Solitary extramedullary plasmacytoma of the larynx: a rare cause of dysphonia

Abstract

Solitary extramedullary plasmacytoma (SEP) of the larynx is a rare haematological malignancy and an infrequent cause of persisting dysphonia. We present the case of a 54-year-old woman with a long-standing history of dysphonia. While clinical examination showed a rather inconspicuous prominent right vestibular fold, an MRI revealed a laryngeal mass with erosion of the thyroid cartilage. A biopsy taken during rigid endoscopy demonstrated plasma cell infiltration with light chain restriction amidst amyloid deposits. After exclusion of systemic involvement, the diagnosis of an SEP of the larynx with secondary amyloidosis was made. The patient received primary radiation therapy. Another biopsy taken 3 months after the end of therapy did not show any signs of ongoing neoplastic plasma cell disease. The patient was therefore considered to be in remission. She is currently receiving regular follow-up and has not shown signs of persistent or progressive disease for the past 18 months.

Keywords: ear, nose and throat/otolaryngology; haematology (incl blood transfusion); radiotherapy.

Figure 1

Initial presentation of the false vocals fold on the right without apparent ulcerations or tumorous lesions.

Figure 2

An MRI taken prior to therapy shows an infiltrating laryngeal mass.

Figure 3

Coronal CT imaging displays a mass eroding through the thyroid cartilage on the right.

Figure 4

Histological specimens demonstrate plasma cell infiltration next to amyloid deposits in characteristic “Congo red” staining (circle).

Figure 5

Positron emission tomography CT demonstrates metabolic activity in the right false vocals fold.

Figure 6

An MRI after therapy does not show significant changes in the area of the plasmacytoma.

Figure 7

The post-therapeutic presentation of the false vocals fold on the right.