顎下腺原発髄外性形質細胞腫の１例

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  • Extramedullary plasmacytoma of the submandibular gland-a case report-

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Background: Extramedullary plasmacytoma originating in a submandibular gland is extremely rare. We report a case of extramedullary plasmacytoma of the submandibular gland.<BR>Case: A 62-year-old man noticed a slowly expanding swelling in the left submandibular area. Aspiration cytology for a left submandibular gland tumor was performed 10-months later. and based on the presence of a few scattered atypical cells showing unevenly distributed nuclear chromatin and high N/C ratio, we made a tentative diagnosis of plasmacytoid myoepithelioma. 2-months late a tumor measuring 5.0×4.0× 4.0 cm was surgically resected from the left submandibular gland. Macroscopically, the resected tumor showed solid and peripherally invasive growth. Histological examination revealed medullary proliferation of tumor cells containing abundant oxyphilic cytoplasm and a peripherally located nucleus containing unevenly distributed chromatin. The cytoplasm of the tumor cells stained red with Methylgreen-Pyronin stain, and electron microscopic examination revealed a well-developed rough-surfaced endoplasmic reticulum. Immunohistochemical staining of the tumor cells showed positive immunoreactivity for CD45, CD138, IgA, and light chain (κ). Based on these findings, the tumor was diagnosed as an extramedullary plasmacytoma.Conclusion: Plasmacytoma of the submandibular gland is extremely rare. It has a better prognosis than plasma cell myeloma, but can undergo a transition to plasma cell myeloma. Serum bio chemical tests do not show the characteristic pattern of extramedullary plasmacytoma. Aspiration cytology is effective tool for the diagnosis of extramedullary plasmacytoma. There are some differential diagnosis includes acinic cell carcinoma, oncocytic carcinoma, myoepithelioma, malignant lymphoma, neuroendocrine carcinoma, and other tumors of the submandibular gland. It is important to observe the characteristic features and/or appearance of tumor cells and perform immunohistochemical staining and an electron microscopic examination.

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