Extramedullary Plasmacytoma of the Paranasal Sinuses: Combining Surgery with External Radiotherapy

Extramedullary plasmacytomas (EMP) are rare neoplasms characterized by the proliferation of a single B-lymphoid cell clone, arising primarily in the head and neck region. The purpose of this study is to report our experience in the management of EMPs arising in the paranasal sinuses. We retrospectively reviewed clinical records of 7 patients (4 men and 3 women), admitted between 1995 and 2010 for EMPs of the paranasal sinuses—5 within the ethmoid and 2 in the maxillary sinus. Treatment consisted in endoscopic resection followed by external RT. The mean follow-up period is 50 months (range 9–67 months). Local recurrences developed in 2 out of 7 cases. Both recurrences occurred in maxillary EMPs and they underwent salvage treatment—combination of RT and surgery. At the time of analyzing these data 5 patients (70 %) were alive and two (30 %) have died of their disease. A single patient, presenting local relapse at 6 months, died due to the disease at 9 months. One patient progressed to multiple myeloma. Larger controlled clinical trials are necessary to establish an optimal treatment of choice that implies an individualized management of these patients.     

Early extramedullary plasmacytoma confined to the lamina propria of the gastric mucosa: case report.

A case of early gastric plasmacytoma in a 51-year-old woman is reported. The demonstration of monotypic IgM-kappa immunoglobulin in biopsy specimens by an immunoperoxidase technique contributed to the histological diagnosis. The patient had non-ulcerative lesions (of approximately 15 x 16 cm) of a superficially spreading type of gastric plasmacytoma. Extensive histological analysis of the resected stomach showed the IgM-kappa monoclonal proliferation of plasmacytic tumor cells to infiltrate merely into the lamina propria of the gastric mucosa and not to extend deeply into the submucosa, proper muscle and serosa of the stomach.     

Plasmacytoma of the parotid gland

Extramedullary plasmacytoma of the parotid gland is an extremely rare lesion of which there have been only four other reported cases. The importance of these lesions rests in the possibility of their being a harbinger of multiple myeloma or their subsequent transformation to multiple myeloma. Because of its extreme rarity, the proper management remains unclear.     

50例孤立性浆细胞瘤临床分析

目的对孤立性浆细胞瘤(SP)的特点和预后因素进行回顾性分析,以帮助临床诊断、治疗及对预后的判断。方法入组50例SP患者,并对其进行随访,应用Kaplan-Meier法对其临床特点、治疗及预后因素进行回顾性分析。结果髓外浆细胞瘤(EMP)组与骨孤立性浆细胞瘤(SPB)组、放疗组与未放疗组、年龄﹤60岁与年龄≥60岁组的log rank检验结果提示,生存曲线差异均无统计学意义(P均>0.05)。50例SP患者与168例多发性骨髓瘤(MM)患者的生存曲线差异有统计学意义(P<0.05)。结论 SP患者中,EMP与SPB的生存状况无明显差异,SP好发于中老年人,预后较好,部分可转化为MM。     

骨孤立性浆细胞瘤的影像学表现

目的分析不同部位骨孤立性浆细胞瘤的X线、CT和MRI表现,进一步认识与提高骨孤立性浆细胞瘤的诊断准确率。方法回顾性分析12例经临床病理证实的发生于椎体、肱骨、肋骨的孤立性浆细胞瘤病例,总结分析其影像学表现。结果12例孤立性浆细胞瘤为肋骨3例、胸椎6例、肱骨3例,其中1例肱骨发生病理性骨折。X线及CT表现为穿凿样溶骨性骨质破坏、膨胀性生长,边界较清,其中1例骨皮质增厚、硬化,所有均未见明显骨膜反应。与肌肉信号相比,MRI在T1WI表现为稍低信号,T2WI表现为高信号,所有均未见瘤周水肿,但可见不同程度的软组织浸润,5例可见软组织肿块形成,增强明显强化。结论X线平片对骨孤立性浆细胞瘤的诊断敏感度较低;CT能清晰显示瘤体内增厚的骨嵴或残存的骨质;MRI可明确髓腔内外病变与周围软组织的关系。平片、CT和MRI三者联合综合评价有助于提高骨孤立性浆细胞瘤的诊断准确性。     

原发睾丸恶性淋巴瘤：（附13例报告）

自1977～1988年我院共收治13例原发睾丸恶性淋巴瘤,占同期睾丸恶性肿瘤的11.5％。本病少见,大部分发生在50岁以上。本文50岁以上者10例,约占80％。此病预后差,本文11侧2年内死亡,占85％。5年生存率仅为15％。本文5例术后辅以放、化疗,8例术后单纯化疗,两者生存期无明显差异,故我们认为手术 化疗为本病的首选治疗方案。     

Extramedullary plasmacytoma presented as a non-functional invasive pituitary macro-adenoma

Pituitary adenomas are the most common etiology of sellar masses. Intra-sellar plasmacytomas are rare causes of sellar tumors of non-pituitary origin and may mimic non-functional pituitary adenomas clinically and radiologically. We report an uncommon case of an intrasellar plasmacytoma presenting as the only manifestation of multiple myeloma.     

Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma

Background: A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP),but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities inthe management of SP. Materials and Methods: Data from 38 consecutive patients with solitary plasmacytoma,including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed.15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiationdose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS),multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) werecalculated and outcomes of different therapies were compared. Results: The median follow-up time was 55months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariateanalysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) andOS (100% vs 70%, p=0.041). Conclusions: Radiotherapy alone can be considered as a more effective treatmentfor SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires furtherstudy.     

Synchronous occurrence of extramedullary plasmacytoma and squamous cell carcinoma in situ in the larynx: a case report

Extramedullary plasmacytoma of the larynx is rare, especially when coexisted with squamous cell carcinoma in situ. We report a 56-year-old woman with hoarseness for 6 months and dysphonia for a week. Fiberoptic laryngoscopic examination showed a red, smooth-surface swelling in the submucous region of the left ventricle and ventricular band of the larynx. The patient underwent vertical laryngectomy and modified left neck dissection. Postoperative pathologic examination revealed coexisting plasmacytoma and ca...     

10例头颈部髓外浆细胞瘤的临床分析及文献复习

背景与目的:髓外浆细胞瘤(extramedullary plasmacytoma,EMP)为一种罕见肿瘤,主要发生在头颈部,约80%的EMP发生于上呼吸道及上消化道。在临床表现和病理学上,该肿瘤极易与头颈部常见的一些肿瘤相混淆。本研究通过回顾性分析,探讨头颈部髓外浆细胞瘤的临床特点及其诊断及治疗。方法:回顾分析我院1977年1月～2003年12月期间收治的10例头颈部髓外浆细胞瘤患者的资料,全组10例患者中,单纯手术治疗2例、手术加辅助放疗2例、根治性放疗5例(其中1例于放疗后行辅助化疗),1例未治疗。结果:临床表现主要表现为局部肿物及其引起的相应症状。本组患者所有病例均经病理学诊断为浆细胞瘤,3例行免疫组化检测IgG,1例为λ型,2例为κ型。6例检测过尿本周蛋白均为阴性;4例检测过M蛋白,均为阴性;4例骨髓穿刺均未见异常;4例全身骨X线检查均正常。末次随访2004年5月,随访率90%,6例无瘤生存的患者中有5例无瘤生存时间超过1年(其中3例超过15年);死亡3例;失访1例。结论:EMP的诊断主要依靠临床表现和病理;放疗和手术是治疗头颈部髓外浆细胞瘤的主要手段。     

睾丸恶性淋巴瘤12例临床分析

目的 探讨睾丸恶性淋巴瘤的诊治经验，以提高患者生存率。方法 对12例睾丸恶性淋巴瘤患者的临床资料进行分析。结果 该病的主要临床特点为无痛性睾丸肿大，确诊后行根治性睾丸切除术及放化疗，化疗方案以CHOP、CHOP—B、CHOP-E和HEPP为主。结论 该病恶性程度高，预后差，应积极进行综合治疗，以提高患者生存率。     

Plasmacytoma of Bronchus Treated by Radical Radiotherapy-A Rare Case with Four and a Half Years Follow up

Plasmacytoma of the bronchus is a very rare plasma cell neoplasm affecting the bronchus. Here we report a case of plasmacytoma of the bronchus treated by radical radiotherapy in July 2002. The tumor responded very well to treatment and showed a slow but sustained regression in the size over two years. Presently, he has completed four and a half years of follow-up and is free of disease.     

Sonographic Appearance of Hepatic Hydatid Disease

The sonographic appearance of 25 proved cases of hepatic hydatid disease was characterized and correlated with surgical and pathologic findings. Sonography has a very high accuracy in detecting the type, size, number and location of hepatic hydatid cysts. It also indicates whether they are live (Type I, IR, II) or dead (Type HI). The presence of hydatid cysts in the rest of peritoneal cavity and their complications can also be detected. It is of immense help in the selection of cases in which urgent surgery is needed e.g. contained (Type IR), communicating and direct rupture of hydatid cysts. When hydatid cysts are infected, they lose their characteristic sonographic appearance and become hyperechoic. This article details the findings and emphasize the criteria for recognizing hepatic hydatid disease.     

浆细胞骨髓瘤CD56表达的临床病理及预后意义

目的CD56在浆细胞骨髓瘤(PCM)中的表达及其临床病理和预后提示意义.方法选取浆细胞骨髓瘤22例为研究对象,同时选取原发的髓外浆细胞瘤(EMP)3例和反应性浆细胞增生5例进行对比研究.S-P免疫组化染色方法检测CD56在不同病变中的表达.结果反应性浆细胞增生及原发的EMP中均无CD56表达,而9例(41%)PCM CD56+.CD56+患者的整体生存时间和无疾病生存时间长于CD56-者(1og-rank检验,P＜0.05).CD56表达与患者年龄、临床分期和组织学分级均无相关性(P＜0.05).结论CD56是PCM较常见、较特异的一个免疫表型,但不能将其作为确定PCM中具独特临床病理学特点亚群的标记,只是PCM的一个预后提示因子.此外,CD56可能是鉴别原发EMP和PCM髓外浸润的一个有意义的标记.     

两性腺原发性淋巴瘤26例临床病理分析

目的: 探讨发生在睾丸、卵巢的原发性淋巴瘤的临床病理形态特点、临床分期和预后的关系。 方法: 对21例原发性睾丸恶性淋巴瘤、5例卵巢原发性恶性淋巴瘤进行组织形态学和免疫组织化学染色观察,依据WHO新分类进行分型,Ann Arber(1971)国际分期法进行临床分期并结合文献对其临床病理特点及随访资料进行分析。 结果: 睾丸恶性淋巴瘤平均好发于60～70岁,随访21例患者中,弥漫大B细胞性淋巴瘤13例,中位生存期35.2个月,5年生存率38.5%;T细胞性淋巴瘤5例,中位生存期18.6个月,2年生存率40.0%,无5年生存率。B小淋巴细胞性淋巴瘤1例及淋巴浆细胞样淋巴瘤2例,5年生存率100%。就诊时病程处于Ⅰ期8例,中位生存期75.1个月。Ⅱ期8例,中位生存期36.5个月。Ⅲ、Ⅳ期5例,中位生存期8个月。卵巢原发性恶性淋巴瘤少见,病情进展迅速预后差。本组5例均为B细胞性淋巴瘤,其中小淋巴细胞性3例,淋巴浆细胞样淋巴瘤2例,Ⅰ期1例,Ⅱ期2例,Ⅲ期2例,其中2例失访,随诊3例均于1年内死亡。 结论: 睾丸原发性恶性淋巴瘤预后与临床分期、组织学分型关系密切,术后放、化疗有利于提高患者生存率,卵巢原发性恶性淋巴瘤预后差。     

Sonographic Evaluation of Chest Masses in Children

The sonographic appearances of 12 intrathoracic masses in children are presented. Seven out of 12 masses were malignant and presented with opaque hemithorax on chest X-ray. Different types of masses encountered were: Lymphoma, Neuroblastoma, Ewing's sarcoma, metastatic Ewing's sarcoma, Teratocarcinoma, Pseudotumor of the lung, Neuroenteric duplication cyst, Bronchogenic cyst and tubercular mediastinal lymph nodes.