Extramedullary Plasmacytoma of the Larynx Treated by a Surgical Endoscopic Approach and Radiotherapy

Abstract

Extramedullary plasmacytoma (EMP) is a rare variant of plasma cell myeloma that affects soft tissues. The head and neck region are the most affected sites, although others have also been described. Herein we report an uncommon case of EMP of the larynx in a 65-year-old male who presented with a history of progressive dysphonia and hoarseness. Laryngeal fiberscopy evidenced a reddish pedicled voluminous mass in the left false cords and ventricle. Microscopic suspension laryngoscopy was performed under general anaesthesia and a 4 W Acublade CO2 Laser was used for transoral resection of the lesion. This was followed by adjuvant radiotherapy, with the widely recommended doses on the supraglottic region, to achieve better local control. Diagnosis of EMP is based on immunohistochemistry and the exclusion of systemic plasma cell proliferative disorders. Diagnosis of solitary EMP can be made only if studies for disseminated disease and X-ray and/or magnetic resonance imaging of the spine, pelvis, femurs, and humerus and bone marrow biopsy are negative. As there are no internationally established guidelines, treatment of EMP is mainly based on consensus of expert opinion.

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

“…The prognosis of patients with newly diagnosed sEMP-L in our cohort was good, and no patient experienced progression once a response was obtained during the follow-up period. This observation is in line with the reports from the literature [ 9 , 10 , 15 , 16 ]. The median OS for all patients was not reached during the observation time, while the 5-year estimate was established at 86% (95% CI, 79–94%), and the 10-year OS at 81% (72–90%).…”

Outside the box—Surgery for aggressive plasmacytoma in scar

“…A recently published consensus of the Chinese Myeloma Working Group 14 regarding surgical management of myeloma bone disease (MBD), recommended the surgical removal of huge and rapidly growing EMPs while aiming to preserve all vital structures in proximity and within the tumor. Very rarely is surgery recommended as treatment for EMP, as reported in solitary parotid lesions, exophytic vocal cord, and eye lid 15‐17 . In our case, none of the standard treatments were effectively able to control the growth of this tumor, as it posed an immediate threat to the patient's life from bleeding and infection.…”

“…Very rarely is surgery recommended as treatment for EMP, as reported in solitary parotid lesions, exophytic vocal cord, and eye lid. [15][16][17] In our case, none of the standard treatments were effectively able to control the growth of this tumor, as it posed an immediate threat to the patient's life from bleeding and infection. Taking the patient to surgery represents a paradigm shift, "buying" time and controlling the urgent hazard, even at the expense of a largescale surgery, that may not usually be undertaken in view of an aggressive systemic disease.…”

Extramedullary plasmacytoma of the larynx: Literature review and report of a case who subsequently developed acute myeloid leukemia

“…Finally, 70 studies comprising a total of 98 cases were left for analysis. Therefore, a total of 99 unique patients including our case were identified and the individual patient data collected are given in Table I ( 5 – 71 ). The clinical characteristics for the 99 patients included were summarized in Table II .…”