Merzouqi B, Halily S, Oukessou Y, Regragui M, Abada R, Mahtar M. Unusual presentation of a soft palate mass: A rare case report of solitary extramedullary plasmacytoma.
Int J Surg Case Rep 2021;
79:193-197. [PMID:
33482447 PMCID:
PMC7819814 DOI:
10.1016/j.ijscr.2021.01.033]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/06/2022] Open
Abstract
Plasmacytoma is a rare clonal neoplastic disorder of bone marrow that originates from plasma cells. It usually presents as a multiple myeloma. Less than 5% of patients present with either a single bone lesion as a solitary bone plasmacytoma or, even more rarely, as a soft tissue mass of monoclonal plasma cells representing a solitary extra medullary plasmacytoma (SEP).
Diagnostic criteria of a SEP include a solitary lesion, histopathological confirmation, negative bone marrow examination or clonal plasma cells infiltration less than 10% of all nucleated cells, normal results on skeletal survey, negative urine test for Bence Jones protein, absence of anemia, hypercalcemia or renal impairment, absent or low serum or urinary level of monoclonal immunoglobulins.
The primary treatment for most patients is radiotherapy, but surgery may also be required, and multidisciplinary decision between surgeon, hematologist and radiotherapist is crucial for planning optimum care.
Our case report is unique in the clinical presentation and treatment option (chemotherapy) as the patient refused other treatment options.
Introduction
Plasmacytoma is a rare clonal neoplastic disorder of bone marrow that originates from plasma cells. It usually presents as a multiple myeloma (MM). Less than 5% of patients present with either a single bone lesion as a solitary bone plasmacytoma (SBP) or, even more rarely, as a soft tissue mass of monoclonal plasma cells representing a solitary extra medullary plasmacytoma (SEP).
Case presentation
We report a case of a 59-year-old man presenting with a mass of the soft palate evolving for a year. Physical examination showed an extension to the nasal cavity. Biopsy with immunohistochemical study demonstrated sheets of mononucleated plasmacytoid cells diffusely expressing CD138. The plasma cells showed monoclonal light chain Kappa. Further investigations did not show any other locations including bone and bone marrow. Thus, diagnosis of solitary extramedullary plasmacytoma of the soft palate was established. The patient was treated with chemotherapy with total remission on his one year follow-up.
Discussion
SEP may arise in any organ, either as a primary tumor or as part of a MM. Almost 90% of SEP arise in the head and neck, especially in the upper respiratory tract. Primary treatment for most patients is radiotherapy, but surgery may also be required, and multidisciplinary decision between surgeon, hematologist and radiotherapist is crucial for planning optimum care.
Conclusion
SEP is an extremely rare condition which requires diagnostic and therapeutic management in the same level of MM. Prognosis is better than the two other forms (MM and SBP).
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