A B
figure 1A. monoclonal infiltration of plasma cells, B. with atypical
nuclei and occasional binucleate forms and basophilic cytoplasms.
Immunohistochemistry was done for kappa and lambda light chains that was
positive for lambda chains which confirmed the monoclonal nature of
plasma cells.
Further diagnostic work-up was performed. Complete blood cell count and
biochemistry except slight anemia was all normal. The results of serum
immunoglobulin and protein electrophoresis concentration and
distribution were normal. (Table1) bone marrow aspiration and biopsy
were normal and plasma cells represented ˂6% of all nucleated cells.
Moreover, Test for serum myeloma protein and Bence-jones protein in
urine was negative.Besides,no osteolytic lesions were identified in the
skeletal survey.also,the abdominal ultrasonography was normal. These
findings confirmed the diagnosis of extramedullary plasmacytoma of the
sphenoid sinus.
Surgical resection was performed with an endoscopic endonasal
transsphenoidal approach by going through the opening of the left
sphenoidal sinus and dissection of medial wall of right sphenoid sinus,
the mucus layer of sphenoid sinus was removed and anterior wall of
sphenoid sinus dissected and the tumor extracted through the inferior
region of the sinus. Lateral extending of the tumor to the medial
cranial fossa and surrounding optic nerve dissected and optic nerve
decompressed; during the procedure, dura remained intact.
Table 1 results of serum immunoglobulin and protein electrophoresis