Multiple myeloma presenting as an asymptomatic forehead mass resembling solitary plasmacytoma

Abstract

A 77-year-old woman presented with a 3-month history of a painless, progressively enlarging mass on the right side of the forehead. She reported no associated constitutional or neurological symptoms. Local examination revealed a 5 cm, domeshaped, tender mass. CT and MRI showed a well circumscribed, 11 × 10 × 7.5 cm osteolytic lesion in the right front-parietal region, which infi ltrates the overlying skin and the frontal lobe.Treatment included radical excision of the lesion and skin reconstruction with a microvascular free fl ap. Histopathological examination confi rmed the diagnosis of plasmacytoma with Lambda light chain restriction of the frontal bone. Th e patient had an uneventful recovery from the procedure and was subsequently referred to a haematologist to detect a possible multiple myeloma. On laboratory examination, there was anaemia and low albumin levels. Creatinin levels did not show renal dysfunction. A monoclonal IgG Lambda component was detected in serum protein electrophoresis.A bone scan was performed that revealed multiple osteolytic lesions in the cranial vault, ribs and both humerus, confi rming the diagnosis of a multiple myeloma. Th e patient was treated with radiotherapy (40 Gy on the frontal lesion) and chemotherapy (melphalan and prednisone), but died of disease 18 months after the diagnosis.