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Corvo MADA, Granato L, Ikeda F, de Próspero JD. Extramedullary nasal plasmacytoma: Literature review and a rare case report. Int Arch Otorhinolaryngol 2015; 17:213-7. [PMID: 25992016 PMCID: PMC4423260 DOI: 10.7162/s1809-97772013000200016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 05/21/2011] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Extramedullary plasmacytoma is a plasma cell tumor that grows within any of the soft tissues of the organism. Similar to all plasmacytic dyscrasia, the disease is extremely rare. AIM This study reports a case of an extramedullary plasmacytoma of the nasal cavity and provides a literature review on the topic. CASE REPORT A 51-year-old woman presented at our tertiary university hospital with a 6-month history of progressive nasal obstruction, predominantly to the right side, and self-limiting epistaxis. Examination revealed a large pale-reddish tumor within the right nasal cavity. Anatomopathological analysis showed features consistent with a plasmacytoma diagnosis, which was subsequently confirmed by immunohistochemical techniques. Further assessment revealed the solitary nature of the condition, consistent with extramedullary plasmacytoma. Radiotherapy was initiated, which led to partial regression of the symptoms. The tumor was surgically removed by using a mid-facial degloving approach. The patient evolved with a naso-oral fistula and underwent 3 corrective surgeries. No evidence of associated systemic disease was found after 5 years of follow-up. CONCLUSIONS This case report, which describes a rare tumor of the nasal cavity, is expected to improve the recognition and referral of this condition by ear, nose, and throat (ENT) specialists for multidisciplinary management and long-term follow-up.
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Affiliation(s)
- Marco Antonio Dos Anjos Corvo
- MSc in Otorhinolaryngology. Assistant Professor, Department of Otorhinolaryngology, Santa Casa de Misericórdia de São Paulo
| | - Lídio Granato
- PhD in Otorhinolaryngology, Federal University of São Paulo. Associate Professor, Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo
| | - Felipe Ikeda
- Fellow in Otolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo
| | - José Donato de Próspero
- PhD. Associate Professor, Department of Pathology, Irmandade da Santa Casa de Misericórdia de São Paulo
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Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, Biasotto M. Oral lesions and lymphoproliferative disorders. JOURNAL OF ONCOLOGY 2010; 2010:202305. [PMID: 20871659 PMCID: PMC2939410 DOI: 10.1155/2010/202305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/26/2010] [Indexed: 11/17/2022]
Abstract
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.
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Affiliation(s)
- P. Castellarin
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - G. Pozzato
- Department of Haematology, University of Trieste, 34142 Trieste, Italy
| | - G. Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Trieste, 34127 Trieste, Italy
| | - R. Di Lenarda
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - M. Biasotto
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
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Shahrizal TA, Prepageran N, Rahmat O, Mun KS, Looi LM. Isolated Extramedullary Plasmacytoma of the Middle Turbinate. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908800208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extramedullary plasmacytoma is a rare plasma cell proliferative disorder with a predilection for the head and neck region. Occasionally, it presents as a solitary lesion in the nasal cavity. We report a case of an isolated lesion in the middle turbinate of the right nasal cavity. The lesion was completely excised via an endoscopic approach. We also review the pathology and management of plasmacytomas in general.
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Affiliation(s)
- Tengku A. Shahrizal
- Department of Otorhinolaryngology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Narayanan Prepageran
- Department of Otorhinolaryngology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Omar Rahmat
- Department of Otorhinolaryngology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kein-Seong Mun
- Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Lai-Meng Looi
- Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Munar-Ques M, Martinez-Nadal J, Torres-Rovira JJ, Sole M, Zabay-Becerril JM, Mulet-Ferrer JM. Finding of vascular amyloid TTR in inferior nasal concha in a patient with FAP TTRVal30Met. Amyloid 2008; 15:272-4. [PMID: 19065300 DOI: 10.1080/13506120802525061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report the case of a female patient with familial amyloid polyneuropathy (FAP) who demonstrated TTR amyloid deposition in the inferior nasal conchal vessels. To our knowledge this location has not been described previously in FAP; in addition, it was detected in a patient who had undergone successful liver transplantation (LTX) 4 years earlier. The amyloid deposition was found incidentally during examination of a right nasal obstruction caused by a nonspecific inflammatory polyp. Small focal deposits of amyloid TTR were observed on deep thick walled vessels, contrasting with the massive deposition reported in neoformed vessels in amyloidomas. This amyloid was clearly deposited between the onset of FAP and LTX and had probably decreased since the graft. If amyloid deposition is frequent in inferior nasal concha in FAP, this location could be a suitable biopsy site.
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Creach KM, Foote RL, Neben-Wittich MA, Kyle RA. Radiotherapy for extramedullary plasmacytoma of the head and neck. Int J Radiat Oncol Biol Phys 2008; 73:789-94. [PMID: 18707826 DOI: 10.1016/j.ijrobp.2008.04.077] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/25/2008] [Accepted: 04/29/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE To define the effectiveness of radiotherapy in the treatment of patients with extramedullary plasmacytoma of the head and neck (EMPHN). METHODS AND MATERIALS We searched the Mayo Clinic Rochester Department of Radiation Oncology electronic Tumor Registry and identified 18 consecutive patients with a diagnosis of solitary EMPHN. Sixteen patients were treated with radiotherapy at initial diagnosis and 2 received salvage radiotherapy for local failure after surgery. Median dose administered was 50.4 Gy. Median follow-up was 6.8 years. RESULTS One patient (6%) developed a marginal recurrence 12 months after treatment. Six patients (33%) developed multiple myeloma (2 patients) or plasmacytomas at distant sites (4 patients) at a median of 3.1 years after diagnosis (range, 0.02 to 9.6 years). Median and 5- and 10-year overall survival rates from the date of diagnosis are 12.5 years, 88%, and 55%, respectively. Two patients (11%) developed a radiation-induced malignancy at 6.5 and 6.9 years after treatment. CONCLUSIONS Radiotherapy provides excellent local and regional tumor control and survival in patients with EMPHN. To the best of our knowledge, this is the first report of presumed radiation-induced malignancy in this patient population.
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Affiliation(s)
- Kimberly M Creach
- Graduate Medical Education-Translational Year Program, Saint John's Mercy Medical Center, St Louis, MO, USA
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Grover N, Chary G, Makhija P, Rout P. Extra Medullary Plasmacytoma of the Nasal Cavity: Treatment Perspective in a Developing Nation. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500712] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extramedullary plasmacytomas are uncommon tumors, with a worldwide annual incidence of 3 per 100,000 population. They account for 1% of all tumors of the head and neck and 4% of all nonepithelial tumors of the nasal tract. A variety of treatment options has been suggested. These treatments vary according to the site of presentation, the presence of locoregional spread, and the histologic picture. Radiotherapy has been widely used as a treatment modality, but little has been written about surgery as a single management modality. However, such an option assumes importance in a developing nation, where patient follow-up is erratic and treatment costs must be kept low. We discuss the feasibility of surgery in such a circumstance, and we describe our surgical treatment of a case of extramedullary plasmacytoma in an elderly woman who presented to our hospital in India.
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Affiliation(s)
- Nancy Grover
- From the Department of Otolaryngology–Head and Neck Surgery, St. John's Medical College Hospital, Bangalore, India
| | - Geetha Chary
- From the Department of Otolaryngology–Head and Neck Surgery, St. John's Medical College Hospital, Bangalore, India
| | - Purnima Makhija
- Department of Pathology, St. John's Medical College Hospital, Bangalore, India
| | - Pritilata Rout
- Department of Pathology, St. John's Medical College Hospital, Bangalore, India
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Baek BJ, Kim SW, Park H, Park JK, Han KY, Oh CH. Extramedullar Plasmacytoma Arising from the Nasal Septum. EAR, NOSE & THROAT JOURNAL 2005. [DOI: 10.1177/014556130508401114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of extramedullary plasmacytoma of the nasal septum in a 65-year-old woman. She presented with a 2-month history of left-sided nasal obstruction and intermittent blood-tinged nasal crusting. Nasal endoscopy revealed that a dark-red mass had arisen from the nasal septum; no evidence of invasion to adjacent tissues was seen. A biopsy specimen was diagnosed as a plasmacytoma (kappa light chain—type). Serum and urine electrophoresis failed to detect any myeloma component or Bence Jones protein. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. The mass was completely removed via an endoscopic approach. No recurrence was noted at the 2-year follow-up.
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Affiliation(s)
- Byoung J. Baek
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
| | - Seong W. Kim
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hoon Park
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jin K. Park
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
| | - Kyung Y. Han
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
| | - Cheon H. Oh
- Department of Otolaryngology–Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea
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Maruya SI, Kurotaki H, Hashimoto T, Ohta S, Shinkawa H, Yagihashi S. Inflammatory pseudotumour (plasma cell granuloma) arising in the maxillary sinus. Acta Otolaryngol 2005; 125:322-7. [PMID: 15966706 DOI: 10.1080/00016480410022994] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSIONS Inflammatory pseudotumours in the maxillary sinus may present as malignant tumours and manifest locally aggressive features characteristic of such tumours. Despite their locally destructive features, they pursue a benign course after local excision. OBJECTIVE Inflammatory pseudotumour (plasma cell granuloma) is an uncommon non-neoplastic lesion comprising a proliferation of spindle myofibroblasts and chronic inflammatory cells. Despite its benign histopathological nature, it may exhibit aggressive behaviour that is yet to be characterized in the head and neck area. MATERIAL AND METHODS We present the cases of two adult patients with inflammatory pseudotumour arising from the maxillary sinus. Immunohistochemistry and polymerase chain reaction for immunoglobulin from tissue sections were performed to confirm the polyclonality of the infiltrating plasma cells. RESULTS CT and MRI disclosed expansive soft masses eroding surrounding soft and bony tissues. Histopathologically, the lesions were unencapsulated and composed of numerous plasma cells, histiocytes and spindle cells with minimal nuclear pleomorphism.
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Nappi O, Boscaino A, Wick MR. Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis). Semin Diagn Pathol 2004; 20:338-56. [PMID: 14694984 DOI: 10.1053/j.semdp.2003.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.
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Affiliation(s)
- Oscar Nappi
- Division of Anatomic Pathology, Histopathology, & Diagnostic Cytopathology, Department of Laboratory Medicine & Pathology, A. Cardarelli Hospital, Naples, Italy
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Ampil FL, Borski TG, Nathan CAO, Mulcahy G, Walker M, Chin HW, Stucker FJ. Cavernous sinus involvement by extramedullary plasmacytoma of the sphenoid sinus. An argument for the use of adjuvant chemotherapy. Leuk Lymphoma 2002; 43:2037-40. [PMID: 12481905 DOI: 10.1080/1042819021000015998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 63-year-old man with cavernous sinus involvement from extramedullary plasmacytoma (EMP) of the sphenoid sinus is described. Transient resolution of retro-orbital headache and continued progression of the locally extensive tumor were noted after chemotherapy was given following a poor response to 5400 cGy of local irradiation. To determine whether adjunctive chemotherapy will improve the outcome of these particular patients, we propose that a randomized trial comparing radiotherapy to chemoradiation be conducted.
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Affiliation(s)
- Federico L Ampil
- Division of Radiation Oncology, Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA
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Webb CJ, Makura ZGG, Jackson SR, Helliwell T. Primary extramedullary plasmacytoma of the tongue base. Case report and review of the literature. ORL J Otorhinolaryngol Relat Spec 2002; 64:278-80. [PMID: 12232475 DOI: 10.1159/000064142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary extramedullary plasmacytomas (PEMP) are rare malignant neoplasms with a predilection for the head and neck. Eighty percent of all PEMP are located in this area. CASE REPORT The authors present a case of lingual plasmacytoma in a 65-year-old man, diagnosed on biopsy and treated with external beam radiotherapy.
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Affiliation(s)
- Chris J Webb
- Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK.
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Hermann P, Jahnke K. [Space-occupying lesion of the nasal septum in a patient with left-sided facial pain. Mucocele of the septum]. HNO 2002; 50:570-1. [PMID: 12168390 DOI: 10.1007/s00106-001-0572-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Windfuhr JP, Ott G. Extramedullary Plasmacytoma Manifesting as a Palpable Mass in the Nasal Cavity. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208100217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of plasmacytoma of the nasal cavity in a 60-year-old man. The patient had a history of a steadily growing and palpable mass in the opening of the left nostril. The tumor was found to be localized, and it was identified as an extramedullary plasmacytoma. The patient underwent therapy with 55 Gy of radiation. Six months following the cessation of radiotherapy, the size of the tumor had not changed. The mass was then completely excised under microscopic vision. Histopathologic examination identified the growth as a plasmacytoma with monotypic light-chain expression. To optimize the management of patients with an extramedullary plasmacytoma of the head and neck, interdisciplinary management is mandatory.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology-Plastic Head and Neck Surgery, St. Anna Hospital, Duisburg, Germany
| | - German Ott
- Department of Pathology, University Hospital, Wuerzburg, Germany
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