Head and neck manifestations of plasma cell neoplasms

Solitary plasmacytoma of the skull base: A case report and literature review

Plasmacytoma of the skull base is a rare entity. We present a case of sphenoid plasmacytoma in a 51-year-old woman who had nasal obstruction, intermittent epistaxis, headaches, decreasing visual acuity, and diplopia. Computed Tomography (CT) scan and magnetic resonance imaging (MRI) showed a large heterogeneous, expansile lesion measuring 75 mm × 54 mm, centered on the sphenoidal bone and the clivus. Biopsy confirmed the diagnosis of solitary plasmacytoma after ruling out systemic spread by the initial assessment. The patient was successfully managed by external beam radiotherapy and a complete response was obtained after 12 months of follow-up.

Plasmacytoma of the Head and Neck: Case Series and Review of the Literature

Solitary plasmacytoma is a rare neoplasm characterized by localized proliferation of monoclonal plasma cells and is classified as solitary bone or solitary extramedullary plasmacytoma. Here, we present two rare cases of plasmacytoma of the head and neck. The first is a 78-year-old male who presented with a 3-month history of epistaxis and progressive obstruction of the right nasal passage. Computerized tomography (CT) imaging revealed a mass in the right nasal cavity with destruction to the maxillary sinus. An excisional biopsy was performed revealing anaplastic plasmacytoma. The second is a 64-year-old male with a past medical history significant for prostate cancer who presented with a 2-month history of left ear pain and progressive non-tender temporal swelling. A PET/CT revealed a highly avid, destructive, and lytic left temporal mass with no other evidence of distant disease. A left temporal craniectomy and infratemporal fossa dissection revealed plasma cell dyscrasia with monoclonal lambda in situ hybridization. Although plasmacytomas are uncommon tumors of the head and neck, they may mimic other entities that require different treatment. Prompt and accurate diagnosis is critical for appropriate therapeutic decisions and prognosis.

Fine-needle aspiration cytology for the diagnosis of plasma cell neoplasms in the head and neck region: A systematic analysis of the literature

BACKGROUND

Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions.

AIMS

To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region.

MATERIALS AND METHODS

Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies.

RESULTS

A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%.

CONCLUSION

This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

A Case of Synchronous Multiple Primary Malignancies Involving Multiple Myeloma and Pharyngeal Plasmacytoma in an Elderly Male: A Case Report and Review of the Literature

Monoclonal plasma cells form the solitary neoplasm known as solitary plasmacytoma. Isolated extramedullary plasmacytoma is less common than solitary bone plasmacytoma. An elderly male presented with coughing blood and was diagnosed with pharyngeal plasmacytoma with synchronous multiple myeloma. Herein, we present this challengingly rare case to increase awareness of this unusual entity.

Solitary Extramedullary Plasmacytoma of the Larynx and Secondary Laryngeal Involvement in Plasma Cell Myeloma: Single-Centre Retrospective Analysis and Systematic Literature Review

The involvement of the larynx in plasma cell myeloma (PCM) may manifest as solitary extramedullary plasmacytoma of the larynx (sEMP-L) or as infiltration of the larynx during newly diagnosed or relapsed systemic disease with bone marrow involvement (plasma cell myeloma with laryngeal involvement, PCM-L). To increase knowledge about these rare conditions, we performed a retrospective analysis along with a comprehensive literature review of cases of sEMP-L or PCM-L. Six patients (two sEMP-L and four PCM-L) were identified in our tertiary laryngological centre from 2009 to 2021, constituting 0.88% of all malignant laryngeal tumours. The literature search yielded 187 cases, including 152 sEMP-L and 35 sPCM-L. A comparison of baseline characteristics between sEMP-L and PCM-L performed in the combined cohort of cases from literature review and retrospective analysis revealed that patients with sEMP-L were younger (56 vs. 64 years, p ≤ 0.001) and presented less commonly with thyroid or cricoid cartilage involvement (2.2% vs. 30.8%, p ≤ 0.001). The prognosis of sEMP-L was better than PCM-L (overall survival 86% vs. 55% at 5 years, p = 0.002). Analysis of potential factors that could influence progression-free survival (PFS) in the group of sEMP-L revealed that male sex and cartilage involvement negatively affected PFS in univariate analyses, while only cartilage involvement retained statistical significance in multivariate analysis (HR = 19.94, p = 0.024). In conclusion, PCM with laryngeal involvement is sporadic. Secondary involvement of the larynx during PCM might be more common than sEMP-L and is associated with worse survival. The involvement of cartilage adversely influences the outcome of sEMP-L.

A rare case of Epstein-Barr virus-positive anaplastic plasmacytoma in the sinonasal tract

Epstein-Barr virus-positive anaplastic plasmacytoma in the sinonasal tract is uncommon. Herein, we present the case of a 40-year-old male patient with a right sinonasal tract filled with a soft tissue mass, as shown on CT. Apart from frequent nosebleeds, he did not report any specific sinonasal symptoms, such as nasal obstruction, discharge, or loss of smell. The patient underwent functional endoscopic sinus surgery under general anesthesia. The diagnosis of Epstein-Barr virus-positive anaplastic plasmacytoma was confirmed by lesion biopsy, subsequent immunohistochemical staining, and in situ hybridization.

Case Report: Plasmacytoma of External Urethral Meatus

RATIONALE

Extramedullary plasmacytoma (EMP) can occur in various parts of the body. It is generally accepted that the highest site of occurrence is the head and neck region (80% to 90%), followed by the gastrointestinal tract and the skin. It is worth mentioning that the site of disease, in this case, was the urethral meatus, which is extremely rare in clinical practice.

PATIENT CONCERNS

A 50-year-old female complained of an episode of painless gross hematuria without symptoms of frequent urination, urgency, abdominal pain, abdominal distension, fever, or oliguria. The patient has no history of smoking or drinking and denied any family history of solid malignancy or hematological disease.

DIAGNOSIS AND INTERVENTIONS

Urethrocystoscopy revealed urethral polypoid hyperplasia, which we initially thought could be a urethral caruncle. The patient was asked to undergo caruncle resection after 1 week of potassium permanganate sitz bath, and postoperative pathology revealed plasmacytoma. After that, a whole-body MRI showed no other lesions. She received postoperative radiotherapy.

OUTCOMES

During radiotherapy, the patient's condition and appetite were fair, and the skin mucositis was I°. Pelvic contrast-enhanced MRI and whole-body PET-CT 6 months after urethral meatus lumpectomy and radiotherapy showed changes without obvious abnormal signs. No recurrence or metastasis was detected after one year of follow-up.

LESSONS

Urinary EMP is a rare disease. It is not easy to diagnose due to its rare site of occurrence and non-specific symptoms. The diagnosis of EMP requires a combination of imaging studies and pathological findings. Currently, surgery combined with radiotherapy or radiotherapy alone is the mainstay treatment and usually results in an acceptable local control rate. At the same time, chemotherapy cannot be ignored.

Cauda Equina Syndrome as the Initial Presentation of Concurrent Plasmacytoma and Multiple Myeloma

Multiple myeloma is a hematological malignancy characterized by an abnormal proliferation of monoclonal plasma cells. In some occurrences, plasma cell proliferation results in a solitary lesion (solitary bone plasmacytoma or extramedullary plasmacytoma with minimal bone marrow involvement). Approximately 50% of patients with solitary plasmacytoma develop multiple myeloma within 10 years after the initial diagnosis. While back pain and compression fractures are commonly described presentations of multiple myeloma and plasmacytoma, cauda equina syndrome related to plasma cell infiltration is rare and clinical guidelines are limited. Herein, we present a rare case of a woman with acute cauda equina syndrome (CES) secondary to solitary bone plasmacytoma and multiple myeloma.

The Importance of Alliance between Hematologists and Dentists: A Retrospective Study on the Development of Bisphosphonates Osteonecrosis of the Jaws (Bronj) in Multiple Myeloma Patients

(1) Background: Multiple myeloma is a rare cancer that primarily affects the bone marrow. Osteoclasts are responsible for increased bone resorption and, therefore, bone destruction. Bisphosphonates are a class of drugs that can slow down bone resorption by reducing the number and action of osteoclasts. Intravenous injections of bisphosphonates (generally Zoledronic Acid) are administered to patients affected by Multiple Myeloma, but BRONJ is described as a serious side effect. This 5-year retrospective study aims to evaluate the efficacy of appropriate dental treatment protocols prior to initiating bisphosphonate therapy to prevent the development of BRONJ. (2) Methods: A total of 99 patients with symptomatic multiple myeloma were involved in this study (41-90 years, mean age 65 years, standard deviation 5 years). The data relating to the visits were tracked using a specific server and consulting the clinical reports. The AAOMS (American Association of Oral and Maxillofacial Surgeons) position was applied for both diagnosis and treatment. A total of 79 patients were examined before the administration of bisphosphonates (group A) and 20 after (group B). (3) Results: The entire sample required dental treatment: 23.2% underwent restorative therapy, 8% endodontic treatments, 44.4% tooth extractions. Periodontal disease was present in 41.4% of the patients. No osteonecrosis was observed in the first group, whereas BRONJ was found in five patients of the second one (25%) and two patients (10%) showed osteosclerotic areas under investigation [OR 0.026 (CI 0.0027 to 0.2454)]. (4) Conclusions: In the literature, there are no precise data about the prevalence of BRONJ. Despite the limitation of the present study, we point out that dental treatment before the treatment with intravenous bisphosphonates can help in reducing the incidence of BRONJ and good dental status is necessary for BRONJ prevention.

Solitary plasmacytoma of jaw bone: A case report and systematic review of fifty cases from literature

Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is critical for treatment and survival. Here, a case of SPB of mandible in an elderly female is reported. Histopathological diagnosis of plasma cell neoplasm was confirmed immunohistochemically with MUM1 and CD138 positivity and multiple myeloma (MM) was ruled out on performing systemic workup. Prognosis of SPB worsens when it transforms into MM. A systematic review was undertaken with the objective to determine the factors affecting conversion of SPB to MM. An electronic search was undertaken with PubMed/MEDLINE, Web of Science and Science Direct. Fifty cases of SPB of jaw from 29 publications were reviewed. SPB commonly presents as a painless swelling. Radiographically, it is commonly seen as multilocular radiolucency with well-defined borders. Follow-up data showed that nine cases turned into MM in a mean duration of 1 year 9 months and 12 patients died after median disease-free survival of 6 years 9 months. Prognosis of SPB is found to be affected by tumor size (≥5 cm), anaplasia of tumor cells, Ki-67 labeling index, vascularity of the tumor, presence of clonal bone marrow plasma cells, serum immune globulin level, dose of radiotherapy and persistence of M protein after treatment. There is a need to identify prognostic subgroups in SPB based on these factors. Furthermore, studies are necessary for standardization of treatment protocol to halt or prolong the progression of SPB to MM.

Myeloma of Laryngeal Cartilage: Literature Review and Case Study

BACKGROUND

Myeloma of laryngeal cartilage (MLC) is a rare plasma cell neoplasm which has not been well characterized. However, it is an important differential diagnosis of laryngeal cartilage mass as it can indicate the presence of underlying systemic hematological diseases, such as multiple myeloma (MM), that is associated with poor prognosis. This article is the first of its kind and aims to educate clinicians on future diagnosis and management of similar cases.

METHODS

Search of MLC was performed on the medical literature databases of Medline, PUBMED, and EMBASE. Additionally, institutional database at Gold Coast University Hospital Radiology Department was queried for relevant cases. Based on 16 cases that met the inclusion criteria, the etiology, epidemiology, clinical evaluation, investigations, management, and prognosis of MLC was summarized.

RESULTS

Of all, 94% of MLC occur in males and 81% in those older than 60 years. It is more commonly a manifestation of systemic MM, rather than localized extramedullary plasmacytoma (EMP), 81% and 19% respectively. Additionally, 67% of laryngeal EMPs progress to MM within 3 years from initial diagnosis. Although treatments involving both local and systemic therapy were effective at relieving local symptoms, 39% of MLC patients died during the follow-up period-all of which were due to septicemia caused by secondary infections.

CONCLUSION

Myeloma of laryngeal cartilage is a relatively rare condition that requires accurate diagnosis in order to promptly manage the potentially underlying systemic hematological disease. Currently, more case reports and analytical studies are required to provide evidence-based guidance on etiology, diagnosis, and management of this condition.

Rare Differential Diagnosis of Dyspnea: Extramedullary Plasmocytoma (EMP) of the Larynx-Case Report and Review of the Latest Literature of Laryngeal EMP and Laryngeal Involvement of Multiple Myeloma

Multiple myeloma (MM) of the larynx is extremely rare. It can be either a laryngeal manifestation of a general multiple myeloma or it can occur as a primary laryngeal mass, which is then called extramedullary plasmocytoma (EMP). We present the case of an 81-year-old male patient who was admitted for dyspnea. He had a history of multiple myeloma but was in complete remission since some years. Histological and immunohistological examination of tissue samples revealed an EMP. The patient was first treated by laser surgery in order to reduce the tumor mass and secure the airway. Afterwards, he was systematically treated by radiation therapy with 60 Gy, which achieved a good response and complete remission proven by control laryngoscopy and histological examination of tissue samples taken from the former tumor area three months after laser excision. The latest literature in the field is reviewed. There were only ten cases of EMP in the larynx or laryngeal involvement of MM published within the last five years (Pubmed was searched for “larynx,” “laryngeal” and “EMP,” “Extramedullary Myeloma,” “Multiple Myeloma,” and “MM”). Due to its rarity, there are currently no evidence-based therapeutic guidelines available. For their development, multicenter studies are required.

Multiple myeloma presenting as an unhealed extraction socket: Report of a case with brief review of literature

Multiple myeloma (MM) is a relatively rare malignant hematological disease, which is characterized by a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions. Maxillofacial presentations in patients with MM are not uncommon, but because the symptoms are varied, it is very difficult to diagnose MM in this region especially in patients with initial oral involvement. Furthermore, maxillofacial manifestations as an initial sign or symptom are scarce. We report a case of a 40-year-old male patient who presented with an unhealed socket in lower left back tooth region for the past 2 months. The panoramic radiograph revealed a multilocular radiolucency. Histopathological examination of the biopsy specimen revealed a malignant hematopoietic neoplasm formed by plasmacytoid cells. Radiographic survey and immunoreactivity for CD 138 and lambda chain antibody further confirmed the diagnosis of MM.

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

Introduction

Solitary 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.

Objective

To carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects.

Methods

A 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.

Results

Of the 216 articles found, only 21 articles met the pre-established inclusion criteria.

Conclusion

The 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.

Massive Bone Marrow Crystal-Storing Histiocytosis in a Patient with Iga-Lambda Multiple Myeloma and Extensive Extramedullary Disease. A Case Report

We report a case of multiple myeloma (MM) displaying an unusual course, with metastatic spread in uncommon sites (gastroduodenal and upper respiratory tract, breast, skin and liver) and with a fatal outcome. In our patient this plasma cell neoplasm was associated with a rare condition named crystal-storing histiocytosis (CSH), resulting from the storage in reactive histiocytes of crystalline immunoglobulin inclusions. These crystal-forming paraprotein components are secreted by the neoplastic plasma cells and give rise to the crystalline material of the histiocytes only after their ingestion and degradation by the same histiocytes. In this disorder crystal-storing cells may be present in various tissues (in our case mainly in bone marrow), often with functional alterations of the involved organs. In our opinion the association of this “atypical” MM with CSH is to be considered an uncommon event.

Oral Plasmacytoma in a Dog

A 6-year-old male Pit bull mix dog presented for bleeding from the mouth persisting for five days. A clinical evaluation revealed a 2 × 3 cm soft tissue mandibular mass at the crown of the first premolar, as well as a non-regenerative anemia and hyperproteinemia. Cytologic and histopathologic evaluations of the mass were compatible with an oral plasmacytoma.

Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

PURPOSE

Parasellar plasmacytomas are rare tumors localized to the sellar region arising from plasma cells. Knowledge of clinical, imaging, surgical, and pathological characteristics is limited to single case reports.

METHODS

A retrospective analysis of five primary cases was conducted, followed by systematic review of English language articles using PubMed in accordance with PRISMA guidelines.

RESULTS

Five primary case patients include four men and one woman, ages 60-77, followed up to 3 years. A systematic review identified 65 additional patients, of whom 65% presented with cranial nerve palsies and 15% with hypopituitarism. Sixteen percent had history of known multiple myeloma (MM) while 37% were diagnosed concurrently with MM on presentation of parasellar plasmacytoma. Imaging showed median tumor size of 38 mm (range, 4-70 mm), with MRI intensity similar to that of other sellar masses. Surgical biopsy with immunohistochemical studies confirmed plasmacytoma diagnosis. Eighty-one percent underwent parasellar radiotherapy, and chemotherapy initiated in 59% of the 69 patients with MM. Overall survival rate was 74% at follow-up (median 12 months), with 18% having parasellar recurrences and 38% progressing to systemic MM after presentation of a solitary plasmacytoma (median 3 months).

CONCLUSIONS

Parasellar plasmacytomas are rare tumors that should be considered in the differential diagnosis for lesions involving the sella and arising from the clivus, especially when cranial nerve paresis is apparent, even in the absence of known MM. Although recurrence rates for parasellar plasmacytoma is low, patients should be monitored for progression to MM. Treatment depends on the presence of systemic disease at diagnosis.

Primary laryngeal localization of multiple myeloma: A case report

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Computed tomography and magnetic resonance imaging revealed a gross swelling infiltrating the right glottis and right false vocal fold, sized 33×19×33 mm, with sub-centimeter laterocervical lymph nodes bilaterally. Careful integration of the clinical manifestations with the radiological and pathological data led to the diagnosis of multiple myeloma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among ear, nose and throat specialists, in order to enable a more timely diagnosis.

Solitary Extramedullary Plasmacytoma of the Maxillary Sinus, Progressing to Smoldering Multiple Myeloma with Multifocal Skeletal Involvement, which Resolved Completely Following Chemotherapy Alone

Plasmacytoma is an uncommon malignant tumor originating either from plasma cells located in the bone marrow also known as the solitary bone plasmacytoma, or from plasma cells located outside the bone, for e.g. in mucosal surfaces, referred to as the extramedullary plasmacytoma also called the solitary extramedullary plasmacytoma. Both, solitary as well as extramedullary bone plasmacytomas may, particularly in later stages, be accompanied by other osteolytic bone lesions (multifocal bone involvement) and features such as anemia, hypercalcemia, or renal impairment attributable to and indicative of progression to multiple myeloma. These three distinct disorders together comprise the plasma cell neoplasms and essentially represent a continuum of related disease processes. Extramedullary and solitary bone plasmacytomas of the head and neck region are extremely uncommon, and amongst them plasmacytoma of the maxilla is extremely rare. Such a case is being reported here for its rarity. Also, it was associated with multifocal skeletal involvement, making a correct categorization difficult as well as imperative in order to institute the correct treatment. Radiotherapy is considered to be the treatment of choice of plasmacytoma, with adjuvant chemotherapy for multi focal involvement. Surgery is usually limited to biopsy and excision of any residual disease following radiotherapy. The case presented responded extremely well to chemotherapy alone, with a complete resolution of the maxillary tumor, obviating the need for radiotherapy.

Extramedullary Plasmacytoma of the Maxilla Simulating a Maxillary Radicular Cyst: Quick Diagnosis and Management

Plasma cell tumors are lymphoid neoplastic proliferations of B cells. Multiple myeloma is the disseminated type of this disorder, while localized forms of plasma cell neoplasms are solitary plasmacytoma of bone that is observed as centrally localized in bones, and extramedullar plasmacytoma (EMP) that develops in soft tissues. EMP of the head and neck region is a rare malignant tumor comprising approximately 3% of all plasma cell tumors, and approximately 0.4% of all head and neck malignancies; among them, plasmacytoma of the maxilla is extremely rare. The authors present a case of a patient affected by an EMP of the maxilla simulating a maxillary radicular cyst comparing our results with the recent literature. EMP entity requires a meticulous overview of the patient by the specialist and overall the control of any signs or symptoms of systemic diseases, a fact that would mark a dramatic change in the treatment and prognosis for the patient.

Epiglottic masses identified on CT imaging: A case report and review of the broad differential diagnosis

Epiglottic masses may be cystic, granulomatous, infectious, benign or malignant neoplastic, or manifestations of a systemic disease. When large in size, the airway may become obstructed, and when accompanied by suspicious features such as cartilaginous invasion, extension to the pre-epiglottic or para-glottic spaces, or lymphadenopathy, the radiologist must consider malignancy as a primary differential diagnosis. However, when only benign features are identified, the differential diagnosis is broad. We present a 65-year-old female with an incidental 1 cm exophytic, pedunculated, papillomatous lesion on the laryngeal surface of the epiglottis discovered upon endoscopic evaluation for dyspepsia and heartburn. Because of her risk factors for malignancy, CT scan was requested and revealed only benign features. Subsequent excisional biopsy revealed a benign squamous papilloma; however, multiple additional differential considerations were entertained preoperatively.

Plasmacytoma of the Skull Base: A Meta-Analysis

Objective Extramedullary plasmacytomas are rare tumors. In the current study we aim to characterize its clinical course at the skull base and define the most appropriate therapeutic protocol. Methods We conducted a meta-analysis of articles in the English language that included data on the treatment and outcome of plasmacytoma of the base of skull. Results The study cohort consisted of 47 patients. The tumor originated from the clivus and sphenoclival region in 28 patients (59.5%), the nasopharynx in 10 patients (21.2%), the petrous apex in 5 patients (10.6%), and the orbital roof in 4 patients (8.5%). The chief complaints at presentation included recurrent epistaxis and cranial nerve palsy, according to the site of tumor. Twenty-two patients (46.8%) had surgical treatment; 25 (53.2%) received radiation therapy. Adjuvant therapy was administered in 11 cases (50%) with concurrent multiple myeloma. The 2-year and 5-year overall survival rates were 78% and 59%, respectively. Clear margin resection was achieved in a similar proportion of patients who underwent endoscopic surgery and open surgery (p = 0.83). A multivariate analysis of outcome showed a similar survival rate of patients treated surgically or with radiotherapy. Conclusions The mainstay of treatment for plasmacytoma is based on radiation therapy, but when total resection is feasible, endoscopic resection is a valid option.

Plasmacytoma of the Clivus Presenting as Bilateral Sixth Nerve Palsy

Background and Importance Plasmacytomas are monoclonal proliferations of plasma cells that may arise within soft tissue or bone. The skull base is a rare site for plasmacytomas to occur, and few cases have been reported in the literature. When present in the skull base, plasmacytomas may result in cranial neuropathies and often progress to multiple myeloma more rapidly than other intracranial or skeletal plasmacytomas.

Clinical Presentation A 69-year-old man presented with a primary complaint of diplopia and an examination consistent with bilateral abducens nerve palsy. No other deficits were noted. Magnetic resonance imaging of the skull base demonstrated a large T1 isointense moderately enhancing lesion centered within the clivus. Endoscopic biopsy of the mass revealed sheets and aggregates of mature monoclonal plasma cells. The patient's initial systemic work-up revealed that this was a solitary lesion, and he was treated with radiation therapy to the skull base with a durable local effect at 18-month follow-up. Unfortunately he progressed to multiple myeloma with peripheral osteolytic lesions but has been stabilized on chemotherapeutics.

Conclusion The clivus is an unusual site for intracranial plasmacytomas, and enhancing lesions must be differentiated from chordoma. Characteristic findings on histopathology include an immunoglobulin light-chain restricted clonal proliferation of plasma cells. Treatment is most commonly radiotherapy with surgery reserved for biopsy and palliation. Clinicians should be aware of the increased risk of progression to multiple myeloma in skull base plasmacytomas.

Extramedullary plasmacytoma of gingiva and soft tissue in neck

Plasmacytoma is a malignant disease that present either in bone marrow (medullary plasmacytoma), within the bone (solitary plasmacytoma of bone), or outside of bone, as the extramedullary plasmacytoma. Extramedullary plasmacytoma accounts for 3% of all plasma cell tumours and approximately 90% of extramedullary plasmacytomas affect the head and neck region commonly affecting the nasal cavity, paranasal sinuses, tonsillar fossa and oral cavity. Multiple extramedullary plasmacytoma is defined when there is more than one extramedullary tumour of clonal plasma cells and such presentations are extremely rare. We report such a rare case of multiple extramedullary plasmacytoma involving gingiva and neck. Here is a case report of a 65-year-old female patient presenting with extramedullary plasmacytoma of the gingiva and soft tissue in neck.

Anaplastic Solitary plasmacytoma of mandible, masquerading as sarcoma

Plasma cell neoplasm is characterized by a monoclonal neoplastic proliferation of plasma cells and solitary plasmocytoma of bone (SPB) is a localized form. It usually occurs in vertebrae and secondarily in long bones. Its presence in mandible is extremely rare event. A 48-year-old man consulted to our clinic with a chief complaint of pain in his mandible. Radiography revealed a destructive lesion in body and ramus. The initial pathologic evaluation revealed a high grade pleomorphic neoplasm. The diagnosis was confirmed by immunohistochemical markers. Overall, plasmacytoma with anaplastic features can be confused with high grade sarcoma clinically and histologically.

Extramedullary plasmacytoma of the nasopharynx: A case report and review of the literature

Plasmacytoma is an extremely rare and discrete solitary mass of neoplastic monoclonal plasma cells. Extramedullary plasmacytoma (EMP) tends to occur during the fifth and seventh decades of life and is rarely diagnosed in younger patients. Only four cases of EMP have been previously reported in relatively young patients. Here we report a 15-year-old patient presenting with long-term nasal obstruction, who was found to have EMP of the nasopharynx. The patient was treated with surgery followed by radiotherapy with a satisfactory outcome. To the best of our knowledge, this study describes the the youngest individual with nasopharyngeal EMP to be reported in the literature.

The multiple oral presentations of multiple myeloma

PURPOSE

The purpose of this case series is to show the varied oral presentations of multiple myeloma, illustrating the importance of carefully surveying the oral cavity for suspicious lesions that could be indicative of palpable disease and/or recurrence. The diagnostic criteria and prognostic features for multiple myeloma were also reviewed.

CASE SERIES SUMMARY

This report focuses on five patients with myeloma manifestations involving the oral cavity, in which the oral presentation of multiple myeloma was an early indication of disease relapse. Although the clinical presentation may be variable, the majority of patients will develop lytic bone lesions and less commonly, extramedullary involvement during the course of their disease.

DISCUSSION

The presentation of myeloma can be varied and the oral presentation, although rare, may be the sole manifestation or part of a group of signs of disease progression. Clinical presentations of patients with myelomatous lesions can mimic common dental pathologies, which then, in turn, can lead to delays in diagnosis and treatment.

CONCLUSION

As members of an interdisciplinary oncology team, it is essential to be familiar with oral manifestations of multiple myeloma and proper diagnostic/biopsy techniques in order to avoid misdiagnosis and treatment delays.

Primary Solitary Extramedullary Plasmacytoma Involving the True Vocal Cords in a Pregnant Woman

Primary solitary extramedullary plasmacytoma of the larynx involving the true vocal cords is an extremely rare entity. Extramedullary plasmacytoma has the potential to transform into multiple myeloma and mandates strict vigilance and routine follow-up. We describe such a case in a 29-year-old pregnant woman who presented with progressive hoarseness, dysphagia and intermittent respiratory difficulty. Fiberoptic laryngoscopy revealed a fleshy mass involving the posterior third of the true vocal cords, encroaching on the ventricle and false cords. Histopathology and immunohistochemistry revealed extramedullary plasmacytoma of a monoclonal nature. In spite of Bence Jones proteinuria and a rising serum β2-microglobulin level, a thorough search for metastasis and subsequent treatment with radiotherapy were delayed due to the patient's pregnancy. She is the youngest adult ever reported with primary solitary extramedullary plasmacytoma involving the true cords. Described for the first time in pregnancy, the relevant issues in management are highlighted.

Laryngeal involvement of multiple myeloma

The objectives of this paper are to discuss a rare cause of laryngeal multiple myeloma, to review unique pathologic findings associated with plasma cell neoplasms, to discuss epidemiology, differential diagnosis, and treatment options for plasma cell neoplasms of the larynx. Laryngeal multiple myeloma, also noted in the literature as “metastatic” multiple myeloma, presenting as a de novo laryngeal mass is extremely rare with few reported cases. Laryngeal involvement of extramedullary tumors is reported to be between 6% and 18% with the epiglottis, glottis, false vocal folds, aryepiglottic folds, and subglottis involved in decreasing the order of frequency. We present the case of a 58-year-old male with a history of IgA smoldering myeloma who presented to a tertiary care laryngological practice with a two-month history of dysphonia, which was found to be laryngeal involvement of multiple myeloma. We review the classification of and differentiation between different plasma cell neoplasms, disease workups, pathologic findings, and treatment options.

A case of extramedullary plasmacytoma in the sphenoid sinus with unilateral loss of vision

Extramedullary plasmacytomas are localized tumours formed of monoclonal plasma cells in an extra-skeletal area. They constitute approximately 3% of all neoplasms originating from plasma cells. They generally display a destructive course. When the literature in English was reviewed, only 19 cases with the primary disease localized in the sphenoid sinus were found. We present the case of a 50-year-old male patient who presented with gradually increasing visual loss over 6 weeks, whose radiological tests revealed a formation of mass in the sphenoid sinus pressing against the optic nerve and internal carotid artery. A biopsy obtained by endoscopic sinus surgery was reported to be a plasmacytoma. A diagnosis of extramedullary plasmacytoma was made after investigations for other neoplastic plasma cell conditions proved negative. Extramedullary plasmacytomas were assessed by reviewing the literature.

Primary Solitary Extramedullary Plasmacytoma of the Tongue

Extramedullary plasmacytomas are rare malignancies. Most cases (80%) are seen in the head and neck region, where they represent 1 % of all head and neck malignancies. We report a case of an extramedullary plasmacytoma of the tongue that was treated successfully with three-dimensional conformal radiotherapy. The patient was a 50-year-old woman who was admitted to our hospital with bilateral pain and ulceration on the sides of her tongue. Findings on magnetic resonance imaging and positron-emission tomography did not demonstrate any mass within the tongue or any lymphatic or distant metastasis. A tissue biopsy identified a plasma cell neoplasm. The patient was treated with a total dose of 50 Gy delivered in 2-Gy daily fractions. After 54 months of post-treatment follow-up, she exhibited no sign of systemic myeloma or local recurrence. This case is presented not only for the rarity of the tumor type, but also for its unusual location.

Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

Multiple myeloma is the prototype of malignant monoclonal gammopathies. The most common skeletal sites are pelvis, skull, spine, ribs and femoral and humeral shafts. The classic radiographic presentation of multiple myeloma is lytic skeletal lesions. Other types of presentation include sclerotic and porotic changes. Primary sclerotic manifestations are rare and occur in only 3% of cases. Although exceptional, multiple myeloma must be borne in mind in the presence of bone sclerosis. This report presents a patient with multiple myeloma with a sunburst/hair-on-end pattern on the radiograph and sclerotic skeletal lesions.

Plasma cell tumors of the skull base: four case reports and literature review

Four patients (mean age, 46 years; range, 28 to 60) with skull base plasmacytomas are presented along with a review of the literature examining the progression of anterior and central skull base plasma cell tumors to multiple myeloma. The primary sites were the nasopharynx, orbital roof, sphenoid, and clivus. Three patients presented with extensive local spread of tumor. Two patients were diagnosed with multiple myeloma and treated with chemotherapy. Patients with an isolated plasmacytoma were treated with external beam radiation. A partial or complete response to therapy was seen in all four cases. Skull base plasma cell tumors are uncommon with only a limited number of published reports. Previous literature demonstrates that nasopharyngeal extramedullary plasmacytomas have a lower rate of progression to multiple myeloma than other sites. Patients with clivus, sphenoid, and petrous apex-based plasma cell tumors appear to have a higher risk of developing multiple myeloma than patients with plasma cell tumors involving the nasopharynx.

Place of modern imaging modalities for solitary plasmacytoma: toward improved primary staging and treatment monitoring

Radiation therapy (RT) is the mainstay of treatment of solitary plasmacytoma. In most cases, doses ranging from 40 to 50 Gy yield in a local control more than 80%. However, the prognosis of patients with SP is marked by a high rate of transformation to multiple myeloma (MM), and there is no demonstrated benefit of adjuvant chemotherapy for decreasing this probability. However, clinical benefits could be reached from improving screening for other primary sites of plasmacytoma and earlier discovering signs suggestive of MM. Since such strategy could provide significant information regarding both prognosis and therapy, it has become first importance to improve initial staging of tumor widespread. Although conventional skeletal X-ray survey remains standard, usual sensitivity of radiographies does not permit diagnosing early myeloma lesions and a significant number of patients with supposed SP might be understaged and do not receive the appropriate treatment. The development of more sensitive and specific imaging modalities will make it feasible to earlier detect subclinical lesions, thus leading lead to new approaches in the treatment strategies. Here, we discuss the benefits and limitations of magnetic resonance imaging and positron emission tomography for primary staging of patients with solitary plasmacytoma. Both imaging modalities could also improve target volume delineation and assessment of tumor response after RT.

Multiple cystic swelling: Initial presentation of multiple myeloma

Multiple myeloma, a disease allied to malignancy of reticuloendothelial cells, is not an uncommon condition. However, the diagnosis is often made quite late because the disease has multiple modes of presentation. We are reporting a case of multiple myeloma in a 55-year-old male who presented with multiple cystic swellings on the chest.

Multiple myeloma presenting as spinal cord compression: a case report

Introduction

Spinal cord compression is a potentially devastating condition that demands immediate attention. Efforts must be divided between addressing the symptoms of cord compression and identifying the precise etiology of the condition.

Case presentation

A 76-year-old Peruvian man presented to our emergency department for evaluation of the gradual onset of lower extremity weakness over one month, resulting in falls and a two day history of bladder and bowel incontinence. Surprisingly, the etiology of this case of spinal cord compression was found to be multiple myeloma presenting as a solid tumor.

Conclusion

We report a case of a spinal cord mass resulting in symptoms of cord compression that was diagnosed when aspects of our patient's initial magnetic resonance imaging scan did not correlate with disc herniation, which was the diagnosis with the greatest pretest probability.

Disseminated Plasmacytoma of the Thyroid

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Thyroid involvement is rare, as fewer than 75 cases have been previously reported in the literature. We report a new case of disseminated plasmacytoma of the thyroid, which occurred in a 68-year-old woman. The diagnosis was made with an incisional biopsy. The patient initially experienced a complete response to radiotherapy (46.8Gy in 26 fractions), but she developed multiple metastases at distant sites, including the breast, abdominal wall, and buttock despite various chemotherapy regimens. Ultimately, she was placed on palliative radiotherapy. We also briefly review the diagnostic and treatment options for patients with extramedullary plasmacytoma.

Penile extramedullary plasmacytoma in a dog

Penile tumours are rare in dogs. Reported herein is a case of a penile extramedullary plasmacytoma (EMP) in a 5-year-old male cocker spaniel that was brought to a local hospital for an evaluation of a penile mass. The mass was approximately 1.3 cm in diameter at the time of presentation. In fine needle aspiration and histopathological examinations, the neoplastic cells showed eccentric round nuclei, a moderate amount of basophilic cytoplasm, and a peri-nuclear clear zone, consistent with plasma cell morphology. There was nuclear pleomorphism with mononuclear giant cells and occasional bi-nucleation. Round cells on the periphery of the mass demonstrated plasmacytic differentiation. Immunohistochemically, the neoplastic cells stained positive for MUM1 and light lambda chain. Based on the cytological and pathological observations, a diagnosis of penile EMP was established.