MUCOUS-MEMBRANE PLASMACYTOSIS OF THE UPPER AERODIGESTIVE TRACT - A CLINICOPATHOLOGICAL STUDY

We report 9 patients with an unusual plasma cell proliferative disorde r of the upper aerodigestive tract. Six patients were men and three, w omen. The age at presentation ranged from 40 to 67 years with a mean o f 54 years. Symptoms at presentation included dysphonia, dysphagia, di fficulty breathing, and oral pain. These plasma cell lesions typically produced a cobblestone or warty appearance of the upper aerodigestive tract mucosa including the larynx, pharynx, palate, lips, mouth, tong ue, and trachea in varying combination of multiple sites in each patie nt. Histologically, all lesions were characterized by psoriasiform epi thelial hyperplasia with dyskeratosis and dense subepithelial plasmacy tosis. Plasma cells were mature but so expansive and diffuse in infilt ration as to suggest extramedullary plasmacytoma. Immunohistochemistry for kappa and lambda light chain showed polyclonal immunoglobulin con tent in all cases examined. Microbial cultures and Warthin-Starry stai ns were negative for organisms. A variety of treatments including anti biotic therapy, corticosteroid administration, and surgical resection were unsuccessful. In two patients, the process required tracheostomy. This disorder has not been previously described with the exception of a single reported case, which is included in this series. The etiolog y, pathogenesis, and successful management of mucous membrane plasmacy tosis remain unknown.