Multiple myeloma is a blood cancer of monoclonal plasma cells that accumulate in the bone marrow and produce monoclonal immunoglobulin. Extramedullary involvement is rare at the time of initial multiple myeloma diagnosis (about 3,3% of all cases) and is generally associated with multiple relapses and poor prognosis. We present an extremely rare case of multiple myeloma with unusual hypopharyngeal involvement in an 83-year-old patient, who had a previous localization of plasmacytoma at the level of the cranial vault and was referred to our attention for a clinical picture of dysphonia persisting for approximately two years.