Plasmacytoma

The management of these lesions depends on an understanding of their pathology, since their behavior and management differ. Granuloma, pseudolym-

Neuroblastoma Metastasis Skull
from spiral CT scan. c Postoperative view of the reconstructed skull base. d Postoperative CT scan.

phoma, reactive plasmacytic hyperplasia, olfactory neuroblastoma, lymphoma, anaplastic carcinoma, and metastatic tumors can all have a very similar appearance (Fig. 15.57). Biopsy is essential, as in every lesion of this type. The diagnostic classification of plasma cell neoplastic disorders includes:

1 Solitary plasmacytoma of bone

2 Extramedullary plasmacytoma

3 Myelomatosis

4 Plasma cell leukemia

Solitary plasmacytoma of bone commonly presents as a single large osteolytic lesion, often with multicystic areas of rarefaction. However, almost 50% of solitary plasmacytomas will convert to multiple myeloma

Sphenoud Bone LesionsRemoval Turbinate Bones

Fig. 15.56 a Preoperative coronal MR image showing extensive malignant melanoma in the posterior nasopharynx—much of it was polypoid. b Postoperative appearance 3 years after endoscopic removal of the mucosa on the septum, floor of the sphenoid, and bilateral sphenoethmoid recesses.

Fig. 15.56 a Preoperative coronal MR image showing extensive malignant melanoma in the posterior nasopharynx—much of it was polypoid. b Postoperative appearance 3 years after endoscopic removal of the mucosa on the septum, floor of the sphenoid, and bilateral sphenoethmoid recesses.

Plasmacytoma
Fig. 15.57 CT scan of a plasmacytoma involving the right fron-toethmoid sinuses.

(Majumdar et al., 2002). It is important to look for evidence of systemic involvement and the presence of paraprotein. Extramedullary plasmacytomas present as sessile, pedunculated, or polypoid masses with a pale yellow hue, and fewer patients convert to multiple myeloma.

Solitary lesions can be excised but, as they are highly radiosensitive, they should only be removed if this can be done with minimum morbidity. Radiotherapy is the treatment of choice. Adjuvant chemotherapy is sometimes indicated in an attempt to delay conversion to myeloma.

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