Plasmacytoma of the trachea: a surprising diagnosis

Abstract

A 68-year-old man presented with a complaint of dyspnea on moderate exertion, and physical examination revealed stridor. The patient reported having previously been treated for chronic obstructive pulmonary disease and adenocarcinoma of the prostate, the latter having been treated with 39 radiotherapy sessions. He was a former smoker with a smoking history of 150 pack-years (3 packs/day for 50 years), having quit 4 years prior. We performed contrast-enhanced computed tomography (CT) of the neck and chest, which showed an expansive, well-defined nodular mass in the distal trachea, near the carina, without enhancement or signs of invasion of the tracheal walls (Figures 1 and 2). Bronchoscopy was requested for tumor resection, and symptom resolution was observed after the resection. The histopathological study identified an outer layer with the of appearance of plasmacytoid cells, sometimes with a central eosinophilic nucleolus—"cartwheel appearance"—and hyaline intracytoplasmic inclusions suggestive of Russell bodies. The immunohistochemical profile demonstrated positivity for CD3, CD20, CD45, CD56, kappa light chain, and CD138 in plasmacytes. In the context of the clinical status and test results, the findings were consistent with solitary extramedullary plasmacytoma.