Extramedullary Plasmacytoma of the Larynx: A Case Report of Subglottic Localization

Abstract

Extramedullary plasmacytoma (EMP) is a rare neoplasm of plasma cells, described in soft tissue outside the bone marrow. EMP of the larynx represents 0.04 to 0.45% of malignant tumors of the larynx. A male of 57 years old presented with hoarseness, dyspnea, and biphasic stridor of 2 months. The indirect laryngoscopy (IL) revealed severe edema of the posterior commissure and a polypoid mass in the right posterior lateral subglottic wall. A biopsy of the subglottic mass was performed by a direct laryngoscopy (DL). The histopathologic diagnosis was EMP CD138+, therefore radiotherapy was given at 54 Gy in 30 sessions. The patient had an adequate postoperative clinical course and a new biopsy was performed having tumor-free margins. All laryngeal lesions should be biopsied prior to treatment to determine an accurate diagnosis to guide a proper management of the condition. Radiation therapy to the EMP is considered the treatment of choice, having local control rates of 80% to 100%. The subglottis is the least accessible area of view and the least frequent location of a laryngeal mass, nevertheless the otolaryngologist should always do a complete and systematic exam of the larynx when a tumor is suspected, to detect diagnoses such as a subglottic plasmacytoma.

A case report of multiple extramedullary plasmacytoma of the head and neck

“…It is generally considered that treatment strategies included surgical excision, systemic chemotherapy, radiotherapy, or a combination of those. [13] Ge et al [14] suggested that surgical excision, either alone or with adjuvant radiotherapy, has been proposed and proved to be more beneficial than radiotherapy alone. Takahiro et al [15] showed that surgical excision offers better survival outcomes in the therapy of small and localized EMP of the larynx.…”

Plasmocitoma extramedular de laringe. A propósito de un caso

“…Los PS son tumores infrecuentes de cabeza/ cuello y la mayoría corresponde a plasmocitoma extramedular de ubicación nasosinusal. La localización a nivel laríngeo es muy inusual 2 . En nuestra revisión, sólo se han encontrado 56 casos reportados como PEM a nivel laríngeo.…”

“…Estos tumores son infrecuentes y afectan con mayor preponderancia a varones de más de 50 años. Los principales síntomas están relacionados con el crecimiento local 2 . Los PS se clasifican en: plasmocitoma óseo solitario (POS) y plasmocitoma extramedular (PEM).…”

“…Los PS se clasifican en: plasmocitoma óseo solitario (POS) y plasmocitoma extramedular (PEM). El POS afecta preferentemente huesos largos y esqueleto axial, siendo infrecuente a nivel de cabeza y cuello 1,2 . En contraste los PEM se ubican en áreas submucosas y un 80%-90% se presentan a nivel de cabeza y cuello, específicamente a nivel del tracto aerodigestivo superior, preferentemente a nivel nasosinusal.…”

“…Los PEM de cabeza y cuello se presentan mayormente en forma localizada, siendo poco frecuente que presenten adenopatías en el momento del diagnóstico (5%-20% de los casos) 4 . El diagnóstico es histológico e inmunohistoquímico, donde se observan células plasmáticas monoclonales 2 . En el estudio hematológico, se debe solicitar un hemograma completo, electroforesis en suero/orina, cuantificación de inmunoglobulinas (Ig), biopsia de médula ósea y estudio de extensión 4 .…”