Imaging of a case of extramedullary solitary plasmacytoma of the trachea

Abstract

We describe a case of extramedullary tracheal plasmacytoma that was incidentally discovered in a 73-year-old man on a PET scan performed for assessing the extent of colon cancer. CT scan showed the tumor; multiplanar reformation coupled with virtual bronchoscopy allowed proper treatment planning. The tracheal tumor was resected during rigid bronchoscopy. Relevant investigations excluded multiple myeloma. Follow-up CT showed persistent thickening of the tracheal wall, but there has been no recurrence after one-year followup.

Figure 1

PET scan shows a localized FDG uptake in the middle third of the trachea. (a): PET, (b): CT, (c): PET-CT. (1): axial view, (2): coronal, (3): sagittal.

Figure 2

CT scan. CT coronal reformation shows the longitudinal extent of the tumor, its location 35 mm above the carina, and the severity of tracheal narrowing (40%).

Figure 3

CT scan. Virtual endoscopy demonstrates an endoluminal view of the tracheal tumor.

Figure 4

Snapshot by tracheoscopy during the surgery shows an obstructive and fleshy tracheal mass.

Figure 5

Photomicrograph of surgical specimen. Diffuse infiltrate of neoplastic monoclonal well-differentiated plasma cells is present associated with many deposits of amyloid in the stroma (HES ×200).

Figure 6

Photomicrograph of surgical specimen. The plasma cells express cytoplasmic immunoglobulin with light chain restriction. They also express CD138, marker characteristically positive for plasma cells (immunohistochemistry, kappa ×200).