Canterbury DHB
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This is more likely to be truly localised than plasmacytoma of bone. The most common sites are in the upper respiratory tract and GI tract. Careful staging is essential. 25% of patients will have a monoclonal protein.
This should be distinguished from reactive plasma cells or lymphoma.
It should be demonstrated that the infiltrate consists entirely of plasma cells and that there is no B cell component. In this regard CD138, MUM1/IRF4, CD20 and PAX5 are the most useful markers although it should be recognised that CD20 and PAX5 are sometimes expressed in plasma cell malignancies. Monoclonality and /or an aberrant plasma cell phenotype should be demonstrated with useful markers being CD19, CD56, CD27, CD117 and cyclin D1.
Local radiotherapy 40-50Gy is the treatment of choice. 70% of such patients will be alive and disease-free at 10 years.
Treatment by radical radiotherapy should encompass the primary tumour with a margin of at least 2 cm. The cervical nodes should be included if involved. The first echelon cervical nodes should be included in EP of Waldeyer’s ring. For EP up to 5 cm a radiotherapy dose of 40 Gy in 20 fractions is recommended. For EP >5 cm a higher dose of up to 50 Gy in 25 fractions is recommended.
See BCSH Guidelines 2014.
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Topic Code: 5612
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