138 and IgA Lambda consistent with plasmacytoma (Figure 4).