Pancreatic plasmacytoma with biliary obstruction as a manifestation of multiple myeloma relapse.

is an absence of the classical imaging findings consistent with liver metastases, because of the histological pattern of microinvasion3. The massive sinusoidal infiltration and hepatic vessels obstruction by tumor cells result in ischemia and hypoxic hepatocellular necrosis1,3. We have a short window for investigation since most of these patients die soon after admission4. The diagnosis is frequently made by postmortem liver histology. The majority of neuroendocrine tumors of unknown primary site are poorly differentiated carcinomas with aggressive biology5. These cancers are characterized by multiple sites of metastases and rarely produce symptoms related to secretion of bioactive substances. In addition to the liver, common metastatic sites include bone, lung and brain. Small cell neuroendocrine tumors with metastases, frequently originate in the lungs. Diagnosis of these neuroendocrine tumors depends on immunohistochemical staining for chromogranin and/or synaptophysin.