Primary Cerebral Plasmacytoma: A Rare Case Report with Review of Literature

Abstract

Solitary craniocerebral plasmacytoma is the least common form of extramedullary solitary plasmacytoma (SP). Cerebral SP is very rare. The world literature counts only seven intracranial cases. The authors report a case of cerebral tumor of SP in a 52-year-old female who presented to a hospital with headache and difficulty in walking for 6 months. Contrast-enhanced computed tomography (CECT) brain showed left occipital intracranial space occupying lesions (ICSOL) of size 26 mm × 14 mm adjacent to superior sagittal sinus with disproportionate perilesional edema and midline shift toward the right. She underwent gross total tumor excision with left fronto-temporo-parietal decompressive craniectomy. Microscopic sections showed highly cellular tumor infiltrating white matter and gray matter. Histopathology revealed plasmacytoma. These plasma cells were seen infiltrating the adjoining brain parenchyma. Immunohistochemistry study showed the following pattern of antigens: most of the cells were negative to CD138 antibody, and majority of cells were positive (++ to +++) to CD56 antibody, more groups of cells were positive to lambda antibody than KAPPA. Bone marrow biopsy showed only 1% polyclonal plasma cells. Whole body bone scan showed no evidence of any osteoblastic skeletal metastasis. The patient recovered well, and cranioplasty was done after 6 weeks. Conclusion Cerebral SP is rarely found in clinical practice and if diagnosed properly can save patients life. This case report would definitely address many unexplored facts about cerebral SP and set milestone in the field of clinical research.

Autoimmune Hemolytic Anemia, Amoebic Dysentery, And Intracranial Hemorrhage as Rare Manifestations of Smoldering Multiple Myeloma: A Case Report

“…After further examination, a primary cerebral plasmacytoma with a bleeding tumor without progressing to MM was found because there were no lytic lesions in the bone and only 1 % plasma cells were found on bone marrow aspiration. However, in this case, an excision of the tumor was carried out, histopathological and immunohistochemical examinations were performed and it showed a plasmacytoma (18). Another case reported by Onodera et al was an intracranial plasmacytoma secondary to MM with cerebral hemorrhage without the involvement of bone lesions.…”

Solitary Intracranial Plasmacytoma of the Brain Treated With Primary Radiation Therapy

“…This patient was followed for 16 months post-surgery without evidence of tumor recurrence or the development of MM. Another recent case report presented by Kumar et al (2019) highlighted a primary occipital SIP in a 52-year-old female that was treated with gross total excision and decompressive craniectomy followed by 39 Gy in 13 fractions of palliative whole brain RT [ 16 ]. At 6 months postoperatively, the plasmacytoma decreased in size without evidence of disease recurrence [ 16 ].…”

“…Another recent case report presented by Kumar et al (2019) highlighted a primary occipital SIP in a 52-year-old female that was treated with gross total excision and decompressive craniectomy followed by 39 Gy in 13 fractions of palliative whole brain RT [ 16 ]. At 6 months postoperatively, the plasmacytoma decreased in size without evidence of disease recurrence [ 16 ]. As an alternative to surgical resection, definitive RT alone can be considered for SP (both SBP and SEP).…”

“…The literature describing SIP of the brain is mostly comprised of case reports, owing to the rarity of this diagnosis. In fact, to our knowledge, only 12 case reports have documented an SIP originating within the brain parenchyma (Table 1) [8][9][10][11][12][13][14][15][16][17][18]. In these cases, surgical resection followed by adjuvant RT has been the mainstay of treatment.…”