testicular extramedullary plasmacytoma

extramedullary plasmacytomas are plasma cell tumors that arise outside the bone marrow. they are most often located in the head and neck. extramedullary plasmacytomas account for approximately 3 percent of plasma cell malignancies. the diagnosis of an extramedullary plasmacytoma depends upon the demonstration of a monoclonal plasma cell tumor at an extramedullary site with no evidence of multiple myeloma based upon bone marrow examination and roentgenographic studies, absence of an m-protein in serum and/ or urine, and no related organ or tissue impairment. these tumors are highly responsive to local radiation therapy and rarely progress or recur. a 77 year old man referred for gradual enlargement of scrotum in april, 2004. he had no fever, weight loss or loss of appetite during the period. no tenderness, warmth or erythem of scrotum was observed on physical examination. no lymphadenopathy was detected. later he had temporary relief because of antibiotic therapy . 7 months later, he referred again following the aggravation of his symptom. ultrasonography of his scrotum was done and enlargement in the left testis was reported. lab data including cbc,diff,esr,afp were normal but βhcg titer was reported higher than normal . he underwent radical orchiectomy and the specimen was sent for pathological study. spermatocytic seminoma and plasmacytoma were suspected, but plasmacytoma was reported after the ihc . in order to rule out multiple myeloma, whole body bone scanning with sestamibi and urine bence jones protein were examined, all of which were negative. in bone marrow aspiration, the cellularity was normal and no pathologic lesion was reported. considering clinical and paraclinical evidences, the diagnosis was extramedullary plasmacytoma.