Management of intracranial plasmacytoma

Abstract

The authors report on a study of eight cases of intracranial plasmacytoma to identify the risk of progression to multiple myeloma and suggest the treatment required for cure of solitary lesions. The diagnosis of multiple myeloma or myelomatous changes was made in the immediate postoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with complete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2-25 years); one patient underwent subtotal surgical resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during the long term in patients with intracranial plasmacytoma who do not develop multiple myeloma or myelomatous changes in the early postoperative period. However, lesions that infiltrate the skull base are not likely to be solitary, and patients who harbor these neoplasms should undergo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possible with subtotal surgical resection despite radiation therapy. Definitive treatment should consist of complete surgical resection with adjuvant radiation therapy.

Multiple myeloma with intracranial extension and bilateral renal infiltration: A case report and review of the literature

“…If the tumor is located in an area with restricted surgical access, a complete resection with fractionated radiotherapy at the tumor site may be a good option for intracranial plasmacytomas. However, a number of case reports have highlighted the use of systemic chemotherapy and radiotherapy as the most important part of the treatment (18,19). Recent studies on the fundamental molecular mechanisms responsible for MM cell growth and survival have led to the introduction of novel classes of pharmacological agents, including immunomodulatory drugs and proteasome inhibitors (20).…”

Solitary Plasmocytoma of the Vault

“…In this case, symptomatology depends on the lesion's location [12]. Cosmetic skull deformities have been reported to be a usual cause for referring to a specialist [13].…”

A Review of Stereotactic Radiosurgery in the Management of Brain Metastases

“…Of the approximately 200,000 patients with these malignancies who will die each year, 124,000 will have brain metastases (9). The cause of death in almost 30-50% is persistence of lesions or recurrence following WBRT; however, 10 to 15% of patients will survive at least one year (9,10).…”

“…Of the approximately 200,000 patients with these malignancies who will die each year, 124,000 will have brain metastases (9). The cause of death in almost 30-50% is persistence of lesions or recurrence following WBRT; however, 10 to 15% of patients will survive at least one year (9,10). These data, along with the fact that brain metastases are so frequently three or fewer, provide the rationale for the development of treatment modalities that exceed current palliative measures to actually improve patient survival, neurocognitive function and/or quality-of-life.…”