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Zhang T, Liu W, Liu G, Zhao T. Sequential therapy for extramedullary plasmacytoma of the palate: a rare case report with seven years of follow-up and literature review. J Cancer Res Clin Oncol 2024; 150:431. [PMID: 39340570 PMCID: PMC11438633 DOI: 10.1007/s00432-024-05958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) is a rare solitary malignancy that accounts for 3% of plasma cell neoplasms, and EMP with a primary occurrence in the palate is extremely uncommon. Owing to the long course of EMP and the limited available data on treatment outcomes, there are no definitive guidelines for its management, especially for high-risk patients who are more susceptible to early progression to multiple myeloma. CASE PRESENTATION In this study, we review nine relevant studies and describe a 54-year-old woman who presented with an asymptomatic nonulcerative mass localized in the palate. After initial radical surgical resection of the lesion, the patient was definitively diagnosed with EMP with minimal plasmacytosis in the bone marrow, and adjuvant intensity-modulated radiation therapy with a minimum dose of 39.6 Gy was administrated in the surgical area. There was no evidence of local recurrence, nodal metastasis or progression to multiple myeloma (MM) during the seven-year follow-up period. CONCLUSION Given the atypical clinical features of palate EMP reported in the literature and the encouraging results of our patient, sequential therapy involving surgery and adjuvant radiotherapy for primary palatal lesions in high-risk EMP patients without nodal involvement could be an effective treatment modality.
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Affiliation(s)
- Tianqi Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jing Six Road, Jinan, Shandong, 250021, China
| | - Weidong Liu
- Department of Stomatology, Zibo First Hospital, Zibo, Shandong, 255200, China
| | - Guijun Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jing Six Road, Jinan, Shandong, 250021, China
| | - Tengda Zhao
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jing Six Road, Jinan, Shandong, 250021, China.
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Vasudevan SS, Sayed SBH, Kapartiwar P, Pang J, Asarkar AA, Olinde L, Katz S, Beedupalli K, Nathan CAO. Radiotherapy vs Surgery for Survival and Locoregional Control of Head and Neck Extramedullary Plasmacytoma: A Systematic Review and Meta-Analysis. JAMA Otolaryngol Head Neck Surg 2024:2823071. [PMID: 39207749 PMCID: PMC11362973 DOI: 10.1001/jamaoto.2024.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/29/2024] [Indexed: 09/04/2024]
Abstract
Importance There are significant gaps in the literature pertaining to the locoregional control and survival rates of extramedullary plasmacytoma (EMP) with respect to various treatment approaches. Objective To systematically evaluate the differences in radiotherapy and surgical outcomes in EMP. Data Sources Databases including PubMed, Scopus, Web of Science, Embase, and ScienceDirect were systematically searched from their inception up to November 2023. Study Selection Articles reporting radiotherapy and surgical outcomes of head and neck EMP were included. Data Extraction and Synthesis A random-effects model for meta-analysis was used to obtain pooled estimates and calculate hazard ratios for survival and odds ratios for recurrence and progression of EMP. Main Outcomes and Measures Survival, tumor control, and progression rates to multiple myeloma (MM) between radiation therapy and surgery for EMP of the head and neck. Results Of 742 included patients from 12 studies, 527 (71.0%) were male, and the median (IQR) age was 59.1 (53-62) years. A total of 505 patients (68.1%) received radiotherapy only, while 237 (31.9%) underwent surgery-only treatment for EMP. All included patients had an initial diagnosis of EMP without MM. Comparable trends were observed in overall survival and disease-free survival (DFS) rates at 2, 3, 5, and 10 years between patients with EMP treated with radiotherapy only and surgery only. Notably, there were no significant differences in recurrence rate (odds ratio, 0.65; 95% CI, 0.20-2.06) between radiotherapy-only and surgery-only treatment. However, radiotherapy-only treatment of EMP was associated with decreased odds of progression to MM compared with surgery (odds ratio, 0.4; 95% CI, 0.1-0.9). Sensitivity analysis revealed that the radiotherapy-only population had significantly better 5-year DFS (hazard ratio, 0.55; 95% CI, 0.31-0.96) compared with surgery-only treatment. Conclusions and Relevance This systematic review and meta-analysis provides evidence that patients with EMP receiving radiotherapy had significantly lower chances of progression to MM compared with surgery-only therapy. Additionally, radiotherapy had better 5-year DFS outcomes compared with surgery. Comparable outcomes in terms of overall survival rates, recurrence, and mortality rates were noted between radiotherapy-only and surgery-only EMP treatment groups.
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Affiliation(s)
- Srivatsa Surya Vasudevan
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | | | - Pratiksha Kapartiwar
- Department of Medicine, Shri Vasantrao Naik Government Medical College, Maharashtra University of Health Sciences, Nashik, India
| | - John Pang
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Ameya A. Asarkar
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Lindsay Olinde
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Sanford Katz
- Department of Radiation Oncology, Willis-Knighton Cancer Center, Shreveport, Louisiana
| | - Kavitha Beedupalli
- Department of Medicine, Faculty of Medicine, International University of Africa, Khartoum, Sudan
| | - Cherie-Ann O. Nathan
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
- Department of Surgery, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana
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Yao H, Liu H, Wang X. Toothache as an initial symptom of extramedullary plasmacytoma in the maxillary sinus: A case report. Asian J Surg 2023; 46:6087-6088. [PMID: 37777401 DOI: 10.1016/j.asjsur.2023.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Haolan Yao
- Department of Endodontics, Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Xiangzhu Wang
- Department of Endodontics, Xiangya Stomatological Hospital, Central South University, Changsha, China.
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Zheng YH, Tian B, Qin WW, Zhu QW, Feng J, Hu WY, Chen RA, Liu L. Distribution and survival outcomes of primary head and neck hematolymphoid neoplasms in older people: a population-based study. Clin Exp Med 2023; 23:3957-3967. [PMID: 37093452 DOI: 10.1007/s10238-023-01069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
Primary head and neck hematolymphoid neoplasms (PHNHLN) are defined as a series of hematolymphoid system-derived neoplasms which primarily emanate in head and neck region. Due to the rarity and absence of symptomatic specificity, PHNHLN is easily neglected. The objective of this study is to investigate demographics, pathological subtype distribution, anatomical location, survival outcomes and prognostic factors of PHNHLN among older patients aged ≥ 60. The individual patient information in our study was derived from Surveillance, Epidemiology and End Results database. Descriptive epidemiological methods were used to analyze the distribution of histologic subtypes and primary anatomical sites. Kaplan-Meier survival curves and log-rank test were conducted to evaluate the effect of variables on the prognosis. Cox hazard regression was conducted to identify the independent prognostic factors. The male-to-female ratio in most pathological subtypes was close to 1:1. The most common pathological subtype was diffuse large B-cell lymphoma. The most commonly involved sites outside the lymph nodes were salivary glands, especially parotid gland, followed by tonsil, thyroid gland and tongue. The prognosis of mature T- and NK-cell non-Hodgkin lymphoma (NHL) was bleaker than Hodgkin lymphoma, mature B-cell NHL and plasma cell neoplasm. Age at diagnosis, presence of second primary malignancy (SPM), pathological subtype, Ann-Arbor stage, chemotherapy and radiation were independent prognostic factors of overall survival. Our study comprehensively reported the subtype distribution, anatomical sites and survival outcomes of PHNHLN among older patients, improving understanding of this rare group of cancer entities.
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Affiliation(s)
- Yan-Hua Zheng
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China
| | - Biao Tian
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Wei-Wei Qin
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China
| | - Qing-Wen Zhu
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Juan Feng
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Wu-Yue Hu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Ren-An Chen
- Department of Internal Medicine II, Tumour Hospital of Shaanxi Province, No.309 Yan'ta West Road, Xi'an, Shaanxi, China.
| | - Li Liu
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China.
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China.
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Shen X, Zhang L, Wang J, Chen L, Liu S, Zhang R. Survival trends and prognostic factors for patients with extramedullary plasmacytoma: A population-based study. Front Oncol 2022; 12:1052903. [PMID: 36582797 PMCID: PMC9792764 DOI: 10.3389/fonc.2022.1052903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background Extramedullary plasmacytoma (EMP) is a localized plasma cell neoplasm that originates from tissues other than bone. The survival trends and prognostic factors of patients with EMP in recent years remain unreported. Methods We used the SEER databases to extract the data. Survival curves were calculated using the Kaplan-Meier method and a nomogram was created based on the Cox's proportional hazards model. Results A total of 1676 cases of EMP were identified. Patients in period-2 (2008-2016) show similar survival (p=0.8624) to those in period-1(1975-2007). Age, gender, race, and sites were prognostic of patient outcomes. And the use of surgery was associated with improved survival. The patients were randomly assigned to the training cohort and the validation cohort in a ratio of 2:1. Four factors including age, gender, race, and sites were identified to be independently predictive of the overall survival of patients with EMP. A prognostic model (EMP prognostic index, EMP-PI) comprising these four factors was constructed. Within the training cohort, three risk groups displayed significantly different 10-year survival rates: low-risk (73.0%, [95%CI 66.9-78.2]), intermediate-risk (39.3%, [95%CI 34.3-44.3]), and high-risk (22.6%, [95%CI 15.3-30.9]) (p<0.0001). Three risk groups were confirmed in the internal validation cohort. We also constructed a 5-factor nomogram based on multivariate logistic analyses. Conclusion The survival of patients with EMP did not improve in recent years. The EMP-PI will facilitate the risk stratification and guide the risk-adapted therapy in patients with EMP.
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Affiliation(s)
- Xuxing Shen
- Department of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lina Zhang
- Department of Hematology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Department of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijuan Chen
- Department of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shu Liu
- Department of Radiation Oncology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Run Zhang, ; Shu Liu,
| | - Run Zhang
- Department of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Run Zhang, ; Shu Liu,
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彭 俊, 曾 泉. [Extramedullary plasmacytoma of the larynx:a case report]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:553-556. [PMID: 35822386 PMCID: PMC10128390 DOI: 10.13201/j.issn.2096-7993.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Indexed: 06/15/2023]
Abstract
This paper reported a case of extramedullary plasmacytoma of the larynx. The patient presented with persistent hoarseness and foreign body sensation in pharynx for 5 months. Left anterior laryngeal mass, left epiglottis fold distention was found during laryngoscopy. Cervical image examination showed that the left side wall of the glottis was thickened and showed a lump-like change, part of which protrusion into the laryngeal cavity, the laryngeal chamber became narrow, and the growth of thyroid cartilage was broken outwards and reached the level of the hyoid bone. After completing the examination, the laryngeal tumor resection and biopsy were performed under the suspension laryngoscope. Pathologic findings showed that diffuse proliferation of small cells was observed in laryngeal subepithelial fibrous tissue, with local appearance of private, atypia and mitosis. Combined with immunohistochemical results, it was consistent with plasma cell tumor.
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Affiliation(s)
- 俊 彭
- 重庆医科大学附属第一医院耳鼻咽喉科(重庆,400016)Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 泉 曾
- 重庆医科大学附属第一医院耳鼻咽喉科(重庆,400016)Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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An Unusual Case of Multiple Myeloma with Light-Chain Cast Nephropathy Secondary to a Very Large Plasmacytoma without Bone Marrow Involvement. Case Rep Hematol 2022; 2022:7531142. [PMID: 35237454 PMCID: PMC8885275 DOI: 10.1155/2022/7531142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Here, we report a case of a patient who presented to Strong Memorial Hospital with new-onset renal failure and anemia and was found to have multiple myeloma with lambda light-chain cast nephropathy secondary to a very large (14 cm × 14 cm × 12 cm) plasmacytoma without bone marrow involvement. This case is notable as solitary plasmacytomas are almost never seen with concomitant myeloma-defining CRAB criteria or significantly elevated serum free light-chain ratios. Although solitary plasmacytomas are typically definitively treated with radiation, this case highlights that systemic treatment may be helpful in certain clinical scenarios.
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8
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König L, Herfarth K. [Benefits of radiotherapy for patients with solitary plasmacytoma or multiple myeloma]. Radiologe 2021; 62:30-34. [PMID: 34762165 DOI: 10.1007/s00117-021-00935-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Treatment options for patients with solitary plasmacytoma (SP) or multiple myeloma (MM) should be discussed in an interdisciplinary context. This systematic review focuses on the importance of radiotherapy in MM and SP. OBJECTIVE Summary of local radio-oncological treatment options for patients with SP and MM. MATERIALS AND METHODS Based on a systematic literature search, the current evidence on the topic was analyzed and summarized. RESULTS Patients with SP should be primarily treated with radiotherapy with or without surgery. Irradiation concepts may vary depending on risk factors and manifestation (solitary bone plasmacytoma vs. solitary extramedullary plasmacytoma). Although local control rates are high after radiotherapy, progression to multiple myeloma frequently occurs. In patients with MM, radiation is mainly used in palliative settings for pain relief, prevention of fractures or in patients who suffer from neurological symptoms due to spinal cord compression. Irradiation dose and fractionation should be selected based on treatment indication and general condition of the patient. CONCLUSION Although most patients receive systemic treatment at initial diagnosis, approximately 40% of patients with MM will require radiation during the course of their disease. While radiation is mainly used for palliation in patients with MM, it represents the primary and curative treatment option in patients with SP.
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Affiliation(s)
- Laila König
- Abteilung RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Klaus Herfarth
- Abteilung RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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Skerget M, Dovsak T, Kos G, Zver S. Surgery results in low relapse and progression rates in extramedullary plasmacytoma of the head and neck: A case cohort and review of the literature. Hematol Rep 2020; 12:8396. [PMID: 33282164 PMCID: PMC7686853 DOI: 10.4081/hr.2020.8396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/30/2020] [Indexed: 12/02/2022] Open
Abstract
Extramedullary plasmacytoma of the head and neck is a rare indolent neoplasm. Radiotherapy is often the preferred treatment option with excellent local control and survival. The risk of local recurrence or transformation to multiple myeloma is 10-30%. In our case-cohort, thorough, sensitive initial evaluation for disseminated clonal disease and the incorporation of surgery led to excellent results with no recurrences or systemic progression.
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Affiliation(s)
- Matevz Skerget
- University Medical Centre Ljubljana
- Faculty of Medicine, University of Ljubljana
| | - Tadej Dovsak
- University Medical Centre Ljubljana
- Faculty of Medicine, University of Ljubljana
| | - Gregor Kos
- Institute of Oncology Ljubljana, Slovenia
| | - Samo Zver
- University Medical Centre Ljubljana
- Faculty of Medicine, University of Ljubljana
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Ramos-Martínez E, Lagunas-Rangel FA. Anaplastic extraosseous (extramedullary) plasmacytoma in the right nostril. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2020; 53:257-263. [PMID: 33012497 DOI: 10.1016/j.patol.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
Extraosseous (extramedullary) plasmacytomas are rare plasma cell neoplasms that can result in an erroneous and/or delayed diagnosis as often they are not considered in the differential diagnosis due to their rarity. Furthermore, the anaplastic type is one of the most difficult to recognize in biopsies. We report the case of a patient with an extraosseous plasmacytoma occluded in the right nostril. Its prompt and accurate diagnosis resulted in early treatment and a good outcome, despite the tumour being anaplastic with the risk of progressing into a plasma cell myeloma. The patient shows no recurrence or disease progression after 10 years of follow-up. Our case highlights the clinical and pathological characteristics of this rare disorder that should be considered in order to improve diagnostic criteria and thus early treatment. We also reviewed the pertinent literature.
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Affiliation(s)
| | - Francisco Alejandro Lagunas-Rangel
- Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico City, Mexico.
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You WS, Bhuta S. Myeloma of Laryngeal Cartilage: Literature Review and Case Study. EAR, NOSE & THROAT JOURNAL 2019; 100:NP114-NP119. [PMID: 31284752 DOI: 10.1177/0145561319861379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Woo Sun You
- Department of Ear Nose Throat, 95145Toowoomba Base Hospital, Toowoomba, Queensland, Australia
| | - Sandeep Bhuta
- Department of Medical Imaging, 60093Gold Coast University Hospital, Southport, Queensland, Australia
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Oertel M, Elsayad K, Kroeger KJ, Haverkamp U, Rudack C, Lenz G, Eich HT. Impact of radiation dose on local control and survival in extramedullary head and neck plasmacytoma. Radiat Oncol 2019; 14:63. [PMID: 30987659 PMCID: PMC6466654 DOI: 10.1186/s13014-019-1265-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/28/2019] [Indexed: 12/11/2022] Open
Abstract
Background Patients with plasma-cell neoplasia usually suffer from systemic disease, although a minority (< 5%) may present with solitary involvement of bone or soft tissue (extramedullary plasmacytoma (EMP)). Radiotherapy (RT) is a state-of-the-art treatment for these tumors offering long term curation. Methods and materials Between January 2005 and January 2017, twenty-seven patients underwent RT at our institution. The aim of this study was to analyse the effectiveness of various RT doses for different forms of EMP. Results A total of 33 radiation courses were administered to 27 patients with a median age of 56 years. The median RT dose was 45 Gy (range: 12–55.8). The local control rate was 76% (93% for primary EMP vs. 61% for the secondary EMP lesions; P < 0.05). A complete response (CR) rate to local RT was achieved for 42% lesions (67% for primary EMP vs. 22% for the secondary EMP lesions; P < 0.01). The overall response rate (ORR) for the EMP lesions treated with high-dose regimens (> 45 Gy) versus low-dose regimens (≤ 45 Gy) was 87% versus 67%, respectively (P = 0.2). The median survival with high-dose RT group was significantly longer (P = 0.02). In subgroups analysis, primary EMP patients treated with high-dose RT had a non-significant higher ORR (100% vs. 80%, respectively; P = 0.3,) longer duration of LC (P = 0.3) with a longer survival (P = 0.05) than patients in low-dose group. No significant difference has been detected in secondary EMP patients treated with high-dose RT regarding ORR (60% vs. 62%, respectively; P = 1), and survival (P = 0.4). Conclusion RT is an efficacious treatment modality in the treatment of EMP. A radiation dose ≤45 Gy confer a comparable CR rate to high-dose regimens and appears to be an effective treatment for controlling local EMP progression. Radiation dose-escalation may be beneficial for particular subgroups of patients.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - Kai Jannes Kroeger
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Internal Medicine-A (Hematology, Oncology, Hemostaseology and Pulmonology), University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Cabeçadas J, Martinez D, Andreasen S, Mikkelsen LH, Molina-Urra R, Hall D, Strojan P, Hellquist H, Bandello F, Rinaldo A, Cardesa A, Ferlito A. Lymphomas of the head and neck region: an update. Virchows Arch 2019; 474:649-665. [PMID: 30778677 DOI: 10.1007/s00428-019-02543-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
The field of haematopathology is rapidly evolving and for the non-specialized pathologist receiving a specimen with the possibility of a lymphoid malignancy may be a daunting experience. The coincidence of the publication, in 2017, of the WHO monographies on head and neck and haematopoietic and lymphoid tumours prompted us to write this review. Although not substantially different from lymphomas elsewhere, lymphomas presenting in this region pose some specific problems and these are central to the review. In addition, differences in subtype frequency and morphological variations within the same entity are discussed. The difficulty in diagnosis related to some specimens led us to briefly mention common subtypes of systemic lymphomas presenting in the head and neck region.
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Affiliation(s)
- José Cabeçadas
- Departamento de Diagnóstico Laboratorial, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Prof. Lima Basto, Lisbon, Portugal.
| | - Daniel Martinez
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Simon Andreasen
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Department of Pathology, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Ricardo Molina-Urra
- Pathology and Cytopathology Department, Hospital Base Puerto Montt, Puerto Montt, Chile
| | - Diane Hall
- Department and Pathology, Henry Ford Allegiance Health, Jackson, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences, CBMR, Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Antonio Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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15
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Extramedullary plasmacytoma in the maxillofacial region: A review of the literature and case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2018. [DOI: 10.1016/j.omsc.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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