Wang Man, Liu Lu, Yu Shihuan
Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
Respir Med Case Rep. 2025 Jun 25;56:102244. doi: 10.1016/j.rmcr.2025.102244. eCollection 2025.
This case report describes a rare instance of isolated extramedullary plasmacytoma in the trachea of a 69-year-old female who presented with acute respiratory distress 1 h prior to admission. Chest computed tomography (CT) revealed a nodular lesion within the trachea, characterized by marginal calcification and severe stenosis of the tracheal lumen. Fiberoptic bronchoscopy demonstrated that the nodular lesion significantly obstructed the airway lumen. The patient underwent a technically demanding endoscopic tumor debulking procedure. Histopathological examination via endoscopic biopsy confirmed the diagnosis of plasmacytoma. Further diagnostic imaging, including positron emission tomography-computed tomography (PET-CT), showed abnormal fluorodeoxyglucose (FDG) uptake within the lesion. Bone marrow aspiration smear and biopsy excluded multiple myeloma. Postoperatively, the patient's symptoms markedly improved, and she was discharged on the day of surgery. One month after the procedure, follow-up chest CT and bronchoscopy indicated partial residual tumor without evidence of local recurrence. The patient reported significant improvement in respiratory function and subsequently received radiotherapy targeting the local lesion. Regular follow-up after radiotherapy confirmed no recurrence of the lesion. A literature review indicates that extramedullary plasmacytoma (EMP) is uncommon and predominantly affects the upper respiratory and digestive tracts. Diagnosis typically involves histopathological analysis, bronchoscopic evaluation, and advanced imaging techniques. Treatment strategies are tailored based on the patient's clinical presentation and tumor characteristics. This case underscores the importance of considering intratracheal plasmacytoma in the differential diagnosis of obstructive tracheal masses and highlights the critical role of timely endoscopic tumor debulking in relieving airway obstruction and facilitating subsequent treatment.
本病例报告描述了一名69岁女性气管孤立性髓外浆细胞瘤的罕见病例，该患者在入院前1小时出现急性呼吸窘迫。胸部计算机断层扫描（CT）显示气管内有一个结节性病变，其特征为边缘钙化和气管腔严重狭窄。纤维支气管镜检查显示该结节性病变显著阻塞气道腔。患者接受了一项技术要求较高的内镜下肿瘤减容手术。通过内镜活检进行的组织病理学检查确诊为浆细胞瘤。包括正电子发射断层扫描-计算机断层扫描（PET-CT）在内的进一步诊断性影像学检查显示病变内有异常氟脱氧葡萄糖（FDG）摄取。骨髓穿刺涂片和活检排除了多发性骨髓瘤。术后，患者症状明显改善，并在手术当天出院。手术后1个月，胸部CT和支气管镜检查随访显示有部分残留肿瘤，无局部复发迹象。患者报告呼吸功能有显著改善，随后接受了针对局部病变的放疗。放疗后的定期随访证实病变未复发。文献综述表明，髓外浆细胞瘤（EMP）并不常见，主要影响上呼吸道和消化道。诊断通常包括组织病理学分析、支气管镜评估和先进的影像学技术。治疗策略根据患者的临床表现和肿瘤特征进行调整。本病例强调了在阻塞性气管肿物的鉴别诊断中考虑气管内浆细胞瘤的重要性，并突出了及时进行内镜下肿瘤减容在缓解气道阻塞和促进后续治疗方面的关键作用。
