Zhang Yi, Xu Yong, Xu Yu, Tao Zezhang
Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Ear Nose Throat J. 2015 Oct-Nov;94(10-11):E43-6.
Extramedullary plasmacytoma and tooth eruption into the nasal cavity are both rare events. We report a case of plasmacytoma associated with an ectopic tooth. To the best of our knowledge, such a case has not been previously reported in the literature. A 63-year-old woman presented for evaluation of an 8-month history of a bloody nasal discharge from the posterior naris. Nasal endoscopy detected a slight eminence approximately 0.5 cm in diameter in the right nasal floor. Computed tomography demonstrated a tooth-like, high-attenuation shadow. A biopsy identified chronic inflammation of the mucosa and tissue. A diagnosis of an ectopic tooth in the right nasal cavity was initially considered. The mass and the tooth-like neoplasm were removed via nasal endoscopy. Immunohistochemistry of the excised mucosa showed strong positivity for kappa light chains, positivity for leukocyte common antigen and CD138, and negativity for lambda light chains, epithelial membrane antigen, CD1, and HMB-45. The final diagnosis was an extramedullary plasmacytoma in the right nasal cavity associated with an ectopic tooth. No bone metastasis was observed. Definitive radiotherapy was performed after the operation. During 40 months of follow-up, the patient exhibited no evidence of local recurrence or metastasis. The diagnosis in this case was made difficult by the nonspecific clinical manifestations, the presence of the ectopic tooth, and incorrect interpretation of preoperative histopathology. Physicians should maintain a clinical suspicion for the possibility that an ectopic tooth might be associated with a tumor.
髓外浆细胞瘤和牙齿萌出至鼻腔均为罕见事件。我们报告一例与异位牙相关的浆细胞瘤。据我们所知，此前文献中尚未报道过此类病例。一名63岁女性因后鼻孔血性鼻分泌物8个月病史前来评估。鼻内镜检查发现右侧鼻底有一个直径约0.5 cm的轻微隆起。计算机断层扫描显示一个牙样的高密度阴影。活检确定为黏膜和组织的慢性炎症。最初考虑诊断为右侧鼻腔异位牙。通过鼻内镜切除肿物和牙样新生物。切除黏膜的免疫组织化学显示κ轻链强阳性，白细胞共同抗原和CD138阳性，λ轻链、上皮膜抗原、CD1和HMB-45阴性。最终诊断为右侧鼻腔髓外浆细胞瘤伴异位牙。未观察到骨转移。术后进行了根治性放疗。在40个月的随访期间，患者未出现局部复发或转移的迹象。该病例的诊断因非特异性临床表现、异位牙的存在以及术前组织病理学的错误解读而变得困难。医生应临床怀疑异位牙可能与肿瘤相关的可能性。
