3 a: Endoscopy showing a large gastric mass attached to lesser curvature having a bleeding surface. rare disease and the precise information concerning its incidence, medical demonstration, and pathological features are unfolding gradually [7]. Main extra ITM2A medullary plasmacytomas of the gastrointestinal tract represents 5% of all extra medullary plasmacytomas [8]. Any section of the gastrointestinal tract may be the site of plasma cell infiltration. The small bowel is the most commonly involved site, followed by belly, colon and esophagus [9]. The most common showing symptoms are abdominal pain and gastrointestinal bleeding. A few case reports of solitary gastric plasmacytomas have been described in literature NVP-231 [10], [11]. A case reported a solitary gastric plasmacytoma inside a 46-year-old male who presented with melena and was treated with partial gastrectomy, progressed to having local recurrence and respiratory obstruction due to large mediastinal deposits after 18 months. Eventually transforming into lambda light chain type multiple myeloma with multiple visceral plasmacytomas within a few months [11]. There is only one case reported in literature of a non-secretory PCL with gastric involvement, where a 49 12 months old male was diagnosed with non-secretory Ig A PPCL, co-expressing CD38 and CD13 on immunophenotyping. He presented with epigastric pain and was found to have multiple submucosal people with ulcerations in the body of the belly on endoscopy. On biopsy confirmed to become gastric involvement by PCL and he NVP-231 eventually died of cerebral hemorrhage [12]. Here we present a case of a 79-year-old Caucasian male who presented with symptomatic anemia, and was diagnosed with an aggressive type of plasma cell leukemia and a large ulcerated and hemorrhagic gastric plasmacytoma. 2.?Case demonstration A 79-year-old Caucasian male with past history of hypertension, prostate malignancy post brachytherapy 10 years prior to demonstration, laminectomy for spinal stenosis 6 months before demonstration, chronic kidney disease stage 3 (CKD-3) due to previous unrecovered acute kidney NVP-231 injury from nonsteroidal anti-inflammatory medicines postoperatively presented with 2 weeks of worsening shortness of breath and 3 days of ideal sided chest pain. On further questioning he endorsed having night time sweats for 6 months, anorexia for one month but refused any weight loss. He lived only and performed activities of daily living individually with a good overall performance status. His vital indicators were within normal limits and were maintaining normal oxygen saturation on room air. Physical exam was unremarkable except for splenomegaly. On labs he was found to have hemoglobin of 9.9?g/dl, white blood cell count of 23.3 109/L and a platelet count of 45 109/L. Around the differential the lymphocytes were found to be predominating being 75.9% and neutrophils found to be only 20.4% of the whole white blood cell count. On reviewing aged labs his white blood cell count with differential and platelet count were normal 3 weeks prior to this presentation. He had persistent normocytic normochromic anemia with elevated red cell distribution width for 1.5 years without any additional work up performed. Comprehensive metabolic panel showed a calcium of 13.9?mg/dL (last normal being 3 weeks ago), creatinine of 3.34 (baseline being 1.8C2). Other labs included an undetectable prostate specific antigen, uric acid of 11.5?mg/dl, normal phosphorus and potassium. Computed tomography (CT) chest was done without contrast to evaluate the dyspnea which showed an enlarged spleen, lymph nodes in the gastrohepatic ligament measuring 2.8 1.8?cm and 8?mm to 1 1.5?cm lung nodules. Further work up of the above findings was pursued. Peripheral blood smear showed atypical lymphoplasmacytoid cells being 20%, some rare blasts with no evidence of hemolysis (Fig. 1a). Flow cytometry revealed 30% kappa light chain-restricted plasma cells that were CD45+ (partial), CD38+ and CD138+. They were unfavorable for CD19 and lambda. Regarding his anemia work up he had normal levels of vitamin B12, folate, haptoglobin, elevated LDH of 483 U/L, elevated ferritin, low transferrin and reticulocyte index was 0.21 showing a combination of anemia of chronic disease and hypoproliferative bone marrow. The bone marrow revealed 80% cellularity with markedly decreased erythroid, myeloid and megakaryocytic cell lines. It showed numerous circulating atypical plasma cells and plasmablasts ( 50%)(Fig. 1b). Urine 24?h protein electrophoresis showed a gamma M-spike of 53% and on immunofixation showed kappa chains. Urine protein/creatinine ratio was 4855.42. Total serum protein was.