J Korean Assoc Oral Maxillofac Surg.  2010 Dec;36(6):543-547.

Extramedullary plasmacytoma in the maxillary sinus: a case report

• Kim HK
• Hahm TH
• Nam W
• Cha IH
• Kim HJ

Abstract

Plasmacytoma is a rare malignant neoplasm in the head and neck region and comprises approximately 3% of all plasma cell tumors. This lesion is a unifocal, monoclonal, neoplastic proliferation of plasma cells that usually arises within the bone. Infrequently, it is observed in soft tissue, in which case, the term extramedullary plasmacytoma is used. Approximately 80-90% of extramedullary plasmacytomas involve the mucos-Associated-Lymphoid Tissue of the upper airways with 75% of these involving the nasal and paranasal regions. The plasmacytoma is usually detected in adult males, with an average age at diagnosis of 55 years. The male-to-female ratio is 3:1.Radiographically, the lesion may be seen as a well-defined, unilocularradioluceny with no evidence of a sclerotic border. Some investigators believe that this lesion represents the least aggressive part of the spectrum of plasma cell neoplasms that extend to multiple myeloma.Therefore, plasma cytoma is believed to have clinical importance. We report a case of extramedullary plasmacytoma in the right maxillary sinus of a 59-year-old male with review of the relevant literature.

Keyword

Extramedullary plasmacytoma; Maxillary sinus

MeSH Terms

Adult
Head
Humans
Male
Maxillary Sinus
Middle Aged
Neck
Neoplasms, Plasma Cell
Plasma
Plasma Cells
Plasmacytoma
Research Personnel

Figure

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  Fig. 1. Extraoral view showing facial swelling on right buccal cheek. A: Frontal view, B: Lateral view.

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  Fig. 2. Intraoral view showing soft tissue mass on right buccal cheek mucosa.

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  Fig. 3. Preoperative panoramic view showing radiolucent lesion on right maxillary sinus.

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  Fig. 4. Axial and coronal computed tomography images showing resorpted buccal plate of right maxillary sinus and destructive bony change. A: Axial view, B: Coronal view.

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  Fig. 5. Axial and coronal MRI showing tissue mass on right buccal cheek and maxillary sinus. A: Axial view, B: Coronal view. (MRI: magnetic resonance imaging)

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  Fig. 6. Enlarged mass (arrow) compared with previous MRI. A: Axial MRI on first visit, B: Coronal view on second visit. (11 days after) (MRI: magnetic resonance imaging)

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  Fig. 7. F18-FDG PET showing uptake of FDG on right buccal cheek and maxillary sinus.(F18-FDG PET: F18-fluorode-oxyglucose positron emission tomography)

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  Fig. 8. Perioperative images. A: Preoperative margin design, B: After mass removal, C: Before reconstruction, D: After reconstruction on extraoral soft tissue defect.

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  Fig. 9. Mass removal and reconstruction using RFFF. A: Removed mass by partial maxillectomy, B: Flap design on right forearm, C: RFFF, D: After reconstruction on intraoral and extraoral soft tissue defect using one RFFF. (RFFF: radial free forearm flap)

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  Fig. 10. Histologic findins. A: Dense, homogenous infiltration of plasma cells showing varying degrees of dysplasia, including prominent nucleoli, dispersed chromatin, irregular nuclei and multinu-cleation.(H&E staining, original magnification ×200) B: IgG(+), Kappa(-), Lambda(-).(Immunohistochemical staining ×100)

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  Fig. 11. Postoperative 1 month clinical and panoramic view showing well reconstructed soft tissue defect and partial maxillectomy site on right maxilla area. A: Post operative photo, B: Post operative panoramic view.

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