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[Multiple myeloma presenting with multiple subcutaneous masses].

Hirotsugu Ohta1, Seiichirou Kawano, Akira Yokota

  • 1Department of Neurosurgery, Chikuhou Rosai Hospital, Fukuoka, Japan.

No to Shinkei = Brain and Nerve
|February 1, 2005
PubMed
Summary

This case report details a rare instance of multiple myeloma presenting as multiple subcutaneous skull masses in a 92-year-old female. Conservative treatment was chosen due to poor prognosis and advanced age, prioritizing quality of life.

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Area of Science:

  • Oncology
  • Neurology
  • Radiology

Background:

  • Multiple myeloma is a plasma cell malignancy.
  • Cranial or intracranial plasmacytomas are rare manifestations of multiple myeloma.
  • Subcutaneous involvement of the skull by multiple myeloma is exceptionally uncommon.

Observation:

  • A 92-year-old female presented with rapidly enlarging subcutaneous skull masses and right hemiparesis.
  • Imaging revealed multiple osteolytic skull lesions with high-density subcutaneous masses, exhibiting homogeneous enhancement on MRI.
  • Surgical biopsy of a frontal mass confirmed it as multiple myeloma.

Findings:

  • This represents a unique case of multiple myeloma with multiple subcutaneous skull plasmacytomas.
  • The dural tail sign was observed, suggesting dural involvement adjacent to the tumors.

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  • The patient was managed conservatively due to age and poor prognosis, focusing on quality of life.

    • Implications:

    • This case underscores the diverse and rare presentations of multiple myeloma.
    • Advanced imaging, including 3D CT, is crucial for preoperative evaluation in complex surgical cases.
    • Conservative management may be prioritized in elderly patients with poor prognoses to maintain quality of life.