EXTRAMEDULLARY PLASMACYTOMA OF THE HEAD AND NECK REGION - CLINICOPATHOLOGICAL CORRELATION IN 25 CASES

Extramedullary plasmacytomas (EMP) of head and neck are rare tumours. Between 1972 and 1993, 25 cases of EMP of head and neck were seen at o ur institute. The clinical and pathological features and response to t reatment are presented. At initial presentation, 23 (92%) patients pre sented with disease confined to a single extramedullary site only and two patients had in addition clinical involvement of cervical lymph no des. All except these two patients received radiotherapy to the primar y site only as initial treatment. Initial primary control of local dis ease was obtained in 16 of 24 (67%) patients treated with radical inte nt. With salvage treatment of further radiotherapy and/or chemotherapy , local disease control was achieved in 21 of 24 (88%) patients. One p atient was treated with palliative intent. Conversion to multiple myel oma was seen in two patients (8%). Pathologically, the tumours were cl assified into low, intermediate and high grade, which correlated close ly with outcome. This classification has been used for the first time in extramedullary plasmacytomas and is based on the multiple myeloma g rading criteria devised by Bartl et al (1987). Fifteen of eighteen (83 %) low-grade tumours and only one of six (17%) intermediate- and high- grade tumours were locally controlled after primary radiotherapy. This is statistically significant for local control (P= 0.0019) but not fo r overall survival (P= 0.12), The median survival and 5-year overall s urvival is 68 months and 58.9% respectively. We recommend consideratio n of adjuvant chemotherapy in patients with higher grade disease.