Patient: Treatment history: The patient was admitted to the hospital on 2008-11-25 for “progressive recurrent bleeding for 9 months, aggravated by nasal obstruction for 1 month” and then underwent anterior nostril filling to stop the bleeding. Surgery was planned, but the patient refused surgery, so he was referred to oncology for further treatment. On December 11, 2008, the patient started to undergo radiotherapy for the nasal lesion, and the specific plan was “nasal cavity intensity modulated radiotherapy, 40Gy/20f/4w” 21 times in the first period, and then the MRI of nasopharynx showed that the lesion still remained, so the second plan was made to increase the amount of radiotherapy to 62Gy 10 times. During the radiotherapy period, the patient was treated with nasal irrigation, immunity enhancement and “Ximena” radiotherapy sensitization therapy. Important findings: MRI of nasopharynx showed that “after radiotherapy for plasmacytoma of nasal cavity and nasopharynx, soft tissue signal filled masses were seen in the nasal cavity and nasopharyngeal cavity with long T1 and slightly long T2 signal changes, mucosal thickening of maxillary sinus, pterygoid sinus, mastoid process and septal sinus bilaterally with long T1 and long T2 signal changes, no thickening of posterior wall of nasopharynx, no obvious enlarged lymph nodes in the neck and brain parenchyma were seen. No obvious abnormal signal was seen. The nasal nasopharyngeal plasmacytoma was discharged from the hospital on 2009-01-24 and was reviewed in January. On 2009-2-21 at about 2:30 am, there were obvious bleeding symptoms in the right nasal cavity, during which ephedrine-containing drugs and oral nephrite tablets were injected to stop the bleeding and nasal stuffing was carried out. At about 12:00 noon, there were slight bleeding symptoms in the left nasal cavity accompanied by translucent pus outflow; at about 14:00 pm, the bleeding stopped and hemostatic drugs were taken all the time with no abnormal reflection. Review date: 2009-3-4 Examination site: sinus, nasopharynx MRI (scan + enhancement) Review results: nasal cavity nasopharyngeal plasmacytoma after radiation therapy: soft tissue signal filling in the nasopharyngeal cavity is visible, growing forward into the right nasal cavity, showing long TI slightly long T2 signal change, enhanced lesion significantly enhanced. The mucosa of maxillary sinus, butterfly sinus, mastoid and septal sinus is thickened bilaterally, showing long T1 and long T2 signal changes, and the posterior wall of nasopharynx is not thickened. What kind of medication should be used to control the inflammation or what is the treatment plan during rest at home? The patient’s age is 78 years old, male, because the patient’s blood pressure is unstable, his age is high, his heart is poor, he is protected from treatment and he does not know his condition. Doctor: The patient was diagnosed with plasmacytoma of the nasal cavity and nasopharynx. Extramedullary plasmacytoma (EMP) is a malignant tumor derived from B lymphocytes, formed by the abnormal proliferation of monoclonal plasma cells, and can occur anywhere outside the medulla, most commonly in the head and neck. Extramedullary plasmacytomas are rare in clinical practice and have unique biological behavior and clinical features; EMP is generally slow-growing, with limited or predominantly locally invasive lesions; in a few cases, lymph node metastases may occur, or multiple myeloma may develop within months to years after the onset of the disease. EMP has high radiosensitivity, and radiotherapy alone can achieve a high control rate, so radiotherapy is the first choice for EMP, with a radiation dose of 40-50 Gy to achieve good local control rate. Surgery is another important means of EMP treatment. For lesions located in soft tissues and relatively limited, they can be treated by surgery alone. The patient is 78 years old and has been treated with 62 Gy of radiation therapy, and is now almost two months out of radiation therapy, with MR suggesting soft tissue signal filling the nasopharyngeal cavity. Daily saline nasopharyngeal irrigation is recommended. Regular endoscopy and MR review will be performed, and three months after radiotherapy, depending on the tumor regression, it will be determined whether to save the surgery.