Subglottic extramedullary plasmacytoma with light chain multiple myeloma masquerading as adult-onset asthma

J Voice. 2014 May;28(3):394.e1-4. doi: 10.1016/j.jvoice.2013.10.016. Epub 2014 Feb 1.

Abstract

Extramedullary plasmacytoma (EMP) arises outside the bone marrow and can be associated with multiple myeloma (MM). A 55-year-old gentleman, who presented with dyspnea and expiratory wheeze, was diagnosed and treated for asthma. A subsequent relapse 6 months later prompted an Otolaryngology consult. Preliminary findings showed a benign-looking nodular lesion at the subglottis. Work-up at our institution revealed an Fludeoxyglucose (FDG) avid left subglottic lesion with multiple bone metastases on a Positron Emission Tomography / Computed Tomography (PET/CT). The patient underwent a panendoscopy and laser excision of the subglottic lesion with subglottic jet ventilation. Histology showed an EMP. Further work-up revealed the presence of kappa light chain MM with adverse cytogenetics. Patient was treated systemically with lenalidomide, bortezomib, and dexamethasone for four cycles with rapid improvement in his symptoms. We review the literature about EMP of the subglottis with MM. We present the first case of subglottic laryngeal EMP with MM managed via CO2 laser excision.

Keywords: Extramedullary plasmacytoma; Laser; Lenalidomide; Multiple myeloma; Subglottis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Asthma / diagnosis*
  • Asthma / drug therapy
  • Asthma / physiopathology
  • Biomarkers, Tumor / analysis*
  • Bone Neoplasms / secondary
  • Chemotherapy, Adjuvant
  • Diagnostic Errors*
  • Humans
  • Immunoglobulin Light Chains / analysis*
  • Laryngeal Neoplasms / diagnosis*
  • Laryngeal Neoplasms / immunology
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / therapy
  • Laryngoscopy
  • Laser Therapy / instrumentation
  • Lasers, Gas / therapeutic use
  • Male
  • Middle Aged
  • Multiple Myeloma / diagnosis*
  • Multiple Myeloma / immunology
  • Multiple Myeloma / secondary
  • Multiple Myeloma / therapy
  • Plasmacytoma / diagnosis*
  • Plasmacytoma / immunology
  • Plasmacytoma / secondary
  • Plasmacytoma / therapy
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Biomarkers, Tumor
  • Immunoglobulin Light Chains