多発性骨髄腫に移行した鼻腔原発髄外性形質細胞腫例

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  • A Case of Extramedullary Plasmacytoma of the Paranasal Sinus which Progressed into Multiple Myeloma
  • 臨床 多発性骨髄腫に移行した鼻腔原発髄外性形質細胞腫例
  • リンショウ タハツセイ コツズイシュ ニ イコウ シタ ビコウ ゲンパツズイガイセイ ケイシツ サイボウ シュレイ

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A plasmacytoma is a mass of neoplastic plasma cells (terminally differentiated B cells) that often grows in the nasal cavity and paranasal sinus. Herein, we report on a case of extramedullary plasmacytoma of the nasal cavity that progressed to multiple myeloma. A 58-year-old male with tumors of the nasal cavity underwent tumorectomy at another hospital in 1988, in April and in November 2006. Histopathologic results indicated plasmacytoma. He was referred to our department in February 2007. The initial examination identified dark red bilateral masses with a smooth surface in the inferior nasal meatus, indicating a recurrence of extramedullary plasmacytoma of the nasal cavity. The patient underwent another tumorectomy and subsequent radiotherapy (45 Gy) in May 2007. Follow-up examination detected an increase in IgA levels from June 2008. Although no new lesions were found in the nasal cavity, and although fludeoxyglucose (18F)-positron emission tomography detected no abnormalities, IgA levels continued to rise. A bone marrow biopsy performed in 2011 indicated disease progression to multiple myeloma. Around the same time, the patient complained of pain in the posterior region of the neck, and magnetic resonance imaging detected lesions suspected as being multiple myeloma in the posterior region of the cervical and upper thoracic vertebrae. Pathological fractures were also found in the cervical vertebrae. The patient received radiotherapy to the cervical and thoracic vertebrae and is currently undergoing chemotherapy. The prognosis in patients with extramedullary plasmacytoma is poor once the disease has progressed to multiple myeloma. Disease progression is difficult to detect at the early stage, even with regular tests and medical examinations. Thus, regardless of the recurrence of lesions, it is important to employ a proactive strategy, such as bone marrow biopsy, for long-term regular follow-up in patients with extramedullary plasmacytoma.<br>

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