Solitary giant extradural plasmacytoma

Abstract

Solitary plasmacytoma of the skull is very rare, and only a few cases have been reported in the literature. It remains controversial whether solitary plasmacytoma of the skull is essentially identical with solitary plasmacytoma of bone or not. Solitary plasmacytoma of bone including solitary plasmacytoma of the skull is characterized by a radiologically solitary bone lesion, neoplastic plasma cells in the biopsy specimen, fewer than 5% plasma cells in bone marrow, <2.0 g/dl monoclonal protein in the serum when present and negative urine test for Bence Jones protein (monoclonal light chain). We report one case of a 70-year-old woman who referred to our hospital because of a progressive left parietal swelling. On clinical examination, a painless large soft mass in the right parietal region was observed. Computed tomography revealed an extra-axial mass in the in the left frontoparietal region. The lesion was totally excised despite the bleeding tendency. Histology disclosed the presence of a plasmacytoma. On follow-up examination, 7 months later no tumor recurrence or evidence of multiple myeloma was detected.

Giant solitary extradural plasmacytoma of the skull: illustrative case

“…Thorough hemostasis cannot be overemphasized because plasmacytoma may be a highly vascular tumor and excessive blood loss with cardiac arrest has been reported. 4,7 Therefore, we believe that preoperative embolization in these cases is crucial, as fatal hypovolemic shock was prevented in our patient. It is advisable to perform craniectomy and cranioplasty in all patients because of the high recurrence rate reported when leaving remnant cells of the tumor in the surrounding bone surface.…”

“…3,7 Histological diagnosis requires immunohistochemical staining of neoplastic plasma cells with strong and diffuse expression of CD138. 4 Light chain restriction is present in 92% of the cases and confirms plasmacytoma. However, light chain restriction is not seen in 10% of extramedullary plasmacytomas, and paucicellular hematopoietic lesions may also result in poor light chain restriction determination.…”

“…4,5 Plasmacytoma often lacks neurological symptoms, except in cases of intraparenchymal dissemination or compression of the brain and cranial nerves. 4,6 The diagnosis of SEPS is based on a radiologically solitary bone lesion, plasma cells in the biopsy specimen, less than 5% plasma cells in bone marrow, less than 2 g/dL monoclonal protein (M protein) in the serum when present, a negative urine test result for Bence Jones protein, no evidence of hyperglobulinemia and hypercalcemia, and absence of anemia. 3,7 Histological diagnosis requires immunohistochemical staining of neoplastic plasma cells with strong and diffuse expression of CD138.…”

“… 4 Cosmetic skull deformities have been reported to be a usual cause for referral to a specialist. 4 , 5 Plasmacytoma often lacks neurological symptoms, except in cases of intraparenchymal dissemination or compression of the brain and cranial nerves. 4 , 6 …”

“… 4 , 5 Plasmacytoma often lacks neurological symptoms, except in cases of intraparenchymal dissemination or compression of the brain and cranial nerves. 4 , 6 …”