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Viral Associated Cancers and Disorders / Multiple and Secondary Primary Cancers · Journal article
Medicine · August 14, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report describes a 75-year-old man with primary gastric plasmacytoma who showed delayed histologic remission after radiotherapy (45 Gy in 25 fractions) but subsequently progressed to non-secretory multiple myeloma with skeletal involvement. The report illustrates that systemic progression can occur despite initial absence of systemic disease and that early post-treatment biopsy findings may not predict long-term outcome.
Case report. 75-year-old male with primary gastric plasmacytoma initially presenting with 3-cm gastric mass on screening endoscopy; systemic disease excluded at baseline by comprehensive staging.. Intervention: Definitive radiotherapy 45 Gy in 25 fractions delivered to stomach, followed by systemic therapy with bortezomib, lenalidomide, and dexamethasone (VRd) after progression to multiple myeloma..
Initial gastric lesion approximately 3 cm, suspected advanced gastric cancer on screening endoscopy Biopsy at 3 months post-radiotherapy showed marked regression but residual monoclonal plasma cells with kappa light-chain restriction Biopsy at approximately 9 months post-radiotherapy demonstrated loss of light-chain restriction with polytypic kappa/lambda pattern, consistent with histologic remission
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This case highlights the importance of long-term surveillance in primary gastric plasmacytoma, as early post-treatment biopsy remission does not preclude subsequent systemic progression. Clinicians should maintain heightened awareness for delayed evolution to multiple myeloma and integrate serial clinical, radiologic, and pathologic assessment.
A single case report documenting an unusual clinical trajectory; provides descriptive evidence of disease evolution but lacks comparative data, control group, or generalizable findings.
As stated by the source record.
Quoted from the source exactly as published.
This case highlights the importance of long-term surveillance in primary gastric plasmacytoma, as early post-treatment biopsy remission does not preclude subsequent systemic progression. Clinicians should maintain heightened awareness for delayed evolution to multiple myeloma and integrate serial clinical, radiologic, and pathologic assessment.
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Rationale: Primary gastric plasmacytoma is a rare form of extramedullary plasmacytoma that may mimic gastric adenocarcinoma or lymphoma. Although it is generally considered a localized disease, delayed histologic remission after radiotherapy and subsequent systemic progression remain poorly characterized. Patient concerns: A 75-year-old man was referred after screening endoscopy revealed an approximately 3-cm protruding gastric mass initially suspected to represent advanced gastric cancer. Diagnoses: Repeat biopsy demonstrated atypical plasmacytoid cell proliferation with CD138 positivity and kappa light-chain restriction. Comprehensive systemic evaluation, including bone marrow biopsy, serum and urine electrophoresis, immunofixation, serum free light-chain analysis, and PET/CT, revealed no evidence of systemic disease, supporting a diagnosis of primary gastric plasmacytoma. Interventions: Definitive radiotherapy was delivered to the stomach at a total dose of 45 Gy in 25 fractions. Outcomes: Follow-up endoscopy at approximately 3 months demonstrated marked regression of the lesion; however, biopsy revealed residual monoclonal plasma cells with persistent kappa light-chain restriction. Repeat biopsy performed approximately 9 months after radiotherapy demonstrated loss of light-chain restriction with a polytypic kappa/lambda pattern, consistent with histologic remission. During subsequent follow-up, multifocal osteolytic skeletal lesions developed, and biopsy of the L5 vertebral lesion confirmed plasma cell neoplasm. Following multidisciplinary reassessment, the patient was ultimately managed as non-secretory multiple myeloma, and systemic therapy with bortezomib, lenalidomide, and dexamethasone (VRd) was initiated. Lessons: This case demonstrates that histologic remission after radiotherapy may be delayed and that, although uncommon, systemic progression may occur despite the absence of systemic disease at initial staging. Long-term surveillance integrating clinical, radiologic, and pathologic findings is therefore essential, and early post-treatment biopsy findings should be interpreted in the context of the overall clinical course.
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