Multiple myeloma presenting as plasmacytoma of the base of the skull

A Rare Tumor Causing Optic and Oculomotor Nerve Compression: Clivus Plasmacytoma Case Report

Plasmacytomas rarely affect the skull base and may be found as an isolated lesion or as a part of multiple myeloma. The typical feature of plasmacytomas is aggressive bone destruction in the skull. It is often confused with the chordoma of the clivus. The most common location for skull-base plasmacytomas is the nasopharynx. The most commonly affected cranial nerve in clivus tumors is the abducens nerve. In our 64-year-old male case, a plasmacytoma was detected in the clivus. There was ptosis and decreased vision due to optic nerve and oculomotor nerve involvement due to the plasmacytoma. Radiotherapy was applied for the treatment.

Multiple Myeloma Relapse as Intracranial Plasmacytoma: A Rare Presentation

Multiple myeloma (MM) infrequently involves the central nervous system (CNS). The usual sites of involvement are skull and meninges; however, intracranial tumors are exceedingly rare. We report the case of a 60-year-old female who presented to our center for the complaint of recurrent syncope. The patient was diagnosed with MM approximately one and a half years ago and had received chemotherapy followed by an allogeneic bone marrow transplant and was in remission afterward. We initiated workup for syncope and a brain MRI revealed an intracranial mass. Histopathological studies of the intracranial mass confirm the diagnosis of plasmacytoma and further testing shows relapse of MM. This is a unique case of MM relapse with isolated intracranial plasmacytoma. It usually carries a poor prognosis. Early diagnosis and management are imperative to improve survival. 

Plasma cell tumors of the skull base: four case reports and literature review

Four patients (mean age, 46 years; range, 28 to 60) with skull base plasmacytomas are presented along with a review of the literature examining the progression of anterior and central skull base plasma cell tumors to multiple myeloma. The primary sites were the nasopharynx, orbital roof, sphenoid, and clivus. Three patients presented with extensive local spread of tumor. Two patients were diagnosed with multiple myeloma and treated with chemotherapy. Patients with an isolated plasmacytoma were treated with external beam radiation. A partial or complete response to therapy was seen in all four cases. Skull base plasma cell tumors are uncommon with only a limited number of published reports. Previous literature demonstrates that nasopharyngeal extramedullary plasmacytomas have a lower rate of progression to multiple myeloma than other sites. Patients with clivus, sphenoid, and petrous apex-based plasma cell tumors appear to have a higher risk of developing multiple myeloma than patients with plasma cell tumors involving the nasopharynx.

Pulmonary and intracerebral plasmacytomas in a patient without multiple myeloma: a case report

Extramedullary plasmacytoma of the lung or brain parenchyma is rare. We report herein a case of extramedullary plasmacytoma involving both the lung and parenchymal brain. We review the literature, comparing and contrasting the current case.

Myeloma Presenting in the Base of the Skull

Of 385 consecutive patients with a proven diagnosis of myeloma seen over a 15 year period, only four presented with symptoms and signs due to involvement of the skull base. This rare occurrence is in striking contrast to the frequency with which radiologic changes can be demonstrated in the bones of the calvarium during the course of most individual's disease. Response to treatment was obtained in all four, of whom one is a longterm survivor. This experience is reported emphasising the need to consider the possibility of myeloma in people with unexplained craniospinal symptoms and signs. In addition, the radiologic changes are tabulated in the hope that a pattern may emerge which will alert physicians to the presence of this rare situation.