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The nasopharyngeal flora is generally thought to be a major reservoir for bacterial pathogens of respiratory tract infections in children. We surveyed the bacterial flora in the nasopharynx of 261 outpatients aged 0 to 6 yeas who visited the Department of Otorhinolaryngology and/or Pediatrics from 2005 through 2010. We obtained 118 Haemophilus influenzae (H. influenzae) isolates, 116 Streptococcus pneumoniae (S. pneumoniae) isolates, 44 Staphylococcus aureus (S. aureus) isolates, and 40 Moraxella catarrhalis isolates, and analyzed them by antibiotic susceptibility testing. The overall carriage rates of the H. influenzae strains and S. pneumoniae strains were 45.2% (118/261) and 44.4% (116/261), respectively. The percentages of ampicillin-resistant H. influenzae strains, penicillin-resistant S. pneumoniae strains and methicillin-resistant S. aureus were 80.5% (95/118), 55.2% (64/116) and 40.9% (18/44), respectively. The H. influenzae strain was susceptible to cefditren pivoxil, minocycline, and levofloxacin, while the S. pneumoniae strain was susceptible to cefditren pivoxil, cefotaxime sodium, and panipenem/betamipron. The percentage of ampicillin-resistant H. influenzae strains was invariably high in all years. On the other hand, the percentage of penicillin-resistant S. pneumoniae strains was highest in 2008, and gradually decreased after that. The recovery of susceptibility to penicillin in clinical isolates of S. pneumoniae may reflect recent enlightenment in the appropriate use of antimicrobial drugs.

Carcinoma of the external auditory canal is a relatively uncommon entity, accounting for only 1% of all head and neck carcinomas, and its management is not fully established. We herein conducted a retrospective clinical analysis of 10 consecutive cases of this disease who visited our department between 2003 and 2011. The patients were 3 men and 7 women with an average age of 65.8 years. The clinical stage was T1 in 8 cases and T2 in 2 cases. The histopathological type was squamous cell carcinoma in 7 cases, basal cell carcinoma in 2 cases, and carcinoma in situ in 1 case. The most frequent complaint was otorrhea, typically, bloody otorrhea. One patient received heavy ion radiotherapy, and the other 9 patients underwent surgery; partial resection of the external auditory canal in 3 cases and lateral temporal bone resection in 6 cases. Two patients received postoperative chemoradiotherapy for microscopic residual tumor; one of them developed neck recurrence, and underwent neck dissection followed by another chemoradiotherapy. The patient who received heavy ion radiotherapy died 21 months after the start of treatment and one of the patients who underwent surgery died of another disease, whereas the other patients remain alive and without evidence of tumor with follow-up periods of 6-91 months. These results indicate that surgery rather than radiotherapy is recommended as an initial treatment for carcinoma of the external auditory canal in the early stages.

The pyriform sinus fistula is a rare anomaly that derives from the third, fourth or fifth pharyngeal pouch, and may cause recurrent anterior neck abscesses and/or suppurative thyroiditis. A 16-year-old male presented with acute left anterior cervical swelling. Endoscopic examination showed pus pooling in the left pyriform sinus, and computed tomography (CT) revealed an irregular-shaped abscess in the left anterior cervical region. From these findings, a pyriform sinus fistula was suspected. The patient was treated with antibiotics, and the acute inflammation subsided temporarily. Videofluoroscopy and CT after gastrografin® deglutition were then performed. The latter clearly depicted the fistula arising from the left pyriform sinus extending down to the left thyroid lobe. The patient underwent transcervical resection of the fistula including a partial thyroidectomy. Immediately prior to resection, the fistula was stained by injecting crystal violet solution through the opening in the pyriform sinus using a curved laryngoscope. The fistula was readily identified intraoperatively by the injected stain, and successfully resected. The patient showed temporary vocal cord paralysis of the affected side, which recovered within 2 months after surgery. No recurrence has been seen in 8 months of follow-up. We would like to stress that CT combined with contrast medium deglutition is a powerful means to enable a definitive diagnosis of this anomaly and could thus be useful in planning a surgical procedure.

Postoperative topical ear treatment in infants is often difficult and troublesome. We removed congenital middle-ear cholesteatoma via partial transcanal myringectomy in 3 infants. Subjects were 2 boys and a girl aged 2–3 years. Two also had bilateral secretory otitis media. Cholesteatoma was closed type and was confined to the mesotympanum in all cases—the anterosuperior quadrant in 2 and the anterosuperior-anteroinferior quadrants in one. Operative procedure was as follows: the tympanic membrane was partially resected in proportion to cholesteatoma size without elevating ear canal skin. Cholesteatoma was removed through the perforation created, followed by immediate underlay myringoplasty using a temporal fascia graft. To eliminate postoperative topical treatment, no packing was placed in the ear canal. The fascia graft epithelialized satisfactorily in the three cases. The postoperative clinical course of two subjects has been uneventful in 10 to 13 months of follow-up. The third infant developed recurrent cholesteatoma and underwent a second operation 15 months after the first surgery. No re-recurrence has been seen in the 14 months since reoperation. Our approach involves minimal surgical invasion, requires no postoperative topical treatment, and is thus useful in removing congenital cholesteatoma confined to the mesotympanum, particularly in infants.

Cisplatin is a potent and pivotal anticancer drug in the treatment of various solid tumors including head and neck cancers. Since the beginning of its clinical use in the early 1980s, cisplatin has been one of the most prevailing and reliable anticancer drugs. Its major limitation, however, is the development of resistance during the courses of chemotherapy. The mode of action of cisplatin is mediated by the formation of DNA adducts, which activate several signal transduction pathways, eventually leading to cellular apoptosis. Cisplatin resistance depends on a number of factors that reduce drug uptake, promote cytoplasmic detoxification, and increase DNA repair activity. We herein review a novel mechanism of cisplatin resistance involving the transcriptional regulation of DNA repair genes by ZNF143. ZNF143 is overexpressed in cisplatin-resistant cells, and its knockdown increases sensitivity to cisplatin but not to oxaliplatin, etoposide, or vincristine. We show that ZNF143 is associated with p73, but not with p53. p73 enhances the action of ZNF143 by facilitating the binding of ZNF143 to ZNF143 binding sites and cisplatin-modified DNA. We further present direct evidence that DNA repair genes, Rad51 and FEN-1, are targeted by ZNF143 and overexpressed in cisplatin-resistant cells. These lines of evidence indicate that the interplay among ZNF143, p73, and ZNF143 target DNA repair genes is responsible for cisplatin resistance. Prediction of cisplatin sensitivity and molecular targeted therapy for ZNF143 remain to be conducted in future basic and clinical studies for managing cisplatin-resitant cancers.

We report a rare case of chopstick penetration of the parapharyngeal space. A 48-year-old man who fell down while holding chopsticks was injured in the left temporal region, after which he reported temporal and jaw pain and trismus. The first examination found a small laceration on the temporal skin but no visible foreign body. Computed tomography (CT) showed a slender low-density material in the infratemporal fossa extending to the parapharyngeal space. After general anesthesia was administered the laceration was opened and a fragment of broken chopstick was removed. His postoperative clinical course was uneventful and pain and trismus subsided completely. Given the potentially useful clinical and radiological features of wooden foreign body penetration of the head and neck, we review their ramifications bibliographically.

We clinically analyzed 48 consecutive retrospective cases of parotid carcinoma initially treated between 1988 and 2007. Subjects were 30 males and 18 females ranging from 5 to 85 years old (average: 57.9 years). Of the 12 histological types seen, the most common was mucoepidermoid carcinoma, seen in 12 subjects (25.0%). We studied their survival based on 5 potential prognostic factors-stage, T stage, neck metastasis, facial nerve palsy, and malignancy grade-together with features of mortality and recurrence. Overall 5-year disease-specific survival was 71.2% and 10-year survival 54.9%. Survival rates were significantly lower in stage IV and high-grade malignancy groups than in stage I-III and low-grade malignancy groups. T stage, neck metastasis, and facial nerve palsy tended to compromise survival. Recurrence developed in 2 subjects, in whom significant recurrence risk factors were stage III-IV (particularly, stage IV), T3-4, and high-grade malignancy. Of 18 deaths, causes were distant failure in 11 and local failure in 5. None died of nodal failure. Analysis of these prognostic factors is important in selecting appropriate surgery and in determining indications for postoperative radiotherapy and chemotherapy, leading to better treatment outcome in those with parotid carcinoma.

We analyzed 19 consecutive cases of paranasal sinus mucoceles manifesting visual disturbance requiring surgery. Subjects were 12 men and 7 women aged 37 to 82 years (average; 57.4 years). Six negative prognostic factors examined were: (i) patients' age 70 years, (ii) time from onset to surgery 8 days, (iii) sphenoid sinus involvement, (iv) abnormal ocular fundus findings, (v) optic canal bone defect, and (vi) preoperative visual acuity ≤0.1. A prediction equation obtained by multivariate analysis provided highly accurate in predicting visual prognosis. We also found that factors ii), v), and vi) were mainly responsible for visual prognosis, whereas the impact of factors iii) and iv) was minor. We explored predicting more simply and feasibly visual prognosis with sufficient accuracy using the number of positive items from among the above 6 factors, using the number of those of i), ii), iv), v), and vi), or using the number of those of i), ii), v), and vi). Sensitivity/specificity was 80/93%, 80/100%, and 100/93%. We would like to stress that accurate prediction by these methods is helpful in managing paranasal sinus mucocele associated with visual disturbance.

Chondrosarcoma is rare, accounting for 0.2% of all malignant head and neck tumors. We report a case of chondrosarcoma arising from the nasal septum. A 63-year-old woman seen for 15-month of nasal obstruction and headache was found in rhinoscope, to have a bilaterally bulging posterior nasal septum. Computed tomography (CT) confirmed a tumorous mass extending to the sphenoid sinus and partially to the right posterior ethmoid sinus. T1- and T2-weighted magnetic resonance imaging (MRI) showed low and high intensity in spotty gadolinium enhancement. Transnasal endoscopic biopsy under general anesthesia yielded a histopathological diagnosis of chondrosarcoma. The woman refused proposed wide tumor resection for religious reasons but alternatively underwent carbon ion radiotherapy of 70.4 Gy, markedly reducing the tumor without severe complications. She has been remaining fairly well without recurrence in the 13 months since irradiation.

A 48-year-old man seen for painless anterior neck and bilateral subauricular masses was found in computed tomography (CT) to have a ring-enhanced cystic anterior neck lesion containing a small calcification. Subauricular masses were positive in both fluorodeoxyglucose positron emission tomography (FDG-PET) and 99mTc-pertechnetate scintigraphy showing hypo- and hyperintensity in T1- and T2-weighted magnetic resonance imaging (MRI). Based on a preoperative diagnosis of thyroglossal duct carcinoma, not a benign cyst, associated with Warthin’s parotid glands tumors, not lymph node metastasis, the man underwent resection of the masses. Histopathologically surgical specimens confirmed our preoperative diagnosis. The man’s postoperative clinical course was uneventful and he remains currently disease-free in the 29 months after surgery.

We report a case of vascular leiomyoma of the nasal cavity. A 90-year-old woman visited our hospital because of recurrent epistaxis, and she was found in fiberscopy and computed tomography to have a well-defined spherical submucosal mass in the left nasal vestibule. The lesion showed low intensity in T1- and intermediate intensity in T2-weighted magnetic resonance imaging, with homogeneous intense gadolinium enhancement. The tumor was excised in a transnasal approach using an ultrasonic scalpel. Histopathological and immunohistochemical findings yielded a definitive diagnosis of venous vascular leiomyoma. Vascular leiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft-tissue mass arising in the submucosal tissue of the nasal cavity.

Churg-Strauss syndrome (CSS) is a systemic vasculitic disorder affecting small blood vessels of the upper and lower respiratory tract. Subjects with CSS often have otorhinolaryngological manifestations, but clinical characteristics have not been detailed. We report a case of CSS associated with chronic hypertrophic eosinophilic sinusitis. A 66-year-old man treated for bronchial asthma and seen for a 1-month history of nasal obstruction was found in physical and radiological tests to have chronic pansinusitis with nasal polyposis. Clinical laboratory tests showed marked peripheral blood eosinophilia (35%, 3080/μl). When conservative treatment was ineffective, the patient underwent endoscopic transnasal polypotomy. Surgical specimens histopathologically showed conspicuous eosinophilic infiltration consistent with chronic hypertrophic eosinophilic sinusitis. His postoperative clinical course was uneventful. Three months later, he developed purpura of the extremities and general fatigue with deteriorated of peripheral blood eosinophilia (58%, 11020/μl). The defintive diagnosis was CSS. He was administered steroid pulse therapy-methylprednisolone of 1,000 mg/day for 3 days followed by tapered doses-combined with transoral cyclophosphamide. Following complete remission, he remains currently free of theh disease. Chronic hypertrophic eosinophilic sinusitis morbidity has been increasing in the last decade, and diagnosticians must be aware that this prevalent sinusitis may be a manifestation of a rare condition such as CSS.

Eikenella corrodens (E. corrodens) is a Gram-negative facultative anaerobic bacillus that originally was thought to be an attenuated and indigenous bacterium. In this study, we investigated the clinical and bacteriological characteristics of E. corrodens infections of the tonsil. Seventeen consecutive patients treated in our department for E. corrodens infections of the tonsils were retrospectively analyzed. Microbial specimens were subjected to light microscopic examination, aerobic culture using chocolate and sheep blood agar media, and anaerobic culture using Brucella HK agar medium. Cultured bacteria were subjected to antimicrobial susceptibility tests using the broth microdilution method. The patients were 11 males and 6 females, ranging in age from 4 to 53 years with an average of 22.8 years. One patient had liver cirrhosis, while the other patients had no particular risk factors or underlying diseases. E. corrodens was detected from the surface of the tonsil in 4 cases, from the resected tonsillar tissue in 11 cases, and from pus in the abscesses in 2 cases. Twelve patients demonstrated polymicrobial infections. Streptococcus was the most frequently detected pathogen coexisting with E. corrodens. Isolated E. corrodens was susceptible to third-generation cephems, carbapenems, and new quinolones; and moderately susceptible to benzylpenicillin, ampicillin, cefotiam, and minocycline; but resistant to first-generation cephems, oxacillin, erythromycin, and clindamycin. In conclusion, E. corrodens infections of the tonsils are not rare even in hosts with normal immunity. We should be aware of this bacteria in tonsillar infections.

We investigated the clinical usefulness of distortion product otoacoustic emissions (DPOAEs) for the prediction of hearing outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL).Thirty-two patients with ISSNHL (time from the onset to the start of treatment≤14 days) were enrolled in the study. They received steroid administration (400mg/day of hydrocortisone sodium succinate followed by tapered doses) combined with hyperbaric oxygen therapy. DPOAEs (f2/f1=1.2, L1=80dBSPL, L2=70dBSPL, geometric mean (GM) of f1 and f2=531-5, 500Hz, every one-third octave) were measured before and after treatment. The degree of hearing recovery was classified into four categories (complete recovery, good recovery, satisfactory recovery, no change) according to the criteria of the Ad Hoc Committee of the Japanese Ministry of Health, Labour and Welfare.The DPOAE output in the high-frequency range (GM of f1 and f2≥2, 781Hz) before treatment was higher in the complete recovery group than in the other three groups. The DPOAE output at 2, 781Hz and 4, 375Hz was significantly higher in the complete recovery than in the satisfactory recovery and no change groups (Student's t-test, p

Hyperbaric oxygen (HBO) therapy combined with steroid administration is an effective treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but is sometimes unfeasible for patients with underlying diseases, particularly for those with steroid-intolerance. We conducted a controlled retrospective analysis of patients with ISSNHL who received HBO in combination with stellate ganglion block (SGB), prostaglandin (PG) E1, or steroid therapy in order to identify possible alternative regimens.Three hundred and six consecutive patients with ISSNHL (average hearing levels of 5 frequencies (250-4000Hz)≥40dB; time from the onset of hearing loss to the start of treatment ≤30 days) were enrolled. One hundred and ten, 95, and 101 patients underwent SGB+HBO (SGB group), PGE1+HBO (PG group), and steroid+HBO therapy (steroid group), respectively. Hearing recovery was evaluated by grade assessment, by hearing gain, and by hearing improvement rate compared to the unaffected contralateral ear.The overall hearing outcome did not differ among the three groups. In patients with initial hearing levels

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a powerful tool for the detection of malignant tumors. We herein reported a case of cervical metastasis from unknown primary. Primary tumor was successfully diagnosed by FDG-PET. A 70-year-old man presented with a right-sided cervical lymph node swelling. Fine needle aspiration cytology in the previous hospital showed class III atypia, however, the primary tumor was not found by physical examination, fiberscopy, computed tomography (CT), or magnetic resonance imaging. Open biopsy of the neck demonstrated that the lesion was metastatic squamous cell carcinoma, and he subsequently underwent neck dissection on the affected side. FDG-PET and PET/CT after surgery revealed demonstrated uptake in the right piriform recess of the hypopharynx. The patient was eventually referred to our department, and underwent biopsy of the piriform recess via direct endoscopy. Histopathological diagnosis was the poorly-differentiated squamous cell carcinoma, and then he received radical radiotherapy of 72Gy to the whole neck. There was no evidence of recurrence on FDG-PET performed four months after radiation. The literature on the clinical usefulness of FDG-PET for the diagnosis of head and neck cancers were reviewed.

We report a rare case of schwannoma arising from the pharyngeal branch of the vagus nerve. An 18-year-old woman presented with an egg-sized nontender upper cervical swelling. Computed tomography and magnetic resonance imaging (MRI) revealed a well-defined tumor measuring 50mm in its major axis in the left carotid space. The tumor was moderately enhanced, and showed hypointensity and isointensity on T1- and T2-weighted MRI, respectively. Otorhinolaryngological findings were otherwise normal. A schwannoma was most likely suspected, and she underwent transcervical resection of the tumor. A cordlike strand connected to the cephalad end of the tumor was severed, while both the vagus and hypoglossal nerves were identified and preserved. The histopathological diagnose is schwannoma. After surgery, the patient manifested a curtain sign toward the unaffected side without showing vocal cord palsy or Homer's syndrome, indicating that the tumor had arisen from the pharyngeal branch of the vagus nerve. Clinical characteristics of schwannomas in the carotid space were reviewed.

Basaloid squamous cell carcinoma is a rare and high-grade variant of squamous cell carcinoma. Here we report two cases of this tumor of the head and neck. The first case was a 71-year-old man who presented with an 8-month history of foreign body sensation in the throat. Physical examination and computed tomography demonstrated a tumor measuring 17mm in diameter on the right lateral pharyngeal wall. He underwent tumor resection via lateral pharyngotomy followed by reconstruction with a sternocleidomastoid myocutaneous flap. The histopathological diagnosis was basaloid squamous cell carcinoma. Because he manifested recurrent aspiration pneumonia postoperatively, total laryngectomy was eventually performed. The second case was a 41-year-old man who complained of persistent oral pain. An ulcerated lesion measuring 10×5mm was seen on the left buccal mucosa, and squamous cell carcinoma was suspected through biopsy. He underwent transoral resection, and the lesion was histopathologically diagnosed as basaloid squamous cell carcinoma. Both patients are currently free from disease about one and a half years after surgery. The pathology, clinical characteristics, and treatment of basaloid squamous cell carcinoma are bibliographically reviewed.

A case of papillary carcinoma arising from a thyroglossal duct cyst is reported. A 43-year-old man was referred to our clinic with an anterior cervical mass. CT scan and MRI imaging revealed a ring-enhanced cystic mass in his anterior neck, while ultrasonography showed an irregular echo in the mass. He was preoperatively diagnosed with thyroglossal duct cyst, and underwent resection of the mass by Sistrunk's procedure. Histopathological examination of the surgical specimen showed papillary carcinoma in the thyroglossal duct cyst. Because the histological findings indicated that the tumor had been completely resected, no additional treatment was given. His postoperative course was uneventful, and the patient is currently free from disease 3 years after surgery.It is known that carcinoma, mostly papillary carcinoma, occurs more frequently in thyroglossal duct cysts than in the ordinary thyroid gland. Ultrasonography is a sensitive and useful method for detecting calcified lesions for the diagnosis of this disease. The epidemiology and clinical characteristics of papillary carcinoma associated with thyroglossal duct cyst were reviewed in the literature.

We report two cases of large vestibular aqueduct syndrome, a rare congenital malformation of the inner ear originally described by Valvassori and Clemis in 1978.The first case was a 38-year-old woman who had complained of progressive hearing loss since childhood and periodic episodes of recurrent vertigo since 30 years of age. She had been misdiagnosed as having Meniere's disease by previous doctors. The second case was a 9-year-old boy with acute hearing loss several hours after minor head collision. Psychogenic hearing loss was initially suspected, but was eventually ruled out based on diminished auditory brainstem response. When these patients were initially seen in our clinic, both patients showed severe bilateral combined hearing loss on pure tone audiogram. Definitive diagnosis was established by magnetic resonance imaging, which demonstrated expanded endolymphatic ducts and sacs.Clinical characteristics and possible pathogenesis of large vestibular aqueduct syndrome is discussed with a review of the literature.

MALT lymphoma is characterized as a type of low-grade extranodal B cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). It is thought to be associated with autoimmune diseases, e. g., Sjogren's syndrome and Hashimoto's disease, or inflammatory diseases, e. g., Helicobacter pylori infection of the stomach. We report a rare case of MALT lymphoma of the cheek. A 76-year-old woman was referred to our clinic, complaining of swelling of the left cheek. CT and MRI showed a solid mass with a smooth surface in the subcutaneous region of her left cheek. Total resection of the tumor was performed. The tumor was histopathologically diagnosed as MALT lymphoma. No other lesions were detected in systemic examinations. A complete remission was obtained with 4 courses of Rituximab (anti-CD20 monoclonal antibody) therapy and irradiation at 40Gy. The patient is currently free from disease 21 months after surgery.

We report a case of liposarcoma of the hypopharynx in a 76 year-old male that recurred repeatedly and was associated with histological changes over a period of 10 years. The initial histological diagnosis was a tumor of the well-differentiated type, and the patient underwent simple extirpation via lateral pharyngotomy. Eight years after the original surgery, lateral pharyngotomy was repeated for resection of a recurrent tumor, which proved to be of the dedifferentiated type. Two years after the second surgery, the tumor recurred again, growing more rapidly, and the patient displayed dyspnea and dysphagia. CT scans and MRI findings revealed a large hypopharyngeal tumor expanding from the mesopharynx to the cervical esophagus. The patient subsequently underwent pharyngolaryngoesophagectomy combined with free jejunum transplantation. The resected tumor was histologically diagnosed as myxoid in type.Most liposarcomas of the hypopharynx are histologically low-grade malignancies, patients with this disease often survive for years. However, in cases of recurrence, the histological features of the tumor occasionally change to higher-grade malignant types. In view of this possibility, complete surgical excision is very important in the initial treatment of liposarcoma, and physicians should not hesitate to perform wide excision in cases of recurrence.

We report a case of extramedullary plasmacytoma of the maxilla, which was difficult to diagnose definitively by conventional histopathology because of the presence of epithelial antigens.A 62-year-old male with a 7-month-history of unilateral epiphora and nasal obstruction followed by swelling of his left cheek is presented. Physical findings, CT scanning and MRI imaging revealed a maxillary tumor, T4N0M0. Blood test, serum and urine protein analyses and bone marrow examination showed no abnormality. No other systemic lesion was found in X-rays and 67Ga- and 99mTc-scintigrams. Exploratory resection was performed, and the tumor was pathologically diagnosed as an undifferentiated carcinoma on the basis of its morphological features and positive immunohistochemical examination for epithelial markers such as cytokeratin and epithelial membrane antigen (EMA). The patient received preoperative local irradiation of 40Gy, and underwent total maxillectomy followed by irradiation of 50Gy and administration of cisplatin and 5-fluorouracil.Nineteen months after the surgery, the patient manifested a tumor in the thyroid region with high serum gamma-globulin and IgG levels. In addition, IgG-kappa-type myeloma protein was detected by immunoelectrophoresis of the serum. The patient underwent subtotal thyroidectomy. Although the tumor cells of the surgical specimen still exhibited epithelial markers, electron microscopic observation, immunohistochemical examination and Southern blot analysis demonstrated rough endoplasmic reticulum-rich cytoplasm, kappa (+) lambda (-) of Ig light chain and rearranged bands of Ig heavy chain, which are characteristic of plasmacytoma. The tumor was, consequently, diagnosed as extramedullary plasmacytoma. Serum gamma-globulin and IgG levels returned to the normal range 4 months after the second surgery.In conclusion, we emphasize that plasmacytoma may express epithelial antigens, and thus the importance of multiple supplementary methods to diagnose this neoplasm.