Metastatic haematological malignancy presenting as a sellar mass

Area of Science:

• Neuro-oncology
• Hematology
• Endocrinology

Background:

• Multiple myeloma is a hematologic malignancy characterized by the proliferation of plasma cells.
• Sellar masses can present with various symptoms, including headaches and visual disturbances.
• Extramedullary disease in multiple myeloma, while uncommon, can involve various organs.

Observation:

• A 60s male with a history of multiple myeloma presented with a sellar mass causing headaches and double vision.
• MRI revealed a large sellar mass with invasion into the sphenoid and cavernous sinuses.
• Biopsy confirmed a sellar plasmacytoma, a rare extramedullary manifestation.

Findings:

• The sellar lesion consisted of mature plasma cells exclusively staining for kappa-light chain immunoglobulins.
• Pituitary function tests revealed hypogonadotrophic hypogonadism.
• The patient was treated with chemotherapy for myeloma and radiotherapy for plasmacytoma.

Implications:

• This case underscores the potential for sellar plasmacytoma as an extramedullary manifestation of multiple myeloma.
• Early diagnosis and appropriate treatment are crucial for managing such rare presentations.
• Further research into the mechanisms and management of extramedullary plasmacytomas is warranted.