PP020: Extramedullary malignant tumors in the head and neck region – A case report

Extramedullary malignant tumor refers to a malignant tumor of bone marrow origin arising outside the bone marrow. The most common ones on the head and neck region are plasmacytoma and myeloid sarcoma. Of these two, plasmacytoma is more common, though it still is rare consisting only 0.4% of all hematological malignancies. It is slowly growing, typically located submucosally and it is associated to multiple myeloma. Myeloid Sarcoma (MS) consists of immature myeloid cells and it is often associated with acute myeloid leukemia (AML). Rapid growth is typical for myeloid sarcoma. A diagnosis of MS is based on immunohistochemistry and differential diagnostics can be challenging. Treatment of MS is always systemic and surgery is used only for decompression. Case report 34y male fire fighter was sent to ORL consultation due to right nostril obstruction. He had allogenic bone marrow transplantation for AML five years earlier and the disease had been in remission. A solid prominence was palpable on the right maxillary bone. CT and a sublabial biobsy were performed. After several immunohistochemical analyses the tumor was defined as MS and the patient received induction chemotherapy. Now patient has had a consolidation course, but new bone marrow transplantation has not been done due to severe infection problems. Conclusion biopsy should not be hesitated when treating patients with atypical swelling symptoms especially if the patient has a history of hematologic disease. It is also important to remember that the treatment of head and neck tumor is not always surgical.