plasma cell neoplasms are characterized by the neoplastic proliferation of a single clone of plasma cells , typically producing a monoclonal immunoglobulin . plasma cell neoplasms can present as a single lesion ( solitary plasmacytoma ) or as multiple lesions ( multiple myeloma ) . solitary plasmacytomas most frequently occur in the bone ( plasmacytoma of bone ) , but can also be found outside the bone in soft tissues ( extramedullary plasmacytoma).1 approximately 5% of all cases of plasma cell disorders are solitary plasmacytomas of the bone.2 however , the involvement of the pancreas is rare . we report a case of an extramedullary plasmacytoma of the pancreas diagnosed using ultrasonography - guided fine needle aspiration ( eus - fna ) with a review of the literature . a 58-year - old woman was transferred to our hospital for further evaluation of pelvic pain that was aggravated by walking and began approximately 2 months before admission . the initial laboratory tests showed a hemoglobin level of 10.6 g / dl , and blood urea nitrogen was 12.0 mg / dl . the level of total protein level was 9.7 g / dl and the albumin level was 3.3 g / dl . skeletal surveys detected a small osteolytic lesion without a sclerotic rim in the left parietal bone and a large bone destructive osteolytic lesion in the right inferior pelvic bone ( fig . further evaluation showed a serum free light chain lambda level of 3,475.3 mg / l and a 2-microglobulin level of 4.6 mg / l . contrast - enhanced abdominal computed tomography ( ct ) revealed a suspicious ill - defined marginated mass in the body of the pancreas ( fig . 2 ) . to further characterize the lesion , magnetic resonance imaging ( mri ) of the pancreas was performed . t2-weighted mri indicated that the pancreatic proximal body contained a mass of subtle high signal intensity ( fig . linear eus ( eu - me1 ultrasound system ; olympus , tokyo , japan ) ( gf - uct 240 ; olympus ) revealed a 1.21.0-cm sized , hypoechoic , heterogeneous , well - defined round mass in the pancreatic body ( fig . 4a ) ; fna was performed via a transgastric approach and five passages were made with a 22-gauge needle ( echotip ultra , echo-22 ; cook endoscopy , winston - salem , nc , usa ) ( fig . the cytopatholgy results showed a small cell neoplasm and the immunohistochemical profile was compatible with plasmacytoma ( fig . the patient began combination therapy consisting of bortezomib , mephalan , and prednisolone with local radiation therapy for the right pelvic bone lesion . multiple myeloma is a disease characterized by malignant proliferation of plasma cells typically involving medullary bones . extramedullary plasmacytomas represent 3% to 4% of all plasma cell neoplasms and have a male predominance , with a three to five times higher incidence in men than in women ; they usually occur in the sixth and seventh decades of life . approximately 80% to 90% of tumors develop in the head and neck area , although gastrointestinal involvement has been reported in 10% of cases . pancreatic involvement of myeloma is relatively rare , with an incidence rate of 2.3% based on autopsy studies . however , previous studies failed to describe the type of disease entity , and did not distinguish between multiple myeloma , myelomatosis , solitary bone myeloma , or extramedullary plasmacytoma.3 - 6 the radiological differentiation of extramedullary plasmacytoma of the pancreas from other pancreatic tumors such as poorly differentiated pancreatic neoplasm , lymphoma , and metastasis is difficult . most cases of plasma cell infiltration of the pancreas are microscopic , and well - formed masses are unusual . the latter may present as a focal mass or a diffuse enlargement of the pancreas ; typically , the patient presents with jaundice and abdominal pain related to the obstruction of the biliary tree because pancreatic plasmacytoma is often located in the head of the pancreas . in the present case , the mass was detected incidentally because it was located in the body of the pancreas . on ultrasound , pancreatic plasmacytoma appears as a multilobulated heterogenous or a homogenous hypoechoic mass . the ct features have been described as a focal multilobulated solid hypodense mass with homogeneous intravenous contrast enhancement or diffuse enlargement of the pancreas . mri features include pancreatic enlargement with a lobulated contour , lower signal intensity than that of the liver on t1-weighted images , and diffusely increased signal intensity on t2-weighted pulse sequences with heterogeneous enhancement.7,8 in our case , imaging findings were compatible with those of previous western reports . the diagnosis of an extramedullary plasmacytoma is based on evidence of a monoclonal plasma cell tumor outside the bone marrow . in the present case eus - fna has an excellent safety profile regarding the risk of pancreatitis , bleeding , and perforation . major complications have been reported in 2.5% of 355 patients who underwent eus - fna for a solid pancreatic mass.9 potential complications include acute pancreatitis , infection , and sedation - related complications ; no deaths have been reported.10 seeding of the needle track with tumor cells is rare . previous studies reported that the risk of seeding of pancreatic adenocarcinoma via eus - fna is 2.2% , which is low compared with that ( 16.3% ) of ct or transabdominal ultrasonography - guided percutaneous biopsy.11,12 moreover , seeding of a pancreatic extramedullary plasmacytoma during eus - fna is yet to be reported . in conclusion , we safely performed eus - fna in a patient with pancreatic plasmacytoma , and were able to provide an accurate visualization and histopathologic diagnosis . although there are approximately three case reports describing pancreatic involvement of multiple myeloma diagnosed by eus - fna in the english language literature,7,13,14 to the best of our knowledge , this is the first time it is reported in korea .
extramedullary plasmacytoma involves organs outside the bone marrow ; however , involvement of the pancreas is rare . 
 we recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography - guided fine needle aspiration ( eus - fna ) . 
 eus - fna , which has a high diagnostic accuracy and an excellent safety profile , is the modality of choice for establishing tissue diagnosis . 
 we report a case of extramedullary plasmacytoma of the pancreas diagnosed using eus - fna .