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Case-Report
*Corresponding Author: Bipin chaurasia, Study undertaken in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Bangladesh
Citation: Chaurasia B, Jahan N, Mosharef Hossain ATM, Bhattachariya R, Barua KK, Halder K, and KM Tarikul Islam. Plasmacytoma of Skull Mimicking Meningioma and Metastasis J. Neuroscience and Neurological Surgery 3(3): DOI:10.31579/2578-8868/053.
Copyright: © 2019 Bipin chaurasia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 15 May 2019 | Accepted: 24 June 2019 | Published: 03 July 2019
Keywords: plasmacytoma; meningioma; metastasis;
Plasmacytoma is a tumor arising from plasma cell, which mainly grows within soft tissue or within axial skeleton. When it is present as a discreet solitary mass it is called as solitary plasmacytoma and it is rare. We report a case of 46 years male presented to us with the complaints of painless swelling in the left front parietal region which is about 8.6x6.5cm in diameter .Magnetic resonance imaging(MRI) revealed an extra axial mass in fronto parietal region with overlying bone destruction mimicking meningioma with bony erosion. We did fronto parietal craniectomy and complete resection of tumor with bone margin subsequent cranioplasty also done.Histopathology of which revealed plasmacytoma. After that we did urinary bence jones protein which was negative.
Plasmacytoma is malignant proliferation of plasma cell, mainly arise from proliferation of a single clone of B lymphocyte 3% of which present as solitary lesion [1]. The international myeloma working group lists three types of plasmacytoma: solitary plasmacytoma of bones, extramedullary plasmacytoma & multiple plasmacytoma. Solitary plasmacytoma occurs as lytic lesion. An osteolytic plasmacytoma lesion in skull with no systemic involvement is extremely rare.[2] Multiple myeloma, extramedullary plasmacytoma and solitary bone plasmacytoma all are the three subgroup of plasma cell tumor.[3]
We present a case of plasmacytoma present in frontoparietal region
Case report
A 77 years male admitted to our department with complaints of gradual enlargement of a painless swelling on his vertex for one year. On examination we found a painless mass in left frontoparietal region measuring about 8.5 x 6.4 cm in diameter which was firm in consistency, not mobile, fixed with underlying & overlying structure, on general physical examination no other abnormality detected, neurological examination was also normal. He has no significant past medical or surgical illness. On MRI of brain revealed a iso to hypointense extra axial lesion involving the left frontoparietal region measuring about 8 x 6 cm causing mass effect over the brain parenchyma (Figure 1, 2, 3, 4).
After Intravenous gadolinium showed strong enhancement of the lesion. On CT scan of brain revealed there is a lytic lesion in left frontoparietal region causing a bone defect (Figure.5, 6).
On magnetic resonance venogram displayed the superior sagittal sinus is compressed by the tumor. complete blood count all are within normal range.as our initial diagnosis was may be a case of meningioma or metastasis so we did all metastatic work up eg.thyroid scan, Ultrasonography of whole abdomen and tumor marker but all were normal, He underwent craniectomy peroperative tumor was found to involve the subcutaneous tissue to bone upto dura & which was completely extradural, tumor was moderately vascular, total removal of tumor with involved bone was removed (Figure 7,8).
cranioplasty was done with bone cement (Figure 9,10).
Histopathology revealed plasmacytoma .his post-operative period was uneventful, as there was no other site of lytic lesion and we removed tumor in en bloc with part of dura so radiotherapy was not performed.
Discusson
Plasma cell tumor are divided in three type solitary plasmacytoma of bone (SPB), extramedullary plasmacytoma & multiple myeloma. Multiple myeloma is systemic disease which involved multiple osteolytic lesions, atypical plasma cell in biopsy , amyloid deposit & abnormalities in immunoglobulin production, and the others are local form of plasma cell tumor , According to Bataille and Sany, the diagnostic criteria for SPB include an isolated tumor composed of malignant plasma cells; absence of other lesions on skeletal radiographic survey; absence of plasmacytosis in the bone marrow, absence of anemia, hypercalcemia, or renal involvement & the Vertebrae and pelvic bones are mostly involved by SPB.[3] Solitary plasmacytoma of skull is rare disease and considered to be curable with resection & radiotherapy.[4] Due to its rarity most of the time preoperatively it is misdiagnosed as meningioma or metastasis . As compared to SPB the prognosis of solitary plasmacytoma of skull is good if it is diagnosed on strict criteria. [1] so making the appropriate diagnosis is necessary for further management & follow up, though from some literature they think that solitary plasmacytoma is the initial presentation of multiple myeloma with progression of time this may convert into multiple myeloma. [5]
We went through published literature [ Table:1(4,6-12)] of patients diagnosed as a case of solitary plasmacytoma of skull received en bloc removal of tumor including cranioplasty.
All of those patients are histopathologically proven plasmacytoma of skull among them four patients receive only surgery, no post-operative radiotherapy or chemotherapy, and four patients received surgery along with post-operative radiotherapy, and on follow up among them seven patient has no recurrence except one patient whom post-operative follow up is not available.
Radiotherapy is the definitive treatment for solitary plasmacytoma of bone, surgery along with radiotherapy is the treatment of choice based on tumor location and type of removal of tumor, chemotherapy is not needed until there is systemic involvement as like multiple myeloma. [4] if there is gross total resection of tumor in case of isolated local tumor radiotherapy is needed or not is still in quarry, but as sometimes solitary plasmacytoma is the initial presentation of multiple myeloma regular follow up is necessary in all cases.
Conclusion
Isolated solitary plasmacytoma is a very rare tumor,en bloc tumor removal with removal of involved bone up to macroscopic healthy margin with cranioplasty is a treatment option but as radiotherapy is another option so regular follow up should be carried out.
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