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Cerebral tumor with hemi-dural enhancement as unique presentation of multiple myeloma: A case report
Rick H G J van Lanen1,2, Sandra M H Huijs3, Alida A Postma2,4
1Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Introduction:
Intracranial multiple myeloma (MM) is a rare manifestation of MM, a malignant plasma cell disorder that primarily affects bone marrow. Dural involvement in MM is even rarer and can manifest as a dural mass. We present a case of MM presenting as an intracranial dural tumor with primary hemi-dural involvement.
Research Question:
This case report aims to investigate the clinical presentation, diagnostic challenges, and treatment approaches for intracranial multiple myeloma, with a focus on the extensive hemi-dural thickening and enhancement seen in this case.
Material And Methods:
A 73-year-old male presented with progressive dysphasia and weakness. MRI revealed a solid left frontal mass with significant mass-effect. Hemi-dural thickening and enhancement was present along with invasion of the skull. The patient underwent surgical resection of the tumor with dural and bone reconstruction.
Results:
Histopathological examination confirmed MM diagnosis. Chemotherapy was started. Follow-up MRI showed complete tumor resection, but extensive hemi-dural thickening and enhancement persisted. Postoperative radiation therapy was considered.
Discussion And Conclusion:
MM with primary dural involvement is rare and poses diagnostic challenges. Postoperative treatment involves chemotherapy, the role of surgery and radiotherapy is not established. The extensive hemi-dural thickening and enhancement observed in this case require further investigation, and a wait-and-scan policy was recommended instead of radiotherapy.
Insights
Intracranial multiple myeloma (MM) is rare, presenting as a dural tumor. This case highlights diagnostic challenges and suggests a wait-and-scan policy for persistent dural thickening post-treatment.
Area of Science:
- Neuro-oncology
- Hematology
- Neurosurgery
Background:
- Multiple myeloma (MM) is a plasma cell malignancy primarily affecting bone marrow.
- Intracranial dural involvement in MM is exceptionally rare, often presenting as a dural mass.
Observation:
- A 73-year-old male presented with dysphasia and weakness.
- MRI revealed a left frontal mass with significant mass effect, hemi-dural thickening, enhancement, and skull invasion.
- Surgical resection was performed, followed by chemotherapy.
Findings:
- Histopathology confirmed MM.
- Post-resection MRI showed complete tumor removal but persistent extensive hemi-dural thickening and enhancement.
- Radiotherapy was considered but a wait-and-scan policy was adopted.
Implications:
- Primary dural MM presents diagnostic and therapeutic challenges.
- The established role of surgery and radiotherapy in dural MM requires further investigation.
- Persistent dural changes warrant careful monitoring rather than immediate aggressive treatment.
