Extramedullary plasmacytoma of the trachea

Abstract

Extramedullary plasmacytomas are plasma cell tumors that occur outside the bone marrow. They constitute around 4 % of all plasma cell neoplasms. The most common site of extramedullary plasmacytoma is the upper aerodigestive tract-nasal cavity, paranasal sinuses and oronasopharynx. We are presenting a case of extramedullary plasmacytoma of the trachea. Trachea is an extremely rare site of plasmacytoma. When extraosseous plasmacytoma occur in uncommon sites, the distinction from B cell lymphomas showing extensive plasmacytic differentiation can be difficult and diagnostically challenging.

Fig. 1

Computerized tomography (sagittal section) of the thorax showing a lobulated soft tissue attenuation mass lesion in the trachea, arising from the posterior wall and protruding intra luminally

Fig. 2

Post contrast axial section showing mass lesion in the trachea, causing partial luminal compromise

Fig. 3

Bronchoscopy showing broad based pedunculated intraluminal tracheal mass which markedly narrow the lumen

Fig. 4

Microscopy showing neoplasm beneath the intact squamous epithelium (H and E, ×100)

Fig. 5

Higher power showing sheets of plasmacytoid cells. (H and E, ×400)

Fig. 6

Tumour cells showing intense positivity for CD138. (IHC, ×400)

Fig. 7

Coronal CT sections through the paranasal sinuses (bone window) reveal a soft tissue mass in the right nasal cavity, region of inferior turbinate, with irregular destruction of adjacent hard palate

Fig. 8

Microscopy of paranasal sinus mass showing sheets of plasmacytoid cells including immature and binucleate forms. (H and E, ×400)