Extramedullary Plasmacytoma in the Nasal Cavity

Extramedullary plasmacytomas (EMPs) are rare tumors developing as a result of the monoclonal proliferation of plasma cells (1). They constitute less than 1% of all head and neck malignancies, and their incidence is 0.03%. They are more commonly seen in men than in women, and their incidence rises with increasing age. EMP etiology is not completely known. It is mostly in the form of solitary masses but may also be observed as multiple masses. The most common localization site of EMPs is the upper respiratory tract submucosa. The most important reason they are seen in this region is that the submucosa is rich in plasma cells (2). In the large case series, conducted by Alexiou et al. (3), the upper airway tract was detected as the localization site in 714 (82.2%) of 869 EMP patients. The most common localization sites in the upper airway tract are the nasal cavity and paranasal sinuses (43.8%), followed by the nasopharynx (18.3%), oropharynx (17.8%), and larynx (11.1%). The rare occurrence of the tumor, its slow progress, and its nonspecific findings make diagnosis difficult. The tumor has a destructive character and may recur. It can cause lymph node metastasis and can progress to multiple myeloma (MM) (4). The most common clinical symptoms are nasal congestion, epistaxis, and nasal discharge. The differential diagnosis of MMs from solitary medullary plasmacytomas has to be made by examinations such as serum electrophoresis, Bence Jones proteinuria, and bone marrow examination. Radiotherapy is the ideal treatment because it is a radiosensitive tumor. Surgery is ideal to provide local control; however, due to the tumor’s localization and greatness, its radical excision is mostly impossible. The effectiveness of chemotherapy is unclear (5).