Intracranial cell plasma granuloma

Abstract

LetterPlasma cell granuloma (PCG) are uncommon non-neoplastic masses of unknown etiology, characterized histologically by proliferation of connective tissue with an inflammatory infiltrate of mononuclear elements 1,2 . They occur more commonly in the lung and conducting airways, but can also be seen in other tissues, such as the meninges 3 . The imaging appearance of meningeal PCG can simulate more common neoplasms, as menigiomas. At computed tomography (CT) scans, the meningeal PCG presents as an extra-axial hyperdense mass with homogeneous contrast enhancement. On the magnetic resonance images (MRI), the tumor is characterized by isointense to hypointense signal on T1 weighted-images (WI) and hypointense signal on T2WI, with intense and homogeneous contrast enhancement 1,2,4 .We report an additional case of meningeal plasma cell granuloma, with emphasis to the differential diagnosis. CaseA 47-year-old man presented with a 1-year history of reduced visual acuity, mainly on the left side, hearing loss, difficulty in walking and urinary retention. The physical examination revealed spastic tetraparesis, ataxia and paresis of VII to XII cranial nerves, beyond left amaurosis, right amblyopia and bilateral hearing loss, worst at right. CT showed a slightly hyperdense and lobulated dural-based mass with intense and homogeneous contrast-enhancement. It was located at the right cerebellum-pontine angle, occupying the basal cisterns, tentorium cerebelli and supra and parasellar regions, compressing the cerebellum, brain stem and aqueduct of Sylvius, resulting in non-communicat- Intracranial cell plasma granuloma GranuLoma pLaSmoCitário intraCranianoDepartments of Radiology and Pathology of the Federal University of Rio de Janeiro, Rio de Janeiro RJ, Brazil: 1 Mestranda do Programa de Pós-Graduação em Medicina; 2 Professora Titular de Patologia; 3 Professor Adjunto de Radiologia. ing hydrocephalus. No bone changes (hyperostosis, permeative and/or destructive lesions) were noticed in the skull base.The MRI corroborated the relation of the lesion with the duramater, and showed a mass with well-defined lobulated margins, iso to low signal intensity on T1-weighted images, low signal intensity on T2-weighted images and homogeneous enhancement after intravenous gadolinium administration (Fig 1 and Fig 2). It occupied the right cerebellum-pontine angle, compressing the brain stem, with probable invasion of both cavernous sinuses. There were multiple other focal masses along the skull base, with partial encasement of vertebral and basilar arteries. The lesions extended to the optic, internal auditory and hypoglossal canals bilaterally. There was a lesion anterior to the medulla oblonga, compressing this structure, with an inferior extension to the anterior aspect of spinal canal.

Frontal Right Plasma Cell Granuloma; Case Report

“…the clinical, radiological, histological, and immunohistochemical manifestations. The diagnosis is made by exclusion and mainly by pathological examination of the lesion [1].…”

“…PCG is not a difficult diagnosis to make, normal plasma cells are found, although they become atypical, with discrete cellular pleomorphism, there may be a dense lymphocytic infiltrate, predominantly B lymphocytes (CD20+), T lymphocytes are also observed in positive immunoreaction for CD3+, CD4+, and CD8+, as well as macrophages (CD68+), dendritic cells (Fascin +), eosinophils and above all it is striking that both kappa and lambda light chains are positive because it is a polyclonal disease [1,6].…”

“…Plasma Cells Granuloma (PCG) is a benign tumor that affects any part of the body, it has been reported at many sites in multiple or single forms [1]. The plasma cell granuloma has received a diversity of names [2], among which stand inflammatory pseudotumor [3].…”

“…PCG is an uncommon disease that can affect any stage of life, but it is more frequently in childhood and young adults, with a slight prevalence in the female gender [1]. Clinical and radiological manifestations are not characteristic, it presents as a nodule or tumors that may appear in any organ, and the symptoms depend on the localization and size of the lesion [2].…”

Primary intracranial plasma cell granulomas presenting as malignant neoplasms

“…The maleto-female ratio was 2.3:1. Thirteen additional cases have been reported since 2003 per our literature search [9,17,22,[24][25][26][27][28][29][30][31][32]. Of these, three cases involved the cerebral hemispheres [17,24,25] and one case involved the cerebellar hemisphere [9].…”