Detection of a extramedullary plasmocytoma in the sphenoid sinuses

Introduction:

Only 5% of plasma cell disorders are extramedullary plasmocytomas and is associated with a solitary plasma cell proliferation. They are mostly found in the upper airway tract (80%).

Methods:

Case report, literature research

Results:

A 62-year old female patient presented with multiple lesions in the sphenoid sinuses. During chemotherapy of a plasmocytoma the patient complained of hypoesthesia in the area of the mandibular nerve on the left. A MRI revealed two exophytic masses confined to the sphenoid sinus. A trigeminial lesion wasn't found so that the mentioned tumors are an incidental finding. A CT of the nasal cavities showed the two masses in the sphenoid sinuses with elevated density. Bone defects lateral from the smaller mass and dorsobasally from the bigger process as well as a 2 cm area of structural defective bone were revealed in the CT. The clivus showed an inhomogenic and opaque structure with denser and less dense areas. Further more the petrous apex was destructed. In our clinic specimen was collected endoscopically from the smaller process and the bigger masses was excised. Histology revealed a dense infiltration of a extramedullary plasmacellular differentiated cells with pleomorphic nuclei and multiple nuclei. After immunohistochemical workup of the tissue characteristics of a cytoma were found: CD 138, MUM 1 and a monotypical expression of the immunoglobuline light chain kappa. These findings were assessed as extramedullary progression of the known plasmocytoma so the patient was treated with antibodies after being staged accordingly.

Conclusions:

Extramedullary plasmocytoma are rarely found in the nasal cavaties but have to be considered as a differential diagnosis when dealing with solid lesions especially with associated osteolysis.

Susann Bär

Uniklinikum Dresden,

Fetscherstr. 74, 01307

Dresden

Email: [e-mail]

Publication History

Publication Date:
23 April 2019 (online)