Intracranial involvement of posttransplant lymphoproliferative disorder multiple myeloma

The Prevalence of Epstein-Barr Virus in Plasma Cell Neoplasms is Higher in HIV-Positive Individuals

AIMS

Epstein-Barr virus (EBV) is causally associated with many hematolymphoid malignancies. This laboratory-based study aimed to establish the prevalence of EBV in plasma cell neoplasms in a large South African cohort and to determine whether there is any correlation between EBV-positivity and human immunodeficiency virus (HIV) status in patients with plasma cell neoplasms, including plasma cell myeloma and plasmacytoma (solitary plasmacytoma of bone and extraosseous plasmacytoma).

METHODS

This single-institution retrospective study included all patients with a histopathologic diagnosis of plasma cell neoplasm between 2003 and 2020. EBV-expression in the plasma cell neoplasms was assessed by EBV-encoded RNA (EBER) in situ hybridization (ISH) and correlated with HIV status. HIV status was determined by retrieving prior serologic results. Formalin-fixed paraffin-embedded tissue from HIV-unknown patients underwent HIV-1 p24 antibody testing.

RESULTS

Sixteen of 89 plasma cell neoplasms (18%) were EBV-positive. There was a significant correlation between EBV and HIV infection in plasma cell neoplasms, with 6/10 tumors from HIV positive patients showing EBV-positivity in tumor cells. The EBV-positive cohort was significantly younger than the EBV-negative group.

CONCLUSION

EBV-positivity in plasma cell neoplasms in this study is higher than previously reported. The significant occurrence of EBV in plasma cell neoplasms from HIV-positive patients suggests a co-carcinogenic relationship between the two viruses.

Intracranial multiple myeloma with intraparenchymal involvement: Case report and literature review

Intraparenchymal extension of multiple myeloma is a rare manifestation of the disease. Here, we present a case of a patient with multiple myeloma lesions situated adjacent to the meninges and intraparenchymally.

Dural Plasmacytoma with Meningeal Myelomatosis in a Patient with Multiple Myeloma

Here, we describe the case of a 66-year-old male diagnosed with multiple myeloma who presented with generalized tonic-clonic seizures. Magnetic resonance imaging demonstrated a right solid extra-axial parieto-occipital lesion with typical characteristics of meningeal myelomatosis. Biopsy was performed, which diagnosed a dural plasmacytoma. Because of this, we started concomitant therapy with radiotherapy and lenalidomide, but the patient has a poor response to treatment and died few weeks after its initiation. Myelomatous involvement of the dura mater is a rare occurrence, given that only few cases were reported in the English literature. This presentation confers an ominous prognosis and must be a suspect diagnosis in patients diagnosed with multiple myeloma presenting neurological symptoms.

Intracranial Involvement by Plasma Cell Neoplasms

OBJECTIVES

Intracranial plasma cell neoplasms (PCNs) arising from the skull, dura, or brain parenchyma are rare tumors and there is only a limited experience in the literature with these lesions.

METHODS

We performed a retrospective clinicopathologic study of fourteen cases of intracranial PCN at our institution encountered over a 26-year-period.

RESULTS

The fourteen patients ranged in age from 30-74 years (median 66 years) and included seven males. For eight patients, their intracranial lesions were the initial presentation of multiple myeloma (MM). Three patients had prior history of MM; their intracranial tumors showed blastic plasma cell morphology, and all three died secondary to MM. The remaining three patients did not or have not developed MM.

CONCLUSIONS

PCNs rarely arise in the intracranial compartment. Intracranial PCN may be the initial presentation of MM. Anecdotally, blastic morphology appears to manifest more aggressive behavior.