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