Solitary extramedullary plasmacytoma (a case report).

S Ghildiyal, M Faria, R Gulati 
 Department of Surgery, V. N. Desai Hospital, Santacruz, Bombay, Maharashtra.

Correspondence Address:
S Ghildiyal
Department of Surgery, V. N. Desai Hospital, Santacruz, Bombay, Maharashtra.

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::   Introduction

Multiple myeloma, a disease of unknown aetiology characterized by proliferation of plasma cells commences insidiously and is usually diagnosed at an advanced stage often with extramedullary manifestations. Solitary plasmacytomas are similar tumours arising from the upper air passages and other extramedullary areas, a proportion of which may ultimately lead to the generalized disease, others dying from local invasion and the remainder showing no further evidence of the tumour either at the local site or distally following treatment.

::   Case report

KJ, a 27-year-old constable, presented with a six months' history of recurrent epistaxis and a blocked left nostril. On nasal examination, a friable, greyish white mass was observed in the left nostril. A biopsy taken from the mass demonstrated plasmacytoma. Skeletal survey was normal, urine revealed no abnormal proteins, and serum protein profile was normal. Radiotherapy was given followed by no recurrence over a follow-up period of six months.

::   Discussion

Willis[6], as well as Stout and Kenney[5] have laid emphasis on the lymphocytic origin of plasmacytomas.

Willis[6] classified them as (1) multiple myeloma -generalized; (2) solitary plasmacytoma of the bone; and (3) solitary plasmacytoma of soft tissue.

Extramedullary plasmacytomas commonly affect the upper respiratory tract and the oral cavity (82%), forming 0.5% of the tumours in this region[4]. Recent series report a male preponderance (1.5:1), a median age of 56 years at the time of diagnosis with a variety of symptoms based on the site of growth[1],[2],[3],[5]. Twenty per cent of the patients show spread of the growth to the draining lymph nodes. Serum monoclonal proteins have been detected in 25% of the cases while in less than 4% Bence Jones proteins in the urine have been found[3],[4].

In view of extreme radiosensitivity of the tumour, treatment of choice is radiotherapy. Recurrence depends on the dose of radiation given and surgery is reserved for the same.

In recent series, with high dose radiotherapy (5000 rads), the local recurrence rate has averaged to around 6%[1],[3],[4]. In one third of the cases, local recurrence heralds the onset of dissemination which may take the form of either typical multiple myeloma or of metastasis of soft tissue or of bones. On the other hand, further local radiotherapy may lead to a second remission lasting for many years.

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