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Dural plasmacytoma mimicking meningioma in a patient with multiple myeloma
Fahri Sahin1, Guray Saydam, Yesim Ertan
1Department of Hematology, Ege University School of Medicine, Bornova 35100, Izmir, Turkey. fsahin@med.ege.edu.tr
Abstract:
Apart from calvarial infiltration, intracranial involvement in multiple myeloma is uncommon. Diffuse leptomeningeal invasion with or without parenchymal involvement is most common. Dural infiltration without involvement of the parenchyma, leptomeninges or skull is rare. The differential diagnosis of a dural plasmacytoma includes meningioma, which has a similar MRI appearance, metastasis, lymphoma and sarcoma of the dura mater. We present a patient with multiple myeloma presenting with an intracerebral mass mimicking a meningioma on MRI. Multiple myeloma had been diagnosed seven years previously. The patient presented with headache and speech disturbance 12 months after autologous peripheral stem cell transplantation for recurrence of multiple myeloma. MRI revealed a left temporal extra-axial mass with a dural tail mimicking meningioma. Histopathological examination of the mass after excision showed multiple myeloma immunopositive for IgG, kappa light chain and CD38. There was no recurrence after postoperative radiotherapy. Plasmacytoma should be considered in the differential diagnosis of a solitary dural mass, particularly in a patient with multiple myeloma.
Insights
Intracranial involvement in multiple myeloma is rare, but dural plasmacytoma can mimic meningioma on MRI. This case highlights the importance of considering plasmacytoma in the differential diagnosis of solitary dural masses in multiple myeloma patients.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Intracranial involvement in multiple myeloma (MM) is uncommon, with leptomeningeal disease being the most frequent presentation.
- Dural infiltration by MM without parenchymal or leptomeningeal involvement is exceptionally rare.
Observation:
- A patient with a history of multiple myeloma presented with an intracerebral mass with dural tail on MRI, mimicking a meningioma.
- The mass was located in the left temporal lobe and caused symptoms of headache and speech disturbance post-stem cell transplantation for MM recurrence.
Findings:
- Histopathological examination confirmed the mass to be a plasmacytoma, immunopositive for IgG, kappa light chain, and CD38.
- The patient experienced no recurrence after surgical excision and adjuvant radiotherapy.
Implications:
- Dural plasmacytoma should be included in the differential diagnosis of solitary dural masses, especially in patients with a known history of multiple myeloma.
- Accurate diagnosis is crucial as treatment and prognosis differ from other dural tumors like meningioma.
