The solitary sellar plasmacytoma: a diagnostic challenge

Abstract

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.

Sellar plasmacytoma presenting with symptoms of anterior pituitary dysfunction

“…Data regarding the anterior pituitary function in patients with sellar plasmacytomas are not always reported, but it is usually well preserved ( 3 , 5 , 6 , 7 , 8 , 9 ), unlike our case. Lee and coworkers ( 6 ) present 1 patient with hypogonadotrophic hypogonadism and 1 patient with hyperprolactinemia, without hypopituitarism.…”

“…In most of these cases, patients presented with headaches and visual disturbances (mainly diplopia, but also visual loss or blurred vision) ( 1 , 6 , 8 ). Cranial nerve involvement was frequent, mostly III, IV and VI nerves ( 1 , 2 , 8 ), but also II, V, VII and VIII ( 1 , 7 , 9 ).…”

“…Sellar plasmacytomas may be easily mistaken with other sellar masses in imaging studies, so the definite diagnosis is histological ( 1 , 8 ). Some features described in the literature that are commonly related to plasmacytomas include large size, extension to adjacent areas and bone destruction (sellar floor, clivus) ( 6 , 7 ).…”

Case Report: Cavernous Sinus Syndrome as the Initial Presentation of Multiple Myeloma

“…Cavernous sinus involvement, however, is more rare and has been reported in only case reports and series (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The majority of cases reported are in patients with known diagnoses of MM or EMP (15,20,21).…”

Intracranial Plasmacytoma Mimicking a Cavernous Sinus Meningioma

“…Risks of this approach include bleeding, infection, as well as injury to the carotid artery and its branches if these are not identified intraoperatively [ 9 ]. Successful histological identification of a plasmacytoma (mature plasma cells) using a core biopsy changed the course of treatment from surgical to medical management, avoiding major neurosurgical resection [ 10 ]. We would like to note that an endoscopic transnasal biopsy was considered for this patient; however, the procedure would have been more invasive.…”