Sinonasal Extramedullary Plasmacytoma With Rare Osteolytic Lesions

Abstract

Plasmacytomas are malignant tumors characterized by abnormal monoclonal proliferation of plasma cells. They originate either from bone or soft tissue and could be primary or a part of a systemic process during the course of multiple myeloma. Extramedullary plasmacytomas (EPs) in the sinonasal tract or nasopharynx are rare and mostly presented as case reports. We describe a unique case of multiple myeloma involving the nasal cavity and the paranasal sinuses with osteolytic expansile lesions of the first cervical vertebrae (atlas), the clavicle, and the skull in a 51-year-old man. The diagnostic approach was challenging, and finally the biopsy of the extramedullary tumor settled the diagnosis of multiple myeloma. The patient underwent posterior occipitocervical fusion due to upper cervical spine instability due to atlas osteolysis. The patient had an uneventful recovery, and he was finally referred to the hematology department. EP of the nasal cavity is a rare entity and requires a high index of suspicion. EP should be included in the differential diagnoses of nasal cavity masses, especially in males in the age group of 50-60 years. A thorough clinical history, examination, and proper laboratory and radiological investigations are important to settle an accurate diagnosis to initiate treatment as soon as possible. Timely diagnosis ensures a better prognosis and deters the progression of the disease.

Diagnosis and management of extramedullary plasmacytoma in nasal cavity: Clinical experience and literature review

“…Alexiou et al reviewed the head and neck EMP in detail and found that the combination of radiation and surgery resulted in a significant lead in 5-year survival, with a 5-year survival rate of approximately 50%. [ 23 ] Moreover, another study revealed that 40% of EMPs spread beyond the primary site and/or developed lymphatic drainage, 62% of patients had deposits in soft tissues and internal organs, and 81% of patients developed bone lesions. [ 12 ] The results of our study on our patient and previous literature review show that nasal EMP has less progression to MM, recurrence and metastasis, which may be related to the short follow-up time.…”

“…Through systematic and gradual screening of literature, 20 full texts including 23 patients were finally obtained. [2,5,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Including our patient, a total of 24 patients consisting of 16 men and 8 women, were included in this study. The median age of onset in men was about 52.9 years, and the age ranged from 45 to 63 years.…”

Solitary plasmacytoma of the maxilla: a case report

“…1, врезка). В прилежащей слизистой оболочке В отличие от предыдущих наблюдений G. Pantazidou [9] описал пациента 51 года с клинической картиной, сходной с таковой в нашем случае, и диагнозом «экстрамедуллярная солитарная плазмоцитома носовой полости и носовых синусов с поражением костной ткани». При ИГХ исследовании у этого пациента в опухоли выявлены позитивные маркеры CD79a, CD138.…”

Plasma cell tumors of the head and neck. Analysis of diagnostic difficulties based on literature and own data

“…Счи тается, что от 11 до 30 % случаев ЭП может прогрес сировать до плазмоклеточной миеломы в течение 10 лет [11]. Так, описан первый случай ЭП, поража ющей области носа и околоносовых пазух, с присутст вием остеолитического поражения шейных позвонков, ключицы и черепа на момент постановки диагноза [12]. Соответственно, при подозрении, выявлении и подтвер ждении ЭП необходимы четкая визуализация опухоли и детальные лабораторные исследования для подтвер ждения или исключения диагноза плазмоклеточной миеломы.…”