Extramedullary plasmacytoma of the maxillary sinus

Abstract

Extramedullary plasmacytomas (EMPs) are localized plasma cell neoplasms that occur within the soft tissues; by definition they cannot occur within bone. They account for 1-2% of all plasma cell growths and have a great predilection for the upper respiratory tract, without specific manifestations. Males are more frequently affected during the fifth and sixth decades of life. At initial presentation, multiple myeloma should be excluded. We report herein the case of a 63-year-old man with an EMP arising in the right maxillary sinus who was referred for surgical excision and postoperative radiotherapy and briefly review the clinical implications and management of this pathology.

Extramedullary Plasmacytoma of the Paranasal Sinuses: Combining Surgery with External Radiotherapy

“…Complete excision of EMP is challenging due to the vicinity of vital structures and the large size of the tumor [3,9,14]. Moreover, surgery is frequently associated with poor functional and cosmetic results [10,11,15,16]. When negative margins are attained, local control rates with surgery alone are similar with those for RT alone [3].…”

“…The most common nasal symptoms, as confirmed by our survey, are progressive nasal obstruction and recurrent epistaxis [13,14]. Other possible symptoms are swelling, headache, nasal discharge or proptosis [15,16], pain usually occurs when there is bone involvement or infection.…”

“…Since the tumor displays submucosal growth and the mucosa might be thickened as a result of a chronic inflammation [16], profound biopsies should be taken to avoid errors. CT, MRI and a full endoscopic examination are mandatory to determine tumor extension [9][10][11][12][13][14][15].…”

“…Current guidelines recommend an irradiation dose between 40 and 50 Gy in 20 fractions with a margin of 2 cm encompassing the primary tumor [9][10][11][12][13][14][15][16][17][18], with greater doses required for tumors larger than 5 cm [1,8,9,14]. Soft tissue plasmacytomas are radiosensitive and regional control can be achieved in more than 80 % of the cases [7-9, 14, 19].…”

An Extramedullary Plasmacytoma of the Nasopharynx : A rare entity

“…The median age of patients with EMPs is 55 years. implicated as possible etiologic agents 6,7,8 . Diagnostic criteria for solitary EMP include monoclonal plasma cell histology, bone marrow plasma cell infiltration showing less than 5% of all nucleated cells, absence of any osteolytic bone lesion, absence of hypercalcemia or renal failure and low levels of paraprotein concentration if present.…”