Plasma cell leukemia presenting as a pancreatic mass

A 62-year-old woman presented with a 3-week history of obstructive jaundice. Computed tomography of the abdomen showed marked enlargement of the head of the pancreas and a prominent pancreatic body, suggestive of a neoplasm with associated pancreatitis. The peripheral blood showed an increased number of plasma cells accounting for 50% of the leukocytes. Biopsy specimens of the pancreas, liver, and a peritoneal lymph node showed a diffuse infiltrate of typical and atypical plasma cells (50% of which had cytoplasmic IgG-lambda). Serum and urine protein electrophoresis revealed a monoclonal IgG-lambda spike and Bence Jones-lambda protein, respectively. The bone marrow was diffusely infiltrated by plasma cells. To our knowledge, this is the first reported case of a plasma cell leukemia presenting as a pancreatic mass producing extrahepatic biliary obstruction.