Plasmacytoma of the nasopharynx.
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]
(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).
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|Title Annotation:||Imaging Clinic|
|Author:||Sarma, Deba P.|
|Publication:||Ear, Nose and Throat Journal|
|Date:||Oct 1, 2004|
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