Sellar Solitary Plasmacytoma Progressing to Multiple Myeloma

Jiang, Changzhen; Lin, Qingsong; Wu, Xiyue; Wang, Chenyang; Kang, Dezhi

doi:10.1097/md.0000000000000058

Cited by 12 publications

(19 citation statements)

References 34 publications

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“…In prior reviews, patients with parasellar plasmacytomas presented at a median age of 56 years, with similar gender predilection [10,55]. Our review found a slightly older median age and a slight favoring of males to females, but still strikingly unlike non-parasellar solitary bone plasmacytomas, which have a male:female ratio of 2:1 [2].…”

Section: Discussionsupporting

confidence: 53%

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Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

et al. 2017

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Purpose Parasellar plasmacytomas are rare tumors localized to the sellar region arising from plasma cells. Knowledge of clinical, imaging, surgical, and pathological characteristics is limited to single case reports. Methods A retrospective analysis of 5 primary cases was conducted, followed by systematic review of English language articles using PubMed in accordance with PRISMA guidelines. Results Five primary case patients include four men and one woman, ages 60–77, followed up to three years. A systematic review identified 65 additional patients, of whom 65% presented with cranial nerve palsies and 15% with hypopituitarism. Sixteen percent had history of known multiple myeloma (MM) while 37% were diagnosed concurrently with MM on presentation of parasellar plasmacytoma. Imaging showed median tumor size of 38 mm (range, 4–70 mm), with MRI intensity similar to that of other sellar masses. Surgical biopsy with immunohistochemical studies confirmed plasmacytoma diagnosis. Eighty-one percent underwent parasellar radiotherapy, and chemotherapy initiated in 59% of the 69 patients with MM. Overall survival rate was 74% at follow-up (median 12 months), with 18% having parasellar recurrences and 38% progressing to systemic MM after presentation of a solitary plasmacytoma (median 3 months). Conclusions Parasellar plasmacytomas are rare tumors that should be considered in the differential diagnosis for lesions involving the sella and arising from the clivus, especially when cranial nerve paresis is apparent, even in the absence of known MM. Although recurrence rates for parasellar plasmacytoma is low, patients should be monitored for progression to MM. Treatment depends on the presence of systemic disease at diagnosis.

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Section: Discussionsupporting

confidence: 53%

“…In prior series, patients with MM were treated with chemotherapy, at times with adjuvant radiotherapy [55,51,52]. Response rates to radiotherapy in these patients are 80–90%, with a 74% overall survival rate, a 50% disease-free survival rate, and an 86% local control rate after 5 years [10].…”

Section: Discussionmentioning

confidence: 99%

Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

et al. 2017

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“…We report a rare case of a solitary sellar plasmacytoma, which initially masqueraded as temporal arteritis. So far, 36 cases of sellar plasmacytomas have been reported in the literature ( 2 , 3 , 5 , 6 , 7 ), but only eight cases were classified as solitary plasmacytomas ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…Solitary plasmacytomas are uncommon and can either arise from bone or soft tissue ( 1 ). Solitary sellar plasmacytomas are exceedingly rare and to date there has only been eight reported cases without progression to multiple myeloma ( 2 , 3 , 4 , 5 , 6 , 7 ). Clinically and radiologically, sellar plasmacytomas mimic benign pituitary tumors, which make the differential diagnosis difficult ( 3 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

The solitary sellar plasmacytoma: a diagnostic challenge

Soejbjerg

Dyve

Bærentzen

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummarySolitary sellar plasmacytomas are exceedingly rare and difficult to distinguish from other pituitary tumors. We report a case of a 62-year-old woman presenting with blurred vision of the right eye and tenderness of the right temporal region, which was interpreted as temporal arteritis. MRI revealed a pituitary mass lesion (20mm×14mm×17mm) without compression of the optic chiasm and her pituitary function was normal. Pituitary surgery was undertaken due to growth of the lesion, and histopathological examination showed a highly cellular neoplasm composed of mature monoclonal plasma cells. Subsequent examinations revealed no evidence of extrasellar myeloma. The patient received pituitary irradiation and has remained well and free of symptoms apart from iatrogenic central diabetes insipidus. Until now, only eight cases of solitary sellar plasmacytoma have been reported. Most frequent symptoms stem from compression of the cranial nerves in the cavernous sinus (III, IV, V), whereas the anterior pituitary function is mostly intact.Learning pointsA solitary plasmacytoma is a rare cause of a sellar mass lesion.The radiological and clinical features are nonspecific, but cranial nerve affection and intact pituitary function are usually present.The diagnosis is made histologically and has important therapeutic implications.

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“…A solitary plasmacytoma is a possible presentation form of multiple myeloma. Sellar plasmacytomas are very uncommon and can be easily mistaken with a non-functioning pituitary adenoma, because of clinical and radiological resemblance ( 1 ). Most cases described in the literature presented with neurological symptoms ( 2 ) and normal (or slightly affected) anterior pituitary function ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Sellar plasmacytoma presenting with symptoms of anterior pituitary dysfunction

Ferreira

Silva

Luiz

et al. 2017

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Sellar plasmacytomas are rare and the differential diagnosis with non-functioning pituitary adenomas might be difficult because of clinical and radiological resemblance. They usually present with neurological signs and intact anterior pituitary function. Some may already have or eventually progress to multiple myeloma. We describe a case associated with extensive anterior pituitary involvement, which is a rare form of presentation. A 68-year-old man was referred to our Endocrinology outpatient clinic due to gynecomastia, reduced libido and sexual impotence. Physical examination, breast ultrasound and mammography confirmed bilateral gynecomastia. Blood tests revealed slight hyperprolactinemia, low testosterone levels, low cortisol levels and central hypothyroidism. Sellar MRI showed a heterogeneous sellar mass (56 × 60 × 61 mm), initially suspected as an invasive macroadenoma. After correcting the pituitary deficits with hydrocortisone and levothyroxine, the patient underwent transsphenoidal surgery. Histological examination revealed a plasmacytoma and multiple myeloma was ruled out. The patient was unsuccessfully treated with radiation therapy (no tumor shrinkage). Myeloma ultimately developed, with several other similar lesions in different locations. The patient was started on chemotherapy, had a bone marrow transplant and is now stable (progression free) on lenalidomide and dexamethasone. The presenting symptoms and panhypopituitarism persisted, requiring chronic replacement treatment with levothyroxine, hydrocortisone and testosterone.Learning points:Plasmacytomas, although rare, are a possible type of sellar masses, which have a completely different treatment approach, so it is important to make the correct diagnosis.Usually, they present with neurological signs and symptoms and a well-preserved pituitary function, but our case shows that anterior pituitary function can be severely compromised.Making a more extensive evaluation (clinical and biochemical) might provide some clues to this diagnosis.

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Sellar Solitary Plasmacytoma Progressing to Multiple Myeloma

Cited by 12 publications

References 34 publications

Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

The solitary sellar plasmacytoma: a diagnostic challenge

Sellar plasmacytoma presenting with symptoms of anterior pituitary dysfunction

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