Plasmacytoma of the skull mimicking an epidural hematoma

Abstract

Rationale:Plasmacytoma as the 1st presentation of skull tumors is a rare disorder. When it is combined with brain trauma or dramatic changes in intracranial pressure, patients are more prone to misdiagnosis.Patient concerns:A 67-year-old woman complaining of a headache presented with a history of head trauma for the past 1 hour. Emergency head computed tomography initially suggested an epidural hematoma.Diagnosis:Emergency surgery was performed to remove the intracranial hematoma, but a tumor-like mass was found during surgery, and pathologic assessment confirmed plasmacytoma. Surgery was difficult because of bleeding. The tumor was radically removed.Interventions and outcomes:The patient underwent whole-brain radiotherapy and chemotherapy. She died 40 months after the surgery.Lessons:Epidural lesions found after a head injury may be assumed to be an epidural hematoma, leading to unnecessary surgery. Diseases such as hematomas, meningiomas, eosinophilic granulomas, bone metastases, and osteosarcomas must be considered.

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

“…[1,12] Histological staining with hematoxylin and eosin reveals a proliferation of atypical plasma cells, usually showing dispersed nuclear chromatin, prominent nucleoli, and a high nuclear-to-cytoplasmic ratio. [12] Although there have been several reports of intratumoral hemorrhage from intracranial lesions in the setting of multiple myeloma, there are no reports of intra-axial hemorrhage from PISP, with only acute subdural hematoma [13] and intraparenchymal hemorrhage [3,5,6,7,15,18,20,23,24,26,27] reported previously [Tables 1 and 2]. Of the cases complicated with intraparenchymal hemorrhage in relation to multiple myeloma, most had a miserable clinical course.…”