Illustration of ileal plasmacytomas, rare tumors after lymphoma treatment.

Unexplained Tumors After Lymphoma Treatment? What You Need to Know About Ileal Plasmacytomas

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Discover how rare ileal plasmacytomas can emerge post-lymphoma chemoimmunotherapy and what it means for long-term health."

In the realm of cancer treatment, where victories are hard-won, unexpected complications can sometimes emerge, casting shadows on the path to recovery. One such rare and intriguing scenario involves the development of extraosseous plasmacytomas (EPs)—tumors arising outside the bone marrow—in the ileum, a part of the small intestine. This article delves into a fascinating case study that sheds light on this phenomenon, offering valuable insights for patients, caregivers, and healthcare professionals alike.

Extraosseous plasmacytomas are uncommon, typically appearing as solitary growths in the upper airway. However, a recent case highlighted in the Annals of Hematology presents a unique situation: multiple plasmacytomas developing in the ileum of a patient previously treated for diffuse large B cell lymphoma (DLBCL). This unexpected occurrence raises important questions about the long-term effects of chemoimmunotherapy and the potential for secondary malignancies.

We aim to break down this complex case into an accessible format, explaining the key findings, potential implications, and what patients need to know about monitoring their health after lymphoma treatment. By understanding this rare complication, we can empower individuals to be proactive in their care and work closely with their healthcare teams to ensure the best possible outcomes.

The Case: A Closer Look at Ileal Plasmacytomas

Illustration of ileal plasmacytomas, rare tumors after lymphoma treatment.

The patient, a 69-year-old man, had a history of DLBCL and had undergone six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone—a standard chemoimmunotherapy regimen—seven years prior to this new development. Initially, this treatment led to complete remission. However, he began experiencing intermittent diarrhea and appetite loss, prompting further investigation.

Initial laboratory tests revealed elevated lactate dehydrogenase levels and severely decreased albumin and cholesterol levels. Despite these abnormalities, initial endoscopic and imaging studies failed to detect any abdominal lesions. It wasn't until the patient presented with acute abdominal pain three weeks later that emergency surgery revealed the presence of multiple whitish, flat tumors scattered across the ileum, with two perforations.

Surgical Findings: Multiple tumors in the ileum, leading to perforations.
Microscopic Analysis: Tumors composed of lymphoid cells, some resembling plasma cells.
Immunohistochemistry: Abnormal cells expressing CD56, MUM1/IRF4, and kappa light chain.
Genetic Analysis: Rearrangement bands differed from the primary DLBCL, indicating a new clonal origin.

Further analysis confirmed the diagnosis of multicentric ileal plasmacytomas. This diagnosis was supported by immunohistochemical analysis, revealing cells expressing CD56, MUM1/IRF4, and cytoplasmic kappa light chain. Notably, the cells were negative for CD19, CD10, and CD20, which are typically expressed in B-cells. Flow cytometry further confirmed these findings. Genetic analysis, including Southern blot analysis and polymerase chain reaction, revealed that the genetic rearrangements in these tumors differed from those in the original DLBCL, indicating a new and distinct clonal origin.

What Does This Mean for Patients?

This case underscores the importance of long-term monitoring and vigilance following lymphoma treatment. While chemoimmunotherapy is highly effective, it can also have long-term consequences, including the potential for secondary malignancies. Patients should be aware of the signs and symptoms of potential complications, such as persistent gastrointestinal issues, and promptly report any concerns to their healthcare providers. Regular follow-up appointments and appropriate diagnostic testing can help detect any emerging issues early, allowing for timely intervention and improved outcomes. The rarity of ileal plasmacytomas highlights the need for further research to understand the underlying mechanisms and develop strategies for prevention and early detection. If you're experiencing unexplained symptoms after lymphoma treatment, don't hesitate to seek medical advice. Early detection and proper management are key to navigating potential complications.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00277-018-3543-y, Alternate LINK

Title: Locally Distributed Multicentric Plasmacytomas In The Ileum Secondary To Lymphoma Chemoimmunotherapy

Subject: Hematology

Journal: Annals of Hematology

Publisher: Springer Science and Business Media LLC

Authors: Masako Yokoo, Kensuke Kojima, Haruna Sano, Keita Kai, Fumiko Arakawa, Koichi Ohshima, Taketo Matsunaga, Shinya Kimura

Published: 2018-11-08

Everything You Need To Know

What are ileal plasmacytomas and how do they relate to lymphoma treatment?

Ileal plasmacytomas are rare tumors, specifically extraosseous plasmacytomas (EPs), that develop in the ileum, a section of the small intestine. Their connection to lymphoma treatment is that they can emerge as a secondary malignancy following chemoimmunotherapy, a treatment often used for diffuse large B cell lymphoma (DLBCL). The case discussed in the article illustrates this, where a patient developed these tumors years after receiving chemoimmunotherapy for DLBCL, which initially went into remission.

What are the typical signs and symptoms of ileal plasmacytomas and how are they diagnosed?

The case highlights that initial symptoms can include intermittent diarrhea and appetite loss. However, these symptoms can be subtle, and initial diagnostic tests, such as endoscopic and imaging studies, may not immediately detect the tumors. Diagnosis often involves a combination of methods. In the reported case, elevated lactate dehydrogenase levels and decreased albumin and cholesterol levels were noted. Surgical findings of multiple tumors in the ileum, microscopic analysis revealing lymphoid cells, immunohistochemistry showing specific protein expressions (CD56, MUM1/IRF4, and kappa light chain), and genetic analysis to determine clonal origin are crucial for diagnosis.

What specific chemoimmunotherapy regimen was used in the case study, and why is it relevant to the development of ileal plasmacytomas?

The patient in the case study received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. This is a standard chemoimmunotherapy regimen often used to treat diffuse large B cell lymphoma (DLBCL). The relevance lies in the potential long-term effects of this treatment, including the increased risk of secondary malignancies like ileal plasmacytomas. Chemoimmunotherapy, while effective in treating the primary cancer, can sometimes compromise the immune system or cause genetic mutations that increase the likelihood of other cancers developing later on.

How do the genetic characteristics of ileal plasmacytomas differ from the original lymphoma, and what does this imply?

Genetic analysis, including Southern blot analysis and polymerase chain reaction, revealed that the genetic rearrangements in the ileal plasmacytomas differed from the original diffuse large B cell lymphoma (DLBCL). This is significant because it indicates that the ileal plasmacytomas were not a recurrence of the initial lymphoma. Instead, they represented a new and distinct clonal origin. This finding emphasizes that the ileal plasmacytomas are a secondary malignancy triggered by the lymphoma treatment, rather than a return of the primary cancer.

What steps should patients take after lymphoma treatment to monitor their health and detect potential complications like ileal plasmacytomas?

Patients should remain vigilant and be aware of potential long-term complications of chemoimmunotherapy. They should promptly report any persistent gastrointestinal issues or any other concerning symptoms to their healthcare providers. Regular follow-up appointments and appropriate diagnostic testing, such as blood tests and imaging, are crucial for early detection of emerging issues. This approach allows for timely intervention and improved outcomes. The article underscores the need for a proactive approach to care, emphasizing the importance of open communication between patients and their healthcare teams. Understanding the potential risks and being proactive about health monitoring can significantly improve the chances of successful management of any complications.