鼻及鼻竇孤立性髓外漿細胞瘤－病例報告

Sinonasal Solitary Extramedullary Plasmacytoma - A Case Report

林岫萱(Hsiu-Hsuan Lin) ； 賴建仲(Chien-Chung Lai)

《台灣耳鼻喉頭頸外科雜誌》 58卷1期 (2023/03) Pp. 27-33

https://doi.org/10.6286/jtohns.202303_58(1).027

摘要

漿細胞瘤係由漿細胞不正常增生所引起的，可分為多發性骨髓瘤、孤立性骨漿細胞瘤及孤立性髓外漿細胞瘤。髓外漿細胞瘤大部分發生於頭頸部軟組織，以鼻腔、鼻咽及鼻竇為好發部位。佔所有頭頸部腫瘤不到1%，約有20－30%會轉變為多發性骨髓瘤，臨床上要詳細診斷與長期追蹤，治療方式為局部放射線治療或合併手術治療。本科於2016年經歷1名66歲男性，主訴右側臉頰悶痛數月，此外無其他症狀。鼻竇內視鏡檢查僅發現下鼻道外側壁微向鼻腔平滑隆起。頂骨鼻棘投射攝影顯示右側上頷竇增厚，電腦斷層檢查顯示右上頷竇前半部低密度病灶合併多處骨侵触及缺損。經下鼻道粗針切片病理暨其他診斷性檢查顯示為孤立性髓外漿細胞瘤。病患接受右上頷竇前壁及內側壁部份切除及術後局部放射治療。追蹤10個月時發現腫瘤復發並向上侵犯右眼框內側壁，遂施行右眼框內側及部分眼底骨壁切除合併鈦骨板眼框重建，術後接受輔助性放射治療。追蹤迄今第5年，預後良好並無復發。

關鍵字

extramedullary plasmacytoma ； sinonasal tumor ； head and neck ； surgery ； orbital reconstruction（髓外漿細胞瘤 ； 鼻及鼻竇腫瘤 ； 頭頸 ； 手術 ； 眼眶重建）

並列摘要

Plasmacytoma can result from an abnormal proliferation of plasma cells. It can be categorized as multiple myeloma, solitary bone plasmacytoma, and solitary extramedullary plasmacytoma (SEP). Most SEPs arise in soft tissues of the head and neck regions, with the nasal cavities, nasopharynx, and paranasal sinuses as the most common sites. They account for less than 1% of all head and neck tumors, and about 20-30% of these lesions turn into multiple myeloma. Thus, detailed diagnosis and long-term follow-up are both mandatory. The main treatment of SEP is local radiation therapy alone or combined with surgery. A 66-year-old male reported pain in the right cheek for several months without other symptoms in 2016. Direct sinonasal endoscopy revealed mild medialization of the lateral nasal wall of the right inferior meatus. The Waters' view showed thickening of the right maxillary sinus, and computed tomography revealed a low-density lesion in the right maxillary sinus, with multiple bony erosions and defects. Core needle biopsy via the right inferior meatus showed a solitary extramedullary plasmacytoma, confirmed after a series of diagnostic tests. The patient underwent partial resection of the anterior and medial walls of the right maxillary sinus and postoperative local radiation therapy. After 10 months of follow-up, tumor recurrence was found with the invasion of the right medial orbital wall. Orbital medial and inferior walls were removed near-totally and reconstructed with a titanium orbital mesh plate. The patient received adjuvant radiotherapy after salvage surgery. So far, at the fifth-year follow-up, there was no recurrence.

並列關鍵字

extramedullary plasmacytoma ； sinonasal tumor ； head and neck ； surgery ； orbital reconstruction