Novel case of primary intracranial solitary plasmacytoma presenting with significant intratumoral hemorrhage

Abstract

Background: Solitary plasmacytoma is a localized lesion comprising monoclonal neoplastic proliferation of plasma cells. This disease is rarely encountered and few reports have described primary intracranial solitary plasmacytoma (PISP). Case Description: We report a case of PISP that presented initially as status epilepticus and exhibited massive intratumoral hemorrhage at the subcortical area. To the best of our knowledge, this is the first recorded presentation of this pathology in this manner. Following evacuation of the hematoma and decompressive craniectomy, the patient underwent radiation therapy and showed no sign of tumor recurrence at 3 years after diagnosis. Conclusion: This case reveals that PISP can present as subcortical intraparenchymal hemorrhage. It should be emphasized that the precise diagnosis of this disease is of utmost importance, because solitary plasmacytoma without a background of multiple myeloma responds well to radiation therapy.

Primary central nervous system other iatrogenic immunodeficiency‐associated lymphoproliferative disorders presenting as extraosseous plasmacytoma with a progressive clinical course: A case report and literature review

“…20,22 In cases where the tumor does not spread continuously with the bone or dura mater, leptomeningeal or hematogenous spread is considered to be related to tumor bleeding owing to its richness of blood flow. 18,20,22 In this case, CSF cytology was initially negative, and no other significant lesions appeared on whole-spine MRI. However, the initial finding of the CSF was bloody, suggesting leptomeningeal or hematogenous spread with potential tumor bleeding, which could account for the multiple CNS lesions, including the intraparenchymal lesions.…”

“…In the first place, primary CNS plasmacytoma with intraparenchymal lesion that presents as EP is rare. [17][18][19][20] Additionally, cases of OIIA-LPD presenting as EP are rarely reported. 21 In this case, there were multiple CNS lesions including an intraparenchymal lesion in the left temporal lobe, and the pathological diagnosis was plasmacytoma.…”

“…Moreover, a middle fossa lesion in the dura matter with erosion of the bone was suspected to be the primary lesion in this case because it has been reported that intracranial EP tends to occur from the skull or the dura. [17][18][19][20]22 Plasmacytoma metastasis in the CNS occurs through the leptomeningeal route, hematogenous spread, or meningeal dissemination. 20,22 In cases where the tumor does not spread continuously with the bone or dura mater, leptomeningeal or hematogenous spread is considered to be related to tumor bleeding owing to its richness of blood flow.…”

“…In cases of primary CNS plasmacytoma presenting as EP, good prognosis can be achieved with postoperative radiotherapy owing to its radiosensitivity. [17][18][19][20]22 It has been reported that WBRT or IMRT on lesions with a total dose of 40-60 Gy was effective for disease suppression. [17][18][19][20][21][22] On the other hand, no consensus has been reached regarding the use of chemotherapy for primary CNS plasmacytoma.…”

Freiburg Neuropathology Case Conference

“…Cross-sectional imaging usually shows homogeneously enhancing soft tissue masses [24]. While literature review provides a few cases describing intracranial plasmocytoma, they have all been reported as extraaxial masses in patients suffering from multiple myeloma [25][26][27]. To our knowledge, this is the first case report presenting a patient with an intra-axial solitary plasmacytoma that shows no connection to the dura or skull interface on cross-sectional imaging.…”