Plasmacytoma of the larynx

Multiple myeloma is a neoplastic proliferation of the plasma cells of clonal character producing similar immunoglobulin or part of the immunoglobulin. Multiple myeloma occasionally occurs as solitary, extramedullary plasmacytoma. The location of plasmacytoma in the larynx is extremely rare. We are describing the case of the larynx plasmacytoma diagnosed for a 79 years old female patient. After histopathologic diagnosis of the laryngeal polyp the patient was examined hematologically in great detail aiming at the investigation of myeloma multiplex. No features of multiple myeloma have been found. Now the patient is under strict laryngological and hematological care.     

Solitary plasmacytoma and extramedullary plasmacytoma of the paranasal sinuses and soft palate

Solitary plasmacytoma of the paranasal sinuses are uncommon neoplasms of B lymphocyte origin. They comprise one per cent of all head and neck tumours of the upper respiratory tract. They can be solitary plasmacytomas of the bone (SPB), an extramedullary plasmacytoma or a local manifestation of multiple myeloma. Conversion to multiple myeloma happens more frequently in SPB. Radiotherapy is the common modality of treatment with, or without, adjuvant chemotherapy. Extramedullary plasmacytoma carries a better prognosis than a solitary plasmacytoma of the bone. We report four cases of solitary plasmacytoma of the bone and an extramedullary plasmacytoma of the paranasal sinuses and soft palate.     

Multiple myeloma involving the thyroid cartilage

Multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma constitute a continuous disease spectrum of plasma cell neoplasms. In the larynx, although extramedullary plasmacytoma in the supraglottic region has been sometimes reported, plasma cell neoplasm with involvement of the thyroid cartilage is extremely rare. We report a case of multiple myeloma involving the thyroid cartilage. A 72-year-old male patient presented with a pathological fracture of the cervical vertebrae. CT scan revealed low-density areas within the thyroid cartilage, but the laryngeal mucosa and submucosal soft tissue were intact. Multiple myeloma was diagnosed, since the tumors in the thyroid cartilage and cervical vertebrae revealed plasmacytoma. Because no other lesion was found, irradiation of the larynx and cervical vertebrae was performed. Neither aggressive change of these lesions nor new lesions have been found over 3-year follow-up following the initial treatment without adjuvant therapy.     

An indolent course of multiple myeloma mimicking a solitary thyroid cartilage plasmacytoma

Multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma constitute a continuum of a disease spectrum, which is called plasma cell neoplasms. These three entities can not be differentiated from each other on a histological basis and, for this reason, clinical evaluation is important in their differential diagnoses. Differential diagnosis guides the proper planning of treatment and helps in estimation of survival. Multiple myeloma located within the larynx is very rare. Because of its rarity, any established diagnostic and treatment criteria do not exist. In this report, a case of laryngeal multiple myeloma is presented for its extraordinary presentation and also for educational purposes. Received: 25 April 2001 / Accepted: 5 July 2001     

Extramedullary plasmacytoma of the larynx presenting with upper airway obstruction in a patient with long-standing IgD myeloma

A rare case of upper airway obstruction due to an extramedullary plasmacytoma of the larynx in a patient with long-standing IgD myeloma is presented. Reports of patients with extramedullary plasmacytomas eventually developing multiple myeloma are common, however, the converse appears to be an extremely rare event. Attention is drawn to the problem of acquiring adequate tissue for diagnostic purposes as well as the use of immunohistochemical staining techniques. The patient required an urgent tracheostomy and was treated with radiotherapy.     

Plasmacytoma of the mastoid bone: solitary and systemic

Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a non-specific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.     

Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey

IntroductionSolitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma.ObjectiveTo carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects.MethodsA search of clinical case reports was performed in the PubMed database using Mesh Terms related to “plasmacytoma” under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits.ResultsOf the 216 articles found, only 21 articles met the pre-established inclusion criteria.ConclusionThe occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.     

Subglottic plasmacytoma: diagnosis and prognosis

A subglottic primary extramedullary plasmacytoma (typ IgA-Lambda) of the larynx is reported. These tumours are very rare. The diagnosis is made more difficult by unspecific symptoms and can only be confirmed by histopathology. Early diagnosis and differentiation between primary extramedullary plasmacytoma and metastasis from a multiple myeloma are very important for the prognosis of the disease. Whether immunology can help to solve this problem is still doubtful: few cases have so far been examined by this method. Paraproteins are often not secreted in extramedullary plasmacytoma; the peroxidase-anti-peroxidase method is therefore helpful for classification of the tumour.     

Extramedullary plasmacytoma of the larynx: a case report from Japan

Laryngeal plasmacytoma is rare in Japan; to the best of our knowledge, only 8 other cases have been previously reported. We report a new case of extramedullary plasmacytoma of the larynx in a 76-year-old Japanese woman. Immunohistochemical investigation revealed that her disease had not progressed to multiple myeloma. The patient declined radiotherapy, and her condition remained stable at the 6-month follow-up.     

Osteosclerotic plasmacytoma of maxillary bone (orbital floor)

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma and extramedullary plasmacytoma. They are usually considered as osteolytic lesions of bone except for the rare occurrence of osteosclerotic lesions. This paper describes the first reported osteosclerotic plasmacytoma of the maxillary bone and orbital floor. The difficulties in establishing a diagnosis and the relationship to other plasma cell neoplasms are discussed. Osteosclerotic plasmacytomas are a rare variant of plasma cell tumors which usually produce osteolytic lesions rather than bony sclerosis. Sixty-eight patients with the osteosclerotic variant have appeared in the world literature, with an overall incidence of about 1 per cent in a large series of plasma cell neoplasms (Dreidger and Pruzanski, 1979). There have been only six previous cases of solitary osteosclerotic plasmacytomas reported (Morley and Schweiger, 1964; Roberts et al., 1974; Rodriguez et al. 1976; Rushton, 1965; Schneinker, 1938; Brigham Medical Review, 1961) involving spine, sternum, or rib. None have previously been reported in the head and neck area. Plasma cell tumors have been classified into multiple myeloma, solitary plasmacytomas of bone, and extramedullary plasmacytomas. Multiple myeloma is a disseminated plasma cell malignancy characterized by the production of homogeneous immunoglobulins (whole or fragments) which appear in the serum and urine. Plasma cell tumors can also occur as solitary plasmacytomas, usually in bone, but also in soft tissue. With time, most solitary plasmacytomas develop disseminated disease with all the characteristics of multiple myeloma (Wiltshaw, 1976). Extramedullary plasmacytomas arise in soft tissue rather than bone, and primarily occur in the head and neck region. Clinically, they remain localized and less frequently develop into disseminated myeloma.     

Plasmacytoma in nasal cavity and maxillary sinus

Summary The interrelationship of extramedullary plasmacytoma (EMP), solitary myeloma of bone (SMB), and multiple myeloma (MM) is unknown. Some authors think that they represent no more than a spectrum of plasma cell tumors; others think that they are completely different entities.We have encountered three cases of plasmacytoma in the head and neck region in the past 5 years. One was present in the nasal cavity and the other two in the maxillary sinus. The former seemed to be secondary to an EMP of 10 years' duration and the latter two, secondary to a MM of 1 or 2 years' duration.We compared these cases clinically and concluded that the plasmacytoma in the nasal cavity was a transitional form of EMP to MM and was responsive to radiation and surgery just as ordinary EMPs occurring in the head and neck region were. The other plasmacytomas in the maxillary sinus appeared secondary to the MM and were not responsive to any treatment.From these facts, the plasmacytoma occurring in the head and neck region secondary to an EMP elsewhere should be treated locally and differently from those originating from MM for which systemic treatment should be started from the beginning.     

Head and Neck Manifestations of Plasma Cell Neoplasms

Multiple myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma are plasma cell neoplasms. They represent distinct manifestations of a disease continuum, whereby the clinical findings are critical to diagnosis. Plasma cell neoplasms are histologically similar, and distinguishing one from the other has significant implications for treatment and survival. Plasma cell neoplasms are relatively unusual malignancies of the head and neck region. We present a case series of plasma cell neoplasms involving the skull base, paranasal sinus, larynx, and mandible as an introduction to a complete review of the literature on plasma cell neoplasms of the head and neck area.     

Multiple myeloma presenting as stridor: A case report

Extrame dullary plasmacytoma of larynx is extremely rare. We report a case of multiple myeloma which presented as extrame dullary manifestation in larynx. The rarity of incidence and difficulty in diagnosis of the disease is discussed.     

Plasmacytoma of the temporal bone: management with a combination of surgery and radiotherapy

The diagnosis of solitary plasma cell neoplasm is based on clinical, radiological and laboratory findings and it can be accepted as the precursor lesion of multiple myeloma as spread of disease occurs in 30-50% of affected patients. However, solitary plasmacytoma of the temporal bone is a rare pathology. We present an interesting case of plasmacytoma of the temporal bone which was controlled by a combination of surgery and radiotherapy.     

Plasmacytoma of the Temporal Bone: Management with a Combination of Surgery and Radiotherapy

The diagnosis of solitary plasma cell neoplasm is based on clinical, radiological and laboratory findings and it can be accepted as the precursor lesion of multiple myeloma as spread of disease occurs in 30-50% of affected patients. However, solitary plasmacytoma of the temporal bone is a rare pathology. We present an interesting case of plasmacytoma of the temporal bone which was controlled by a combination of surgery and radiotherapy.     

Endodermal sinus tumor (yolk sac tumor) of the temporal bone: an exotic disease for otorhinolaryngologists and head and neck surgeons

A case of solitary extramedullary plasmacytoma of the left pterygoid fossa is presented, which is an unusual location for such tumors. A 54-year-old male patient was admitted for retro-orbital and left-sided facial pain which had persisted for several months. Physical, nasal endoscopic and optic examinations showed no abnormalities. No palpable cervical lymph nodes were found. MRI revealed a 2-cm mass in the left pterygoid fossa. A biopsy was carried out and the resulting histological evaluation of the mass confirmed a plasmacytoma. A comprehensive work-up, including bone marrow biopsy, total-body skeletal survey, technetium scintigrams, determination of urine Bence-Jones protein and serum myeloma protein, chest radiograph, total blood count and urinalysis, was carried out in order to rule out multiple myeloma. All of these studies were unremarkable in terms of a systemic disease and therefore the patient was diagnosed as having a solitary extramedullary plasmacytoma of the pterygoid fossa. He was referred for radiation therapy, receiving irradiation of 50 Gy for 6 weeks. The clinical manifestations, imaging findings, pathology and treatment procedures of extramedullary plasmacytoma are described, together with a review of the literature.     

Solitary extramedullary plasmacytoma arising in the pterygoid fossa

A case of solitary extramedullary plasmacytoma of the left pterygoid fossa is presented, which is an unusual location for such tumors. A 54-year-old male patient was admitted for retro-orbital and left-sided facial pain which had persisted for several months. Physical, nasal endoscopic and optic examinations showed no abnormalities. No palpable cervical lymph nodes were found. MRI revealed a 2-cm mass in the left pterygoid fossa. A biopsy was carried out and the resulting histological evaluation of the mass confirmed a plasmacytoma. A comprehensive work-up, including bone marrow biopsy, total-body skeletal survey, technetium scintigrams, determination of urine Bence-Jones protein and serum myeloma protein, chest radiograph, total blood count and urinalysis, was carried out in order to rule out multiple myeloma. All of these studies were unremarkable in terms of a systemic disease and therefore the patient was diagnosed as having a solitary extramedullary plasmacytoma of the pterygoid fossa. He was referred for radiation therapy, receiving irradiation of 50 Gy for 6 weeks. The clinical manifestations, imaging findings, pathology and treatment procedures of extramedullary plasmacytoma are described, together with a review of the literature.     

Plasmacytoma and upper airway obstruction.

Extramedullary plasmacytomas are hematologic malignancies that occur primarily in the head and neck region. They usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses and present as soft tissue masses, but have not been previously reported to cause airway obstruction. In general, detection of plasmacytoma antedates the eventual development of the systemic hematologic malignancy, multiple myeloma, by months or years. We describe a unique case of acute upper respiratory tract obstruction secondary to compression by an extramedullary plasmacytoma occurring in the neck of a patient with history of long-standing multiple myeloma. Upper airway obstruction may be a manifestation of untreated plasmacytoma. It is imperative for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision, as well as radiation therapy, for plasmacytomas can be curative in patients without underlying overt plasma cell dyscrasias.     

Extramedullary solitary plasmacytoma of the head and neck. A clinicopathological study.

Monoclonal extramedullary plasmacytoma (EMP) is a rare, low-grade lymphoma found predominantly in the head and neck region. Only since the introduction of immunophenotyping techniques 2 decades ago has it been possible to differentiate EMP from benign polyclonal plasma cell proliferation. The purpose of this study was to trace the evolutionary profile of the disease under consideration of monoclonality assessment. The records of 24 patients with morphologically diagnosed EMP treated in a single institution underwent clinical and pathological review. Only 14 patients had true monoclonal plasmacytoma. No EMP-related deaths occurred. Two patients had local recurrence, and 2 patients developed multiple myeloma. Review of the literature confirms the low-grade malignancy of EMP. Diagnostic procedures must exclude benign polyclonal plasmacytoma, multiple myeloma, and solitary bone plasmacytoma. The slow natural progression of the disease and the rarity of secondary multiple myeloma favor nonmutilating local surgery whenever possible to avoid the long-term sequelae of radiotherapy.     

Extramedullary plasmacytomas of the larynx and parapharyngeal space: imaging and pathologic features

Extramedullary plasmacytoma is a rare plasma cell neoplasm that can occur in the head and neck. In this article we describe a case of multiple synchronous extramedullary plasmacytomas involving the upper airway, pharynx, and larynx. The clinical, imaging, and pathologic features of this neoplasm are discussed, together with potential treatment options.