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Parillo M, Vaccarino F, Quattrocchi CC. Imaging findings in a case of leptomeningeal myelomatosis, a rare but critical central nervous system complication of multiple myeloma. Neuroradiol J 2023; 36:616-620. [PMID: 36627179 PMCID: PMC10569195 DOI: 10.1177/19714009221150849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Leptomeningeal myelomatosis is a rare complication of multiple myeloma (<1% of the patients). There was an increase in the incidence of leptomeningeal myelomatosis during the last decade; the prognosis of leptomeningeal myelomatosis remains poor, (overall median survival from the time of diagnosis of 2 months). We discuss a rare case of a monoclonal gammopathy evolving into multiple myeloma and finally into a rapidly progressing leptomeningeal disease. A 76 year-old woman in hematologic follow-up for advanced stage multiple myeloma in sixth-line treatment had an episode of generalized tonic-clonic seizure with sphincter release followed by altered state of consciousness. The unenhanced head CT scan showed a mild enlargement of the ventricular system without intra-axial or extra-axial hemorrhages nor significant changes in brain parenchyma. The subsequent contrast-enhanced brain MRI revealed a widespread nodular leptomeningeal enhancement characterized by contrast-enhancement of the pia mater extended into the subarachnoid spaces of the sulci and cisterns, involving supra- and sub-tentorial regions and the statoacoustic nerve in the inner ear canal bilaterally. The fluid-attenuated inversion recovery MRI images demonstrated an abnormally elevated signal within the sulci in the parieto-occipital regions. The radiological diagnosis of leptomeningeal myelomatosis was made. The patient died 4 days after the examination. In patients with long-lasting multiple myeloma and onset of neurological signs or symptoms, a contrast-enhanced brain MRI should be performed to assess the actual burden of central nervous system involvement in leptomeningeal myelomatosis; CT may provide a clue to the diagnosis when progressive enlargement of the ventricles over time is noted.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Yu T, Yin J, Huo H, Zhao H, Wang Z, Jiang J. Subdural anaplastic large-cell lymphoma presenting as a subacute epidural hematoma on imaging: A case report. Medicine (Baltimore) 2022; 101:e30012. [PMID: 35945716 PMCID: PMC9351866 DOI: 10.1097/md.0000000000030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Subdural anaplastic large-cell lymphoma (SALCL) is an extremely rare subtype of primary central nervous system (CNS) lymphoma. Here, we report a very rare subdural lymphoma case, which was misdiagnosed as a subacute epidural hematoma based on the radiological examination. PATIENT CONCERNS We present the case of an 82-year-old patient who presented with a 2-day history of headache and consciousness disorder following head injury. Computed tomography of the head revealed a fusiform isodense/slightly dense shadow under the right temporoparietal occipital cranial plate, suggesting a subacute epidural hematoma. It was initially misdiagnosed as a right traumatic subacute epidural hematoma with hemiplegia of the left limb. According to the patient's condition, an emergency craniotomy was performed to remove the hematoma. However, it was found that the lesion was located under the dura mater and was yellowish-brown with yellowish-brown liquid inside. The appearance of the lesion looked like bean curd residue. Histopathological examination diagnosed ALCL. DIAGNOSIS SALCL presenting as a subacute epidural hematoma on imaging. INTERVENTIONS Operation. OUTCOMES The patient died 1 month after being discharged automatically. CONCLUSIONS This report shows a rare radiography presentation of SALCL. SALCL can mimic the appearance of an epidural hematoma and should be regarded as a differential diagnosis even in patients with a history of craniocerebral injury and the "typical" imaging appearance of an epidural hematoma. The report is hoped to provide a scientific reference for the clinical diagnosis of subdural lymphoma.
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MESH Headings
- Aged, 80 and over
- Craniocerebral Trauma/complications
- Craniotomy/adverse effects
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Epidural, Spinal/surgery
- Humans
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnostic imaging
- Subdural Space
- Tomography, X-Ray Computed/adverse effects
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Affiliation(s)
- Tingting Yu
- Graduate School of Dalian Medical University, Lvshunkou Kou District, Dalian, Liaoning, China
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurology, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
| | - Jibo Yin
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Hongyue Huo
- Graduate School of Dalian Medical University, Lvshunkou Kou District, Dalian, Liaoning, China
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
| | - Haixue Zhao
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Zhongwen Wang
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Jianxin Jiang
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
- *Correspondence: Jinxing Jiang, Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China; Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China (e-mail: )
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