Prognostic factors of laryngeal solitary extramedullary plasmacytoma: a case report and review of literature

Abstract

A paucity of data exists concerning the presentation, natural course and outcome of extramedullary plasmcytoma (EMP). It is difficult to determine the optimal treatment strategy and prognostic factors for EMP. We present an additional case of laryngeal EMP and systemic review relevant reports in the English and Chinese literature. We found, to our knowledge, 147 cases in larynx in the English-language literature and Chinese-literature. The most common treatment modality was radiotherapy alone. The mean survival duration was ~184 months, and the 5- and 10- year survival rates were 76.1% and 67.4%, respectively. The univariate analysis suggested that progression to multiple myeloma and amyloid deposits may be poor prognostic factors. The multivariate analysis suggested that only progression to multiple myeloma may be a poor prognostic factor. Laryngeal EMP is uncommon. Progression to multiple myeloma may be a poor prognostic factor.

Keywords: Extramedullary plasmcytoma; amyloid deposits; larynx; prognosis; progression to multiple myeloma.

Figure 1

Laryngeal stroboscopy revealed a 2 × 2-cm reddish smooth mass overlying the left hemilarynx, the base from the aryepiglottic fold.

Figure 2

MRI showed an irregular mass overlying the left false cord, vocal cord, and piriform sinus, and no enlarged node was present. T1-weighted imaging showed isointensity (A), and T2-weighted imaging showed hyperintensity (B). Diffusion-weighted MRI (DWI) showed that the lesion had high signal intensity (C), and the apparent diffusion coefficient (ADC) was 1.18 × 10^-3 mm²/s (D).

Figure 3

A 3.5 × 2.5 × 2 cm reddish mass in the left aryepiglottic fold, laryngeal ventricle, and false cord was completely excised via neck lateral incision.

Figure 4

Pathological results demonstrated abnormal proliferative plasma cells arranged in a solid sheet, and these cells showed invasive growth involving the surrounding muscles and glands (A). Immunohistochemical staining showed that the cells were positive for CD138 (B), CD79a (C), and lambda light chain (D).

Figure 5

Postoperatively, the patient received radiotherapy (50 Gy in 200-cGy fractions delivered over 30 days) to the laryngeal andcorresponding neck lymph regions.