Extramedullary Plasmacytoma of the Nasal Cavity

medullary neoplasms. The latter are rare tumors, more commonly presenting in the submucosal tissue of the upper respiratory tract. A mass or swelling causing nasal or pharyngeal symptoms is by far the most common presentation of this entity in the head and neck region. We report a case of nasal extramedullary plasmacytoma in a 75-year-old female with left nasal obstruction, epiphora, and hearing loss. A review of the symptoms presentations, diagnosis, treatment, survival, and prognostic factors in the affected patients, is also presented. The most common symptoms of nasal tumors, whether benign or malignant, consist of nasal obstruction, blood-tinged mucus, and epistaxis. Facial asymmetry, loose teeth, and sensory changes around the nose are late symptoms and occur less frequently. Differential diagnosis of a nasal mass includes both benign and malignant tumors. Benign tumors of the nose are rare in comparison with malignant growths. In decreasing order of frequency, the benign tumors are osteoma, hemangioma, papilloma, and angiofibroma. Squamous cell carcinoma is the most common malignant tumor of the nose. Other malignant neoplasms include adenocarcinoma, adenoid cystic carcinoma, sarcoma, and malignant melanoma. A rare malignant tumor of the nasal cavity is extramedullary plasmacytoma. According to Willis,1 plasmacytomas are classified into 3 groups: 1. Multiple myeloma characterized by generalized bone involvement and characteristic radiographic findings, with frequently abnormal serum protein and Bence-Jones proteinuria. 2. Solitary plasmacytoma of the bone, with no evidence of generalized disease. 3. Primary plasmacytoma of the soft tissues that can be single or multiple. Extramedullary plasmacytoma represents less than 1% of all head and neck malignancies and less than 0.4% of upper respiratory malignancies. In 1997, Pahor2 reported on a series of 943 cases of plasmacytomas in the period 1963 to 1972. Twenty-two of these cases were extramedullary plasmacytomas, 14 of which were in the head and neck region. Clinical presentation is that of a submucosal mass or swelling with a polypoid configuration often without bone destructions and causing nasal or pharyngeal symptoms.