Plasmacytoma masquerading as an abscess

Abstract

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells and has been classified as multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma. Extramedullary plasmacytoma is defined as neoplastic proliferation of plasma cells in the soft tissue. Extramedullary plasmacytoma of the head and neck is very uncommon tumors, representing approximately 0.4% of all head and neck malignancies; amongst them, plasmacytoma of the maxilla is extremely rare. We present a case of a 70-year-old male with swelling on the right middle third of the face, mimicking an abscess, but proven to be extramedullary plasmacytoma. This report discusses the clinical, radiographic, histological, and immunohistochemical features of extramedullary plasmacytoma.

Orbital Plasmacytoma Mimicking an Orbital Abscess

“…Biopsy of the mass showed an extramedullary plasmacytoma. 19 Similar to these cases, our patient presented with CT findings and an exam consistent with an infectious orbital abscess. There are a number of reasons, however, arguing against it being infectious and more likely to have been a sterile secondary infiltrate.…”

“…Third, lymphoproliferative diseases (including plasmcytomas) have been reported to create pseudoinfectious abscesses. 18,19,21 Finally, unlike infectious orbital abscesses, plasmacytomas have a tendency toward presenting in the superiotemporal orbit, and may be a result of the increased blood flow in that area of the orbit or a predilection for multiple myeloma to affect the lacrimal gland. 22 Although plasmacytomas have presented as abscesses in other locations in the body, to our knowledge, this is the first report of a plasmacytoma presenting as a sterile abscess in the orbit.…”

Kaposi Sarcoma with Abscessing Clinicopathologic Morphology

“…The possible pathogenetic mechanisms for the intra-tumoral neutrophilic influx are categorized into those related to local, systemic HAART-related [32][33][34][35] and systemic HAART-unrelated [36,37] mechanisms (Table 2), the latter based on responses caused by tumor-associated neutrophils (TANs) in a wide range of cancers [38][39][40][41][42][43][44][45][46][47][48][49][50]. In this study, the local mechanisms for intra-tumoral suppuration include origin of the suppurative component from acute folliculitis in hair-bearing skin, post-traumatic and foreign body reactions, entrapment of superficial acute inflammatory exudate and underlying osteitis.…”

“…TANs have been identified in hematological (Hodgkin and non-Hodgkin anaplastic lymphomas [37,38], plasmacytoma [39], histiocytic sarcoma [40]), epithelial (esophageal [41], gastric [42], pancreaticobiliary [43,44], lung [45], head and neck squamous [36], breast [46,50], renal [47], urinary bladder carcinomas [48]) and germ cell [49] malignancies. In some settings, the neutrophilic influx into tumors has been described as 'pyogenic' [37], 'suppurative' [60] or an 'abscess' [38][39][40]46] in clinical and histopathological presentations. Malignant tumors involving the lung [45], face [39] and bone [38] have masqueraded as an abscess clinically but to the best of our knowledge, KS masquerading as an abscess clinically has been documented only once to date, in a vulval location [61].…”

“…In some settings, the neutrophilic influx into tumors has been described as 'pyogenic' [37], 'suppurative' [60] or an 'abscess' [38][39][40]46] in clinical and histopathological presentations. Malignant tumors involving the lung [45], face [39] and bone [38] have masqueraded as an abscess clinically but to the best of our knowledge, KS masquerading as an abscess clinically has been documented only once to date, in a vulval location [61].…”