MedPix® Patient Chart - Case No: 14058 :: - Review Images

64 year old man presents with nasal congestion, bilateral hearing loss and mass in throat.

Mass in nose and throat.

- Review Images for PT: 14058

Infiltrative and destructive central skull base mass with both intra and extracranial extension. Mass is lobulated, destroys bone, and enhances following contrast administration.

- Review Images for PT: 14058

• Lymphoma
• Nasopharyngeal carcinoma
• Chordoma
• Metastatic disease
• Chloroma, plasmacytoma

- Review Images for PT: 14058

Dx: Plasmacytoma

Dx Confirmed by: Needle biopsy and pathological examination

- Read

Radiation therapy and Chemotherapy

Plasma cells - primary source of immunoglobulins, found in LN, GI submucosa, and bone marrow. A plasmacytoma is a localized lesion, usually of bone composed of monoclonal plasma cells. Most cases +> multiple myeloma, and solitary presenting masses require careful evaluation to exclude other lesions. Some cases of "plasmacytoma" that do not progress to multple myeloma (MM) may be "plasma cell granuloma". Two criteria (Griffiths) for plasmacytoma: survival >12 yrs w/o dissemination and negative bone marrow at autopsy. Conversion to MM usu by 5yrs, rarely >20. Solitary lesions usu spine, pelvis, or extraskeletal (nasal, sinuses, upper airway).
XR - multicystic, expansile w/thickened trabeculae (e.g. AFIP 2468693); pure lytic w/o expansion; pure sclerotic (ivory vertebrae). In spine, may cross intervertebral disc, and simulate infection. Plasmacytoma at any juxtaarticular site may cross joint.
(from RESNICK)