Sonographic Diagnosis of a Tracheal Extramedullary Plasmacytoma

Abstract

olitary extramedullary plasmacytoma (EMP) is a rare tumor constituting 4% of all plasma cell neoplasms. It may occur in any reticuloendothelial system containing organs but is found most frequently in the head and neck regions, which are rich in lymphoid tissue. The most common sites of origin are the subepithelial tissues of mucous membranes of the oronasopharynx and paranasal sinuses. [1][2][3][4][5] Sonography has no role in the evaluation of tracheal lesions. We report a case of tracheal plasmacytoma that was discovered during a sonographic examination of the neck for goiter. The interesting aspect of this case is the presentation of a rare tracheal tumor diagnosed by a sonographic examination.Received January 10, 2005, from the Departments of Nuclear Medicine (M.R., A.S., M.A., A.F.Y.) and Radiology (F.T.) Case ReportA 63-year-old female patient was referred to our department for thyroid sonography and scintigraphy to evaluate a multinodular goiter. The patient had exertional dyspnea for 6 months. Her respiratory symptoms had worsened during the last month. Physical examination revealed a large nodule on the left lobe of the thyroid gland. There were no palpable lymph nodes. An inspiratory fluctuation was sensated on the jugular notch. The remainder of the physical examination was unremarkable. Subclinical hyperthyroidism was detected. The values for total triiodothyronine and total thyroxine were normal; the value for thyrotropin was 0.09 mIU/mL (reference range, 0.35-5.5 mIU/mL). Chest radiography revealed cardiomegaly, and a small calcified parenchymal nodule was evaluated as a sequela from tuberculosis. Electrocardiography showed atrial fibrillation.

Solitary Plasmacytoma of Scalp without Intra Cranial ExtensionA Cytological Rare Case Report

“…Once disease becomes multiple myeloma, then prognosis is not as good as plasmacytoma; chemotherapy should be added [13,14] . The potential for malignant systemic progression is higher for solitary plasmocytomas of bone than for extramedullary plasmocytomas [15] . It has been reported that extramedullary localizations of myeloma originating from the cranial bone are usually responding well to new drugs (e.g., thalidomide, bortezomib, and lenalidomide) compared to CNS myeloma [16] .…”

Extramedullary Plasmacytoma of the Trachea

“…Rarely extramedullary plasmacytoma can occur in the thyroid, hypopharynx, larynx, parotid gland, cervical lymph nodes and middle ear. Other areas affected include gastrointestinal tract, bladder, breast, central nervous system, testis, skin, lung parenchyma and bronchus [1][2][3].…”

“…Extramedullary plasmacytoma respond well to radiation therapy [2,6,13]. Data from literature shows that around 60 % of patients with plasmacytoma of upper aerodigestive tract had no recurrence or progression to multiple myeloma whereas 22 % cases had recurrence and 16 % showed progression to multiple myeloma [2,3,14]. Therefore even though the prognosis of plasmacytoma is better than that of multiple myeloma, a long term follow up is recommended.…”

Plasmacytoma of the trachea: a surprising diagnosis

“…Less common still are tracheal tumors, which account for only 1-2% of all respiratory tract tumors (5,6) , affecting mainly the lower third of the tract (7) . Such tumors can be locally invasive (3) , adenoid cystic carcinoma and squamous cell carcinoma being the malignant tumors most often affecting the trachea (5,6,8) . The most common symptoms are related to airway obstruction, dyspnea being the most common, and become more evident when the tracheal lumen is narrowed by more than 75% (5,9) .…”

“…Extramedullary plasmacytoma of the trachea is a rare plasma cell malignancy (accounting for only 4% of plasma cell tumors), having been described in soft tissues outside the bone marrow, involving the submucosal lymphoid tissue, and occurring at different locations, especially in the upper airways, most often in the paranasal sinuses or nose (5,8,10) . Involvement of the larynx, hypopharynx, cervical glands, esophagus, cervical lymph nodes, middle ear, and mastoid is rare (5) , and tracheal involvement is even rarer (5,11-13) , occurring in only 3% of all extramedullary plasmacytomas (9) .…”