Relapsing intracranial plasma cell granuloma: A case report

Abstract

Plasma cell granuloma is a pathological entity reported in nearly every organ system; however, intracranial cases remain rare. In the current case report, we present a case of intracranial plasma cell granuloma with the longest known follow-up period in the literature. Medical follow-up over 14 years, detailing four recurrences following the patient’s initial presentation and management, is presented. The patient’s treatment course consisted of three craniotomies, 3,600-cGy fractionated radiation and two courses of glucocorticoid therapy. In addition to disease surveillance using clinical examination and imaging, this case represents the first description of the clinical utility of analyzing changes in an inflammatory blood marker, the erythrocyte sedimentation rate, which coincided with recurrence and response to therapy.

Oral plasma cell granuloma: A case report of an ambiguous lesion

“…Therefore, it is important to do excisional biopsy to distinguish PCG from other pathological entities that are cause for great concern because of their potential morbidity or mortality and thus, histopathological analysis remains the gold standard for achieving the diagnosis of PCG. [15] Extramedullary plasmacytoma presents as a soft tissue plasma cell mass outside of bone. Differentiation between reactive PCG and extramedullary plasmacytoma is based on whether lesion is polyclonal or monoclonal.…”

Multiple Intracranial Inflammatory Pseudotumors

“…Radiographically, IPT is classically T2 hypointense with intense homogeneous contrast enhancement [7]. Localization can be extraaxial, intra-axial or both [7][8][9]10]. Depending on the specific appearance the differential can include meningioma, primary central nervous system (CNS) lymphoma, plasmacytoma, tuberculoma, sarcoidosis, and Wegener's granulomatosis [3,[7][8][9][10][11][12].…”

“…Localization can be extraaxial, intra-axial or both [7][8][9]10]. Depending on the specific appearance the differential can include meningioma, primary central nervous system (CNS) lymphoma, plasmacytoma, tuberculoma, sarcoidosis, and Wegener's granulomatosis [3,[7][8][9][10][11][12]. There are reported cases of atypical appearance of IPT resembling malignant brain tumor as well, having T2 hyperintensity and ring-enhancing appearance [3].…”

“…A more recent case was successfully treated using the anti-CD20 treatment Rituximab [7]. The longest follow-up period was 14 years in one patient illustrating four recurrences treated with 2 craniotomies, 3600 cGyradiation therapy and then two courses of steroid treatment [8]. Authors found that following the erythrocyte sedimentation rate (ESR) was useful in following recurrent disease; correlating along with both lesion recurrence and treatment [8].…”