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Hematology

Nasal Mass in a Middle-aged Woman With Multiple Myeloma and Recurrent Fungal Sinusitis

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: June 17, 2021

Clinical Challenge

Article Information and Disclosures

Alice C. Yu, BA¹;

Albert Y. Han, MD, PhD¹;

Joel A. Sercarz, MD¹

Author Affiliations

¹Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles

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A woman in her 50s was admitted to the hospital with new left-sided nasal congestion, facial pain, and cheek numbness. Her medical history included kappa light chain multiple myeloma refractory to multiple chemotherapeutic regimens. She had been admitted 4 months earlier with similar symptoms of facial pain and sinus pressure. At that time, she was found to have persistent sinus mucormycosis, which required multiple rounds of surgical debridement. On this admission, her vital signs were stable, and she was afebrile. Laboratory test results showed a white blood cell count of 0.97 × 10⁹ per liter with absolute neutrophil count of 650 × 10⁶ per liter and platelet level of 17 × 10⁹ per liter. A computed tomography scan showed complete opacification of the left paranasal sinuses (Figure, A). The patient underwent surgical debridement, and a prominent erythematous soft-tissue mass was seen in her left nasal vestibule (Figure, B). The nasal mass was resected for pathologic analysis (Figure, C).

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A woman in her 50s was admitted to the hospital with new left-sided nasal congestion, facial pain, and cheek numbness. Her medical history included kappa light chain multiple myeloma refractory to multiple chemotherapeutic regimens. She had been admitted 4 months earlier with similar symptoms of facial pain and sinus pressure. At that time, she was found to have persistent sinus mucormycosis, which required multiple rounds of surgical debridement. On this admission, her vital signs were stable, and she was afebrile. Laboratory test results showed a white blood cell count of 0.97 × 10⁹ per liter with absolute neutrophil count of 650 × 10⁶ per liter and platelet level of 17 × 10⁹ per liter. A computed tomography scan showed complete opacification of the left paranasal sinuses (Figure, A). The patient underwent surgical debridement, and a prominent erythematous soft-tissue mass was seen in her left nasal vestibule (Figure, B). The nasal mass was resected for pathologic analysis (Figure, C).

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Article Information

Corresponding Author: Joel A. Sercarz, MD, Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 UCLA Medical Plaza, Ste 550, Los Angeles, CA 90095 (jsercarz@mednet.ucla.edu).

Published Online: June 17, 2021. doi:10.1001/jamaoto.2021.1142

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s family for granting permission to publish this information.

References

Dores GM , Landgren O , McGlynn KA , Curtis RE , Linet MS , Devesa SS . Plasmacytoma of bone, extramedullary plasmacytoma, and multiple myeloma: incidence and survival in the United States, 1992-2004. Br J Haematol. 2009;144(1):86-94. doi:10.1111/j.1365-2141.2008.07421.x PubMed Google Scholar Crossref

Pham A , Mahindra A . Solitary plasmacytoma: a review of diagnosis and management. Curr Hematol Malig Rep. 2019;14(2):63-69. doi:10.1007/s11899-019-00499-8 PubMed Google Scholar Crossref

Agarwal A . Neuroimaging of plasmacytoma: a pictorial review. Neuroradiol J. 2014;27(4):431-437. doi:10.15274/NRJ-2014-10078 PubMed Google Scholar Crossref

Bladé J , Fernández de Larrea C , Rosiñol L , Cibeira MT , Jiménez R , Powles R . Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach. J Clin Oncol. 2011;29(28):3805-3812. doi:10.1200/JCO.2011.34.9290 PubMed Google Scholar Crossref

Di Stadio A , Gambacorta V , de Crescenzo S , et al. Extramedullary nasal plasmacytoma arising after polyp excision and the role of the inflammation in tumor development: a case report. Mol Clin Oncol. 2020;12(5):451-455. doi:10.3892/mco.2020.2007 PubMed Google Scholar

Wax MK , Yun KJ , Omar RA . Extramedullary plasmacytomas of the head and neck. Otolaryngol Head Neck Surg. 1993;109(5):877-885. doi:10.1177/019459989310900517 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.