Omar Ramadan is an ENT Registrar at Al Adan Hospital, Kuwait. He has obtained his MS in Otolaryngology from University of Damasacus in 2012. He has completed his ENT Resident from Almouassat University Hospital during 2005-2010.
Rationale: Extramedullary Plasmacytoma (EMP) is an uncommon malignant neoplasm arising outside the bone marrow without clinical evidence of multiple myeloma. EMPs represent less than 1% of all head and neck malignancies mostly occur in nose and paranasal sinuses area. Local lymph node affection occurs at 10-20%. Some cases may be converted to multiple myeloma. Distant metastasis occurs in 35%. We reviewed 18 case reports of nasal plasmacytoma and found that EMP of nasal cavity and sinus affects men more than women and nasal cavity to be the most common site followed by maxillary sinus. Bleeding and nasal obstruction were the most common symptoms of nasal cavity EMP while facial swelling was the most common presenting symptom of the sinus EMP.
On Physical Exam: Reddish pink polypoid mass easily bleeding was the most common finding. Deep biopsies must be taken as the tumor is sub-mucosal and the mucosa may be thickened as the result of an inflammatory reaction and biopsy material should be sent for immunohistochemical assessment.
Treatment: Controversial, most effective radiotherapy with surgery. Prognosis is better than multiple myeloma and regular long-term follow up is mandatory as recurrence and metastases may occur after long time.
Case Report: A 38-year-old female with history of nasal obstruction and epistaxis for several months presented to ER complaining of active epistaxis. Physical examination revealed a fragile and hemorrhagic polypoid mass in the right nasal cavity. CT scan showed a soft tissue mass in the right nasal cavity with contrast enhancement. Histopathological examination results revealed atypical plasma cell infiltration. Treatment was complete mass resection with radiotherapy. A diagnosis of EMP was made with these findings.
Ren Chongxi has graduated from Hebei Medical University and completed his MD from Qing Dao University School of Medicine. He is the Director of Department of General Surgery, a clinical college of integrated traditional chinese and western medicine of Hebei Medical University. He has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Background: A Benign Multinodular Goiter (BMNG) is one of the most common endocrine surgical problems. The appropriate surgical procedure for its effective and safe management is a matter of debate. We report our clinical experience of performing Total Thyroidectomy (TT) for it, focusing on the outcome and complications to evaluate the efficacy.
Methods: The medical records of 407 patients who underwent TT for BMNG between 2008 and 2013 were reviewed retrospectively. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated indications for TT, complication rates, local recurrence rate and outcome after TT.
Results: The indications for TT were compression and or dislocation of the trachea in 265 (65.1%) patients, hyperthyriodism in 109 (26.8%) and cosmetic problems in others. The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy was 0.2%, whereas the incidence of temporary unilateral recurrent laryngeal nerve palsy was 1.2%. Permanent hypocalcaemia occurred in 0.2% and overall temporary hypocalcaemia occurred in 6.6% of patients. Incidental thyroid carcinomas were found on histology in 11 (2.7%) patients. Hemorrhage requiring repeat surgery occurred in 0.2% of patients.
Conclusion: TT seems to be the optimal procedure of choice for BMNG, which has the advantages of immediate and permanent cure and no recurrences.