case_images: PMC9379956_01
case_images: (A) Initial positron emission tomography/computed tomography (PET/CT) image
  demonstrating a mass at the gallbladder fossa with intense
  fluorodeoxyglucose (FDG) uptake. (B) Subsequent PET/CT image demonstrating
  an increase in size and metabolic activity of the gallbladder mass
  approximately 4 months later.
case_images: 10.1177_23247096221117809-fig1.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig1.jpg
case_images: fig1-23247096221117809
case_images: T9, the vertebral body of L5, and the left iliac spine. There was also a 4 cm mass of hypermetabolic activity at the inferior edge of the liver, which was indistinguishable from the gallbladder (Figure 1A). There was also new metabolic activity within a new left perinephric mass and the posterior left ilium (Figure 1B).
case_images: Magnetic resonance imaging (MRI) with gadolinium contrast demonstrating a
  7-cm mass at the gallbladder fossa (white arrow).
case_images: 10.1177_23247096221117809-fig2.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig2.jpg
case_images: fig2-23247096221117809
case_images: Magnetic resonance imaging (MRI) of the liver with gadolinium contrast confirmed a 7 cm mass located at the gallbladder fossa (Figure 2).
case_images: An ultrasound of the liver demonstrating a hypoechoic mass at the gallbladder
  fossa that was most consistent with a complete filling of the gallbladder
  lumen secondary to an obstructive mass.
case_images: 10.1177_23247096221117809-fig3.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig3.jpg
case_images: fig3-23247096221117809
case_images: An ultrasound of the liver further demonstrated a hypoechoic mass at the gallbladder fossa that was most consistent with a complete filling of the gallbladder lumen with an obstructive soft tissue mass that may reflect gallbladder malignancy (Figure 3).
case_images: Hepatobiliary iminodiacetic acid (HIDA) scan demonstrating contrast emptying
  into the biliary duct system and into the duodenum without passing into the
  lumen of the gallbladder, indicating an obstruction of the cystic duct.
case_images: 10.1177_23247096221117809-fig4.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig4.jpg
case_images: fig4-23247096221117809
case_images: A hepatobiliary iminodiacetic acid (HIDA) scan could not visualize the gallbladder (Figure 4).
case_images: (A) Hematoxylin and eosin (H&E) staining demonstrating atypical plasma
  cells with an abundant cytoplasm and eccentric nuclei replacing the normal
  liver parenchyma. (B) Immunohistochemical (IHC) staining demonstrating
  plasma cells with positivity for CD138.
case_images: 10.1177_23247096221117809-fig5.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig5.jpg
case_images: fig5-23247096221117809
case_images: Histopathologic evaluation of the CT-guided biopsy sample demonstrated diffuse proliferation of atypical plasma cells with no evidence of liver parenchyma (Figure 5A). CD56, Kappa in-situ hybridization, and CD138. CD3 was highlighted in a few scattered T cells (Figure 5B).
case_images: Photograph of the extensive cutaneous lesions manifesting as firm, smooth,
  violaceous papules and nodules.
case_images: 10.1177_23247096221117809-fig6.jpg
case_images: PMC9379956_01_10.1177_23247096221117809-fig6.jpg
case_images: fig6-23247096221117809
case_images: The patient noted new-onset, rapidly evolving varying sized, violaceous papules and nodules on chest and abdomen (Figure 6).