Correspondence

Solitary Extramedullary Plasmacytoma

N Engl J Med 1997; 337:1174October 16, 1997

Article

To the Editor:

We wish to report on an unusual presentation of multiple myeloma. A 44-year-old man had a dry cough and slowly increasing dyspnea over four months. He smoked 20 cigarettes a day and had had asthma as a child. He presented after an acute exacerbation, when he expectorated a fleshy mass associated with a large amount of fresh blood. His dyspnea markedly improved thereafter. He brought the mass, wrapped in a handkerchief, to the hospital. The admitting doctor submitted it for histologic examination, which revealed an extramedullary plasmacytoma with kappa light-chain restriction. At bronchoscopy, a polypoid lesion obstructing about 50 percent of his trachea was seen 6 cm distal to the vocal cords. The results of subsequent staging investigations were normal — in particular, the bone marrow examination, protein electrophoresis, skeletal survey, and analysis of urine for Bence Jones protein.

He was treated with radical radiotherapy, with 4-MV photons as a parallel opposed pair (6 by 6 cm), and given a mid-plane dose of 35 Gy in 15 fractions over a period of 21 days. The treatment was tolerated well. The results of bronchoscopy two months after treatment were normal, and the patient remains well, with no evidence of recurrence.

Solitary extramedullary plasmacytomas are rare. The majority involve the upper air passages of the head and are thought to arise in the submucosa, where plasma cells are numerous.1 The rate of progression to multiple myeloma is low in contrast to that for solitary plasmacytomas of bone. Solitary plasmacytomas can be controlled with radiotherapy alone, though it appears that a dose greater than 30 Gy is required.2

Leslie Samuel, M.B., M.R.C.P.
Western General Hospital, Edinburgh EH4 2XU, United Kingdom

William Candlish, M.D.
Alistair Stark, M.D.
Dumfries Royal Infirmary, Dumfries DG1 4AP, United Kingdom

2 References

1. 1

   Wiltshaw E. The natural history of extramedullary plasmacytoma and its relation to solitary myeloma of bone and myelomatosis. Medicine 1976;55:217-238
   CrossRef | Web of Science | Medline

2. 2

   Corwin J, Lindberg RD. Solitary plasmacytoma of bone vs. extramedullary plasmacytoma and their relationship to multiple myeloma. Cancer 1979;43:1007-1013
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   R. Ria, M. Di Ianni, P. Sportoletti, M. Cimminiello, L. Marcomigni, A. Tabilio. (2006) Recurrent primary plasmacytoma of the eyelid with rapid regional metastasis. Leukemia & Lymphoma 47:3, 549-552
   CrossRef