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Multiple myeloma with pathologically proven skull plasmacytoma after a mild head injury: Case report
Wenzhen Yang1, Jing Zheng2, Ruihao Li1
1Department of Neurosurgery, the 2nd Hospital of Lanzhou University.
Rationale:
MM is a malignant tumor originating from the plasma cells of the bone marrow. Central nervous system myelomatosis is very rare and may be a complication of MM.
Patient Concerns:
A 60-year-old man presented with a slowly growing soft mass at his right frontal scalp after a mild head injury 6 months ago.
Diagnoses:
Neuroradiological examinations revealed a solid intracranial-extracranial mass with an osteolytic lesion in the skull. Histopathological examination showed skull plasmacytoma, and postoperative examinations revealed multiple myeloma.
Interventions:
The tumor was completely removed and the skull defect repaired with the titanium mesh. Then, chemotherapy was initiated after surgery with bortezomib and dexamethasone.
Outcomes:
The patient received eight chemotherapies within one year after surgery.
Lessons:
Despite a history of head injury, a differential diagnosis should be kept in mind during the diagnosis of solid intracranial-extracranial masses, especially in the presence of osteolytic skull at the lesioned site.
Insights
A rare case of skull plasmacytoma progressing to multiple myeloma (MM) highlights the importance of considering MM in intracranial-extracranial masses with osteolytic skull lesions.
Area of Science:
- Neuro-oncology
- Hematology
- Surgical Oncology
Background:
- Multiple myeloma (MM) is a plasma cell malignancy primarily affecting the bone marrow.
- Central nervous system involvement in MM is uncommon, but can manifest as myelomatosis.
Observation:
- A 60-year-old male presented with a scalp mass following minor head trauma.
- Imaging revealed an intracranial-extracranial mass with an osteolytic skull lesion.
Findings:
- Histopathology confirmed skull plasmacytoma, with subsequent diagnosis of multiple myeloma.
- Surgical resection and adjuvant chemotherapy with bortezomib and dexamethasone were administered.
Implications:
- Skull plasmacytoma can be an initial presentation of multiple myeloma.
- Differential diagnosis of intracranial-extracranial masses should include MM, particularly with osteolytic skull defects.
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