Plasmacytoma of the nasopharynx.

Extramedullary plasmacytomas are rare neoplastic lesions that may appear in the head and neck. They are characterized by monoclonal proliferation of plasma cells. These lesions account for 4% of all nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx, and they represent 0.4% of all head and neck malignancies. Approximately 80% of extramedullary plasmacytomas are localized in the submucosa of the upper respiratory tract. (1) They usually occur in patients between 50 and 60 years of age, and they are more common in men. (2) The most common locations in the head and neck are probably the nasal cavity and the nasal septum? Other sites are the nasopharynx, maxillary sinus, thyroid gland, soft tissues of the anterior cervical region, parotid gland, tonsil, oropharynx, larynx, orbit, and choroids of the eye and eyelid. Cases of solitary bone plasmacytoma have been reported in the sphenoid bone, mastoid, calvaria and skull vault, hyoid bone, temporomandibular joint, maxilla, and mandible. (4)

The clinical manifestations of extramedullary plasmacytoma of the upper respiratory and digestive tracts can be multiple or associated with symptoms of multiple myeloma from its initial presentation. It can also antedate the eventual development of multiple myeloma months or years later.

We evaluated a 71-year-old man who had a long-term history of diabetes mellitus, diabetic neuropathy, and bilateral hearing loss. He also had a 1-year history of rhinorrhea and epistaxis; nasal steroids and antihistamines had not provided any relief. On nasopharyngoscopic examination, we detected a smooth 2-cm mass in the posterior soft palate that partially obstructed the nasopharynx. Computed tomography (CT) revealed the presence of a moderately enhanced mass in the nasopharynx (figure 1).

[FIGURE 1 OMITTED]

On surgical resection, the gray-tan, mucosa-lined mass measured 3.0 x 2.0 x 2.0 cm. A solid, gray-white lesion measuring 1.5 cm was present in the submucosa. Hematoxylin and eosin staining revealed a poorly differentiated malignant neoplasm made up of sheets of small, round, hyperchromatic blue cells with plasmacytoid features (figure 2). Immunohistochemical studies confirmed that the malignant cells were kappa-restricted plasma cells, confirming the diagnosis of plasma cell malignancy. Serum protein levels were normal, and no gammopathy was detected. Our histologic diagnosis of plasmacytoma was confirmed in a consultation with the Armed Forces Institute of Pathology in Washington, D.C. Findings on bone marrow biopsy and on radiographic and nuclear medicine bone surveys were unremarkable. Assays for Bence Jones protein in urine and serum were negative for myeloma. At the 4-month follow-up, the patient exhibited no evidence of recurrence.

[FIGURE 2 OMITTED]

References

(1.) Miller FR, Lavertu P, Wanamaker JR, et al. Plasmacytomas of the head and neck. Otolaryngol Head Neck Surg 1998;119:614-18.

(2.) Paris J, Dessi P, Moulin G, et al. [Extramedullary plasmacytoma of the nasal cavity: A case report]. Rev Laryngol Otol Rhinol 1999; 120: 343-5.

(3.) Gonzalez Aguilar O, Dragosky M, Pardo HA, et al. [Single extramedullary plasmacytoma of the nose]. Acta Otorrinolaringol Esp 2000;51:348-52.

(4.) Courtmans I, Pigeolet Y, Hedayat AH, Vilain J. Upper airways locations of plasmocytoma. Acta Otorhinolaryngol Belg 2000;54: 487-90.

From the Department of Pathology, Louisiana State University VA Medical Center, New Orleans (Dr. Lorusso and Dr. Sarma), and the Department of Radiology, Louisiana State University Health Science Center, New Orleans (Dr. Palacios).