Malignant Plasmocytoma of the Nasopharynx

Abstract

In 1935 Mattick and Thibaudeau (1), reporting a case of multiple plasma-cell tumors in the upper respiratory tract, stated that “the occurrence of plasma-cell tumors of extramedullary origin is of sufficient interest and rarity to merit the report of even a single case.” Others have repeatedly noted the infrequency of this lesion and expressed similar opinions. Haines (2) suggested that further reports were required of “metastasizing plasma-cell tumors of the upper respiratory tract,” and recognized three clinical types, based on the presence or absence of lymph node and skeletal involvement. Of further interest is the fact that a review of the literature reveals the existence of considerable confusion concerning the malignant character of this group of lesions. Frank (3) referred to the indiscriminate use of the term, “plasmocytoma” for both inflammatory and neoplastic (benign and malignant) accumulations of plasma cells. Hellwig (4), following a thorough review of the literature, classified the extramedullary lesions into five groups, as follows: (1) simple benign tumors; (2) multiple benign tumors; (3) malignant tumors without metastasis; (4) malignant tumors with lymph node metastasis; (5) malignant tumors with osseous metastasis. In his collected series of 128 cases, there were 9 originating in the air passages and metastasizing to bones; 4 of these showed, in addition, metastasis to lymph nodes. All cases terminated fatally. Hellwig also noted the futility of predicting the clinical course or prognosis from the histologic appearance of the lesion. Still others have taken exception to the view that extramedullary plasmocytomas occur as benign lesions. Figi, Broders, and Havens (5), reporting 11 cases of plasma-cell tumors of the respiratory tract found no evidence to support the conception that the lesion is benign. They felt that, while it is true that extramedullary plasmocytomas may vary greatly as to their malignancy and course, there appears to be little evidence to indicate that they are not all malignant lesions, and they should be so treated. The case which is the subject of this report is interesting because of its occurrence in an 18-year-old male, and because it adds further evidence to the view that these lesions should be regarded as malignant neoplasms. Case Report A 20-year-old white soldier was said to have been well until January 1945, when he noticed a swelling on the right side of the neck. This had appeared suddenly, remained well localized, and grew slowly over a period of several months. It was unassociated with pain, fever, or weight loss. Previous medical history was said to be non-contributory. On July 12, 1945, the patient was inducted into military service and was promptly hospitalized because of the discovery of a mass of enlarged right cervical nodes. Physical examination showed the patient to be well developed and well nourished. He did not appear acutely or chronically ill.