Clin Exp Otorhinolaryngol.  2012 Jun;5(2):107-111. 10.3342/ceo.2012.5.2.107.

Solitary Extramedullary Plasmacytoma of the Apex of Arytenoid: Endoscopic, CT, and Pathologic Findings

• Kim KS
• Yang HS
• Park ES
• Bae TH

• KMID: 2117505
• DOI: http://doi.org/10.3342/ceo.2012.5.2.107

Abstract

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm that occurs mainly in the soft tissues of head and neck region, with the paranasal sinuses, nasal cavity and nasopharynx being the most common sites. Solitary EMP of the larynx is very rare but increasingly reported recently. Common sites of involvement in larynx in the order of frequency are the epiglottis, ventricles, vocal folds and ventricular folds. We report an extremely rare case of solitary EMP involving in the apex of arytenoids that was successfully treated by only surgical excision. Because solitary EMP of the apex of artytenoids is extremely rare, it should be included in the differential diagnosis for laryngeal mass. Also, solitary, small, pedunculated and localized EMP of the larynx could be completely removed by laryngeal microsurgery.

Keyword

Extramedullary plasmacytoma; Arytenoid; Surgical excision

MeSH Terms

Diagnosis, Differential
Epiglottis
Head
Larynx
Microsurgery
Nasal Cavity
Nasopharynx
Neck
Neoplasms, Plasma Cell
Paranasal Sinuses
Plasmacytoma
Vocal Cords

Figure

• 

  Fig. 1 Laryngeal examination revealed a mass clearly demarcated, localized in the apex of left arytenoid. The lesion was a reddish, polypoid growth.

• 

  Fig. 2 Computerized tomography of the neck revealed a well demarcated, minimally enhancing, 1.5×1.0×1.2 cm sized mass in the left arytenoid region.

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  Fig. 3 Histopathology revealed a dense monoclonal infiltrate of plasma cells with eccentrically situated nuclei with mild degree of nuclear polymorphism (A: ×200, B: ×400).

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  Fig. 4 Immunohistochemistry was done for kappa (A) and lambda light chains (B) and was positive for lambda chains, which confirmed the monoclonal nature of the plasma cells (×200).

Reference

1. Horny HP, Kaiserling E. Involvement of the larynx by hemopoietic neoplasms: an investigation of autopsy cases and review of the literature. Pathol Res Pract. 1995; 3. 191(2):130–138. PMID: 7567682.

2. Kapadia SB, Desai U, Cheng VS. Extramedullary plasmacytoma of the head and neck: a clinicopathologic study of 20 cases. Medicine (Baltimore). 1982; 9. 61(5):317–329. PMID: 6180279.

3. Medini E, Rao Y, Levitt SH. Solitary extramedullary plasmacytoma of the upper respiratory and digestive tracts. Cancer. 1980; 6. 45(11):2893–2896. PMID: 7379019.

4. Kayrouz T, Jose B, Chu AM, Scott RM. Solitary plasmacytoma. J Surg Oncol. 1983; 9. 24(1):46–48. PMID: 6887936.

5. Kost KM. Plasmacytomas of the larynx. J Otolaryngol. 1990; 4. 19(2):141–146. PMID: 2348508.

6. Pahor AL. Plasmacytoma of the larynx. J Laryngol Otol. 1978; 3. 92(3):223–232. PMID: 632661.

7. Maclennan KA, Schofield JB. Ferlito A, editor. Heamopoeitic neoplasms. Neoplasms of the larynx. 1993. Edinburg: Churchill Livingstone;p. 331–333.

8. Cady B, Rippey JH, Frazell EL. Non-epidermoid cancer of the larynx. Ann Surg. 1968; 1. 167(1):116–120. PMID: 5635178.

9. Nakashima T, Matsuda K, Haruta A. Extramedullary plasmacytoma of the larynx. Auris Nasus Larynx. 2006; 6. 33(2):219–222. PMID: 16406428.

10. Gorenstein A, Neel HB, Devine KD, Weiland LH. Solitary extramedullary plasmacytoma of the larynx. Arch Otolaryngol. 1977; 3. 103(3):159–161. PMID: 836244.

11. Bachar G, Goldstein D, Brown D, Tsang R, Lockwood G, Perez-Ordonez B, et al. Solitary extramedullary plasmacytoma of the head and neck: long-term outcome analysis of 68 cases. Head Neck. 2008; 8. 30(8):1012–1019. PMID: 18327783.

12. Gormley PK, Primrose WJ, Bharucha H. Subglottic plasmacytoma of the larynx: an acute presentation. J Laryngol Otol. 1985; 9. 99(9):925–929. PMID: 4045314.

13. Batsakis JG. Pathology consultation: plasma cell tumors of the head and neck. Ann Otol Rhinol Laryngol. 1983; May-Jun. 92(3 Pt 1):311–313. PMID: 6859750.

14. Koufman JA, Halum SL, Postma GN. Bailey BJ, Johnson JT, Newlands SD, Calhoun KH, Deskin RW, editors. Controversies in laryngology. Head and neck surgery-otolaryngology. 2006. 4th ed. Philadelphia: Lippincott Williams & Wilkins;p. 910–911.

15. Husain M, Nguyen GK. Primary pulmonary plasmacytoma diagnosed by transthoracic needle aspiration cytology and immunocytochemistry. Acta Cytol. 1996; May-Jun. 40(3):622–624. PMID: 8669215.

16. Holland J, Trenkner DA, Wasserman TH, Fineberg B. Plasmacytoma: treatment results and conversion to myeloma. Cancer. 1992; 3. 69(6):1513–1517. PMID: 1540888.

17. Yavas O, Altundag K, Sungur A. Extramedullary plasmacytoma of nasopharynx and larynx: synchronous presentation. Am J Hematol. 2004; 4. 75(4):264–265. PMID: 15054830.