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      Dural plasmacytoma mimicking meningioma in a young patient with multiple myeloma

      case-report

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          Abstract

          Intracranial involvement in multiple myeloma (MM) is rarely found, especially with dural involvement. There are only a few cases found concerning MM with intracranial involvement. MM usually involves an older group of patients. Cases involving young patients are very rare. The differential diagnosis of a dural plasmacytoma includes meningioma, metastasis, lymphoma and sarcoma of the dura mater. We present a young patient, 33 years old, with MM presenting an intracerebral mass mimicking meningioma on MRI. MM was diagnosed the previous year. The patient presented with headache, balance disturbance and back pain. MRI revealed an occipital extra-axial mass with a dural tail. Histopathological examination after excision showed MM. Published literatures on intracranial involvement of MM are also discussed. Plasmacytoma should be considered in the differential diagnosis of a solitary dural mass, particularly in a patient with MM.

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          Most cited references28

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          Handbook of Neurosurgery

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            Multiple myeloma.

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              Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay.

              The purpose of this pictorial essay is to increase awareness of the clinical presentation, neuroradiological findings, treatment options, and neuroradiological follow-up of plasmacytomas and multiple myeloma with intracranial growth. This pictorial essay reviews the clinical features and neuroradiological findings in seven patients (four women, three men; age range at diagnosis 62-82 years) followed in two institutions. Six patients, one with IgG-kappa plasmacytoma, and five with IgG-kappa (n = 3), IgG-lambda (n = 1), and nonsecretory (n = 1) multiple myeloma, had been seen over a period of 9 years in one institution, and the other patient with IgG-kappa plasmacytoma had been seen over a period of 3.5 years in the other. Intracranial involvement is rare, most frequently resulting from osseous lesions in the cranial vault, skull base, nose, or paranasal sinuses. Primary dural or leptomeningeal involvement is rarer. Some typical findings of a dural and/or osseous plasmacytoma include iso- to hyperdensity on CT scan, T1 equal to high signal intensity and T2 markedly hypointense signal on MRI, and high vascularity possibly documented on intraarterial digital subtraction angiography. However, the neuroradiological findings generally lack specificity, since they are generally no different from those of meningioma, metastasis, lymphoma, dural sarcoma, plasma cell granuloma, infectious meningitis, and leptomeningeal carcinomatosis. The spectrum of clinical and neuroradiological evaluation shows that intracranial involvement from plasmacytoma and multiple myeloma must be taken into account in the differential diagnosis of cranial osseous and meningeal disease.
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                Author and article information

                Journal
                Biomed Imaging Interv J
                biij
                Biomedical Imaging and Intervention Journal
                Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Malaysia
                1823-5530
                01 April 2009
                Apr-Jun 2009
                : 5
                : 2
                : e5
                Affiliations
                [1 ] Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
                [2 ] Department of Neurosurgery, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
                Author notes
                [* ] Present address: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. Tel: +818032027926; Fax: +81263370480; E-mail: nunung_afs@ 123456yahoo.com (Nunung Nur Rahmah)

                Part of the paper was presented at AACNS meeting in Nagoya, November 2007

                Article
                10.2349/biij.5.2.e5
                3097756
                21611030
                66b33c86-74f9-4c7b-b2f1-a8a23e4b9946
                © 2009 Biomedical Imaging and Intervention Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 November 2008
                : 21 January 2009
                : 21 January 2009
                Categories
                Case Report

                Radiology & Imaging
                posterior fossa,intracranial plasmacytoma,multiple myeloma
                Radiology & Imaging
                posterior fossa, intracranial plasmacytoma, multiple myeloma

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