Solitary dural plasmacytoma with parenchymal invasion

Abstract

Summary: Primary solitary dural plasmacytoma is an uncommon neoplasm of plasma cell. The clinical presentation and neuroradiological findings of these tumors may be deceptive and resemble to the other most prevalent brain tumors. Solitary plasmacytoma mostly shows a benign behavior and malignant features like local invasion is so rare. We describe the case of parenchymal brain involvement by solitary dural plasmacytoma.

Dural Plasmacytoma with Meningeal Myelomatosis in a Patient with Multiple Myeloma

“…An MRI shows T1 signal iso- or hyperintensity and marked T2 signal hypointensity. This presentation mimics the image of a meningioma, which is the main differential diagnosis together with metastases and lymphoma [ 10 – 12 , 15 ]. Therefore, a histological study is essential to confirm the diagnosis.…”

“…The main diagnosis of dural plasmacytoma should be based on clinical suspicion, which shall depend on the region where the lesion is located and its extension. Clinical presentation of plasmacytomas in the dura mater is usually related to space occupation such as headache, seizures, or focal neurological deficit [ 1 , 5 , 7 , 12 – 15 ]. Diagnosis should be conducted with imaging tests: in a CT scan, it is possible to confirm signal iso- or hyperintensity.…”

“…Therefore, a histological study is essential to confirm the diagnosis. Tumor proliferation of diffuse growth atypical plasma cells with lambda chain positivity is characteristic [ 1 , 15 ].…”

“…Given its high radiosensitivity, reasonable options include radiotherapy given with curative intent, or surgical resection of the plasmacytoma, as thorough as possible, followed by adjuvant radiotherapy. The optimal doses of radiotherapy are controversial due to the scarcity of publications, but authors seem to agree that, in the absence of surgery, the minimum advisable is a total dose of 40–50 Gy given with conventional fractionation [ 1 , 12 – 15 ].…”

Intracranial Calcification Masquerading as Hemorrhage in a Patient with Multiple Myeloma Presenting with Facial Neuropathy

“…In a single-center case-control study by Hinduja et al., about four percent of MM patients had a stroke, of which acute ischemic stroke or transient ischemic attack (TIA) constituted 96 percent, and intracerebral hemorrhage constituted four percent [ 5 ]. Although rare, intracerebral plasmacytomas can arise from meninges and cerebral parenchyma and share radiological features with intracerebral hemorrhage with hyperdensity on CT imaging [ 6 - 9 ]. However, they are also characterized by intense contrast enhancement, peritumoral edema, and rarely intratumoral hemorrhage [ 10 - 13 ].…”