[Multiple myeloma presenting with a solitary cranial tumor with subdural extension: a case report]

We report a case of multiple myeloma presenting with a solitary cranial tumor in the frontal region, extending from subcutaneous tissue to subdural space. To our knowledge, invasion of a tumor beyond the dura mater has never been described in case of multiple myeloma presenting with a solitary calvarial tumor. In the present case, the subdural extension was clearly visualized by several diagnostic means. A 53-year-old female patient visited the clinic of our University Hospital, complaining of a left frontal mass in May 1991. The mass grew rapidly, and she was hospitalized in June. On admission, neurological examination showed nothing abnormal. Laboratory studies showed normocytic normochromic anemia. Protein electrophoresis disclosed hypergammaglobulinemia with S-spike, and serum paraprotein was specific to IgA with lambda light chains by immunoelectrophoresis. Urinary Bence-Jones protein was not detected. An osteolytic lesion visualized in the frontal bone on plain skull radiographs showed destruction of the frontal bone, and an enhanced mass extending from the epidural to subcutaneous space was shown by computed tomography. The mass had compressed the frontal lobe. T1-weighted magnetic resonance images of the area showed isointensity signals, homogeneously enhanced with gadolinium-diethylenetriamide pentaacetic acid. Subdural extension in the deep area of the tumor was suggested. At operation, we confirmed infiltration of the tumor from the dura mater into the subdural space. Postoperative biopsy of bone marrow of the iliac bone demonstrated myeloma cells. The tumor was histologically diagnosed as plasmacytoma. The patient was highly resistant to postoperative combined therapy, and started on a fatal course leading to respiratory insufficiency caused by interstitial pneumonia in April 1992.(ABSTRACT TRUNCATED AT 250 WORDS)