Plasmacytomas occasionally may arise in extraosseous sites, of which the upper respiratory tract is the most common. In our series of 256 nonepithelial tumors involving the nasal cavity, paranasal sinuses and nasopharynx, 10 (4%) were apparently primary extramedullary plasmacytomas. Of our patients with adequate follow-up information, four died of disseminated disease 2, 4, 5 and 6 years after the initial diagnosis. One was alive 6 years after diagnosis with locally persistent tumor. Another was living without recurrence 12 years later. Based on our findings and on the cases reported in the literature, extramedullary plasmacytomas arising in the head and neck area may evolve into one of several different patterns. 1) Some patients have localized disease which is apparently controlled (by surgery, radiotherapy or both) and which never recurs locally or becomes disseminated. 2) In some cases, the tumor recurs locally and is controlled by further therapy. 3) Other patients have a locally persistent and aggressive lesion which cannot be eradicated and which eventually leads to the patient's death by uncontrolled local growth. 4) Still other patients eventually develop evidence of plasma cell neoplasms elsewhere in the body and/or multiple myeloma.

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Twelve cases of meningiomas involving the nasal cavity and paranasal sinuses are reported. Meningiomas only rarely involve the upper respiratory tract; these 12 cases were found among the 566,000 surgical pathology cases that have been studied in this laboratory. In this series, five meningiomas probably arose in the cranial cavity and secondarily extended into the nasal cavity and paranasal sinuses. Because radiographs demonstrated hyperostosis or bone destruction, three other tumors could have involved the cranial cavity, but this was never proven. In two other cases, the meningiomas appeared to involve only extracranial tissues and thus probably were primary extracranial lesions. (The data available in two other cases were insufficient to assess the possibility of intracranial involvement). These patients clinically had nonspecific signs and symptoms similar to those produced by other types of neoplasms growing in the upper respiratory tract. The tumor involved the sphenoid area in seven cases, the nasal cavity in six, the maxilla in five, the ethmoid sinus in four, and the frontal sinus in one. The diagnosis was first established when biopsy material was examined, although in several cases the presence of meningioma was first suggested on radiographic examination. Treatment depended upon the size and location of the tumor. In some cases, surgical resection appeared to control the lesion. These tumors did not appear to respond well to radiotherapy. The histologic differential diagnosis is discussed.