#00064102

A 36-year-old man with a history of plasma cell myeloma and odynophagia. Esophagogastroduodenoscopy evaluation was performed and found mucosal sloughing at the GE junction, suggesting healing esophagitis, and three gastric polyps. The largest polyp was biopsied, which revealed atypical plasma cells in the lamina propria. (A) Hematoxylin and eosin stain (40X) of lamina propria with plasma cell infiltrate; inset demonstrates an atypical plasma cell with Dutcher body. Immunohistochemistry done (all at 40X) demonstrated that the plasma cells stained intensely positive for CD138 (B), MUM-1 (C) inset, and lambda light chain (D). Furthermore, the plasma cells did not take up stains for kappa light chain (C), CD20 (E), nor PAX-5 (F). This immunohistochemical profile, together with the patient’s clinical history, is consistent with plasma cell neoplasm (i.e., multiple myeloma). However, it is a rare presentation to observe in extramedullary or extra-skeletal sites, including visceral organs such as the stomach or esophagus.