PMC2649913_01
Extramedullary myeloma of the head and face. Note the marked distortion of the nose, lips and left eye. The tumour affects the left maxillary and zygomatic area. There was a midline shift of the nose and the chin.
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F1
A 48 year-old black female presented at the Medunsa Oral Health Center with a large swelling of the left side of her face, and proptosis of her left eye (figure 1).
Note the exophytic, irregular lesions protruding from the palate and from the left nostril.
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F2
A large portion of this mass was necrotic (figure 2).
High power photomicrograph of the myelomatous infiltrate. Several plasmablasts with prominent nucleoli are present (H&E stain, x400).
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F3
The densely packed tumour cells were mainly plasmablasts with prominent nucleoli (figure 3).
Sagittal CT cut showing the extensive destruction of the left maxilla, and the left paranasal tissues. The left orbit is filled with tumorous tissue.
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F4
Axial CT cut demonstrating invasion of the tumour into the left orbit, causing proptosis; and the extension of the tumour to the left ethmoidal sinus and the temporal and infra-temporal fossae.
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F5
The intra-orbital tumour mass caused severe proptosis of the left eye (figure 5).
Axial CT cut showing the invasion of the floor of the mouth by the tumour.
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F6
The left submandibular space and the floor of the mouth were also affected by the tumour (figure 6).
Axial CT cut showing the extent of the heterogeneous tumour.
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F7
The mandible appeared normal but had been displaced, without evidence of osteolytic or sclerotic lesions. The tumour mass appeared heterogeneous with hypodense areas of necrosis (figure 7).