Harendra Kumar Gautam

Abstract

We report an extremely aggressive case of extramedullary plasmacytoma of the right maxillary sinus without any known metastasis. A 45 year old male presented to ENT Department with chief complaints of recurrent Right sided nasal mass and nasal obstruction with recurrent episodes of cold for 3 years. Patient also had decreased sense of smell. Before presenting to us, he underwent two previous surgeries for the same complaint elsewhere in the year 2015 and 2017. Patient was a known case of Hypertension for 3 years and took treatment, was immunocompetent. Subsequent investigations including CT scan of Paranasal sinuses and peri-operative findings revealed a sinonasal mass involving right maxillary antrum with erosion of all the walls of maxillary antrum. Soft tissue mass lesion also extending into retro-zygomatic space, nasal cavity and buccal space. The nasal cavity mass lesion extending posteriorly to occupy whole of nasopharynx and overhanging into oropharynx. The patient was treated surgically by Cald well Luc’s approach and mass removed. HPE reports suggestive of tumour comprising of plasma cells with varying degree of maturation and atypia, nucleus- characteristic “clock face chromatin”pattern seen. Abundant basophilic cytoplasm. On IHC- CD 138 weak positive. Suggestive of Extramedullary plasmacytoma. Patient underwent 20 cycles of radiotherapy. Patient is on follow up since then and is asymptomatic. Keywords: Extramedullary plasmacytoma, PNS and HPE.

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