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Katoh T, Yamasaki T, Kataoka S, Sano K, Kawauchi H. Intracranial Invasion of an Extramedullary Plasmacytoma in the Paranasal Sinus: A Case Report with a Reference to Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065896781794770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of extramedullary plasmacytoma arising from the paranasal sinus with intracranial invasion at recurrence is reported. In this case, magnetic resonance imaging was first employed not only to delineate tumor extension into the cranial space, but also to evaluate the therapeutic response. Histological confirmation was made after a biopsy was performed. Despite widespread tumor involvement of orbit in the cavernous sinus and anterior skull base, radiotherapy and subsequent maintenance chemotherapy with cisplatin and etoposide induced a long-term, 42-month partial remission. The pertinent clinical characteristics are reviewed in the literature and the therapeutic problems and prognostic factors are discussed with an introduction of advantage of magnetic resonance imaging.
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Affiliation(s)
- Taiji Katoh
- Department of Otolaryngology, Shimane Medical University, Izumo, Japan
| | - Toshiki Yamasaki
- Department of Neurosurgery, Shimane Medical University, Izumo, Japan
| | - Shingo Kataoka
- Department of Otolaryngology, Shimane Medical University, Izumo, Japan
| | - Keisuke Sano
- Department of Otolaryngology, Shimane Medical University, Izumo, Japan
| | - Hideyuki Kawauchi
- Department of Otolaryngology, Shimane Medical University, Izumo, Japan
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Lee J, Kulubya E, Pressman BD, Mamelak A, Bannykh S, Zada G, Cooper O. Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases. Pituitary 2017; 20:381-392. [PMID: 28251542 PMCID: PMC5429193 DOI: 10.1007/s11102-017-0799-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Parasellar plasmacytomas are rare tumors localized to the sellar region arising from plasma cells. Knowledge of clinical, imaging, surgical, and pathological characteristics is limited to single case reports. METHODS A retrospective analysis of five primary cases was conducted, followed by systematic review of English language articles using PubMed in accordance with PRISMA guidelines. RESULTS Five primary case patients include four men and one woman, ages 60-77, followed up to 3 years. A systematic review identified 65 additional patients, of whom 65% presented with cranial nerve palsies and 15% with hypopituitarism. Sixteen percent had history of known multiple myeloma (MM) while 37% were diagnosed concurrently with MM on presentation of parasellar plasmacytoma. Imaging showed median tumor size of 38 mm (range, 4-70 mm), with MRI intensity similar to that of other sellar masses. Surgical biopsy with immunohistochemical studies confirmed plasmacytoma diagnosis. Eighty-one percent underwent parasellar radiotherapy, and chemotherapy initiated in 59% of the 69 patients with MM. Overall survival rate was 74% at follow-up (median 12 months), with 18% having parasellar recurrences and 38% progressing to systemic MM after presentation of a solitary plasmacytoma (median 3 months). CONCLUSIONS Parasellar plasmacytomas are rare tumors that should be considered in the differential diagnosis for lesions involving the sella and arising from the clivus, especially when cranial nerve paresis is apparent, even in the absence of known MM. Although recurrence rates for parasellar plasmacytoma is low, patients should be monitored for progression to MM. Treatment depends on the presence of systemic disease at diagnosis.
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Affiliation(s)
- Jane Lee
- Pituitary Center, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA
| | - Edwin Kulubya
- Department of Neurosurgery, Keck School of Medicine of USC, 1200 North State Street, Suite 5046, Los Angeles, CA, 90089, USA
| | - Barry D Pressman
- Department of Radiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite M-335, Los Angeles, CA, 90048, USA
| | - Adam Mamelak
- Pituitary Center, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA
| | - Serguei Bannykh
- Department of Pathology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 8725, Los Angeles, CA, 90048, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of USC, 1200 North State Street, Suite 5046, Los Angeles, CA, 90089, USA
| | - Odelia Cooper
- Pituitary Center, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA.
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Na'ara S, Amit M, Gil Z, Billan S. Plasmacytoma of the Skull Base: A Meta-Analysis. J Neurol Surg B Skull Base 2015; 77:61-5. [PMID: 26949590 DOI: 10.1055/s-0035-1560047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Objective Extramedullary plasmacytomas are rare tumors. In the current study we aim to characterize its clinical course at the skull base and define the most appropriate therapeutic protocol. Methods We conducted a meta-analysis of articles in the English language that included data on the treatment and outcome of plasmacytoma of the base of skull. Results The study cohort consisted of 47 patients. The tumor originated from the clivus and sphenoclival region in 28 patients (59.5%), the nasopharynx in 10 patients (21.2%), the petrous apex in 5 patients (10.6%), and the orbital roof in 4 patients (8.5%). The chief complaints at presentation included recurrent epistaxis and cranial nerve palsy, according to the site of tumor. Twenty-two patients (46.8%) had surgical treatment; 25 (53.2%) received radiation therapy. Adjuvant therapy was administered in 11 cases (50%) with concurrent multiple myeloma. The 2-year and 5-year overall survival rates were 78% and 59%, respectively. Clear margin resection was achieved in a similar proportion of patients who underwent endoscopic surgery and open surgery (p = 0.83). A multivariate analysis of outcome showed a similar survival rate of patients treated surgically or with radiotherapy. Conclusions The mainstay of treatment for plasmacytoma is based on radiation therapy, but when total resection is feasible, endoscopic resection is a valid option.
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Affiliation(s)
- Shorook Na'ara
- Department of Otolaryngology, Head and Neck Surgery, The Head and Neck Center, Rambam Medical Campus, Haifa, Israel; The Laboratory for Applied Cancer Research, CRIR, Rambam Medical Campus, Haifa, Israel
| | - Moran Amit
- Department of Otolaryngology, Head and Neck Surgery, The Head and Neck Center, Rambam Medical Campus, Haifa, Israel; The Laboratory for Applied Cancer Research, CRIR, Rambam Medical Campus, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, The Head and Neck Center, Rambam Medical Campus, Haifa, Israel; The Laboratory for Applied Cancer Research, CRIR, Rambam Medical Campus, Haifa, Israel
| | - Salem Billan
- Oncology Department, Rambam Medical Campus, Haifa, Israel
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Clivus and Dural Involvement in a Case of Multiple Myeloma: A Rare Complication of Multiple Myeloma. Indian J Hematol Blood Transfus 2015; 32:135-7. [PMID: 27408375 DOI: 10.1007/s12288-015-0573-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022] Open
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Wein RO, Popat SR, Doerr TD, Dutcher PO. Plasma cell tumors of the skull base: four case reports and literature review. Skull Base 2011; 12:77-86. [PMID: 17167653 PMCID: PMC1656911 DOI: 10.1055/s-2002-31570-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Ustuner Z, Basaran M, Kiris T, Bilgic B, Sencer S, Sakar B, Dizdar Y, Bavbek S, Onat H. Skull Base Plasmacytoma in a Patient with Light Chain Myeloma. Skull Base 2004; 13:167-171. [PMID: 15912174 PMCID: PMC1131846 DOI: 10.1055/s-2003-43327] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Skull base involvement of plasmacytoma is reported in a patient with light chain myeloma. A 39-year-old man was admitted after experiencing paresthesia on the left side of the face and left arm, intermittent diplopia, and hoarseness for 2 years. Cranial magnetic resonance imaging revealed a large midline mass extending from the middle and posterior skull base into the upper two cervical vertebrae. An extramedullary plasmacytoma associated with light chain multiple myeloma was diagnosed after biopsy of the mass and laboratory investigations. The imaging findings and clinical features associated with this rare site of extramedullary plasmacytoma involvement are reported.
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Affiliation(s)
- Zeki Ustuner
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mert Basaran
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Talat Kiris
- Department of Neurosurgery, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Serra Sencer
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Burak Sakar
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yavuz Dizdar
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sevil Bavbek
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Onat
- Institute of Oncology, and Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Tanaka M, Shibui S, Nomura K, Nakanishi Y. Solitary plasmacytoma of the skull: a case report. Jpn J Clin Oncol 1998; 28:626-30. [PMID: 9839504 DOI: 10.1093/jjco/28.10.626] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Solitary plasmacytoma of the skull is very rare and only 35 cases have been reported in the English literature. It remains controversial whether solitary plasmacytoma of the skull is essentially identical with solitary plasmacytoma of bone or not. Solitary plasmacytoma of bone including solitary plasmacytoma of the skull is characterized by a radiologically solitary bone lesion, neoplastic plasma cells in the biopsy specimen, fewer than 5% plasma cells in bone marrow, less than 2.0 g/dl monoclonal protein in the serum when present and negative urine test for Bence Jones protein (monoclonal light chain). Solitary plasmacytoma of bone tends to disseminate or progress to multiple myeloma even as long as 7-23 years after presentation. We report the first case of solitary plasmacytoma of the skull in which both beta2-microglobulin for detection of early renal disturbance and neoplastic plasma cell labeling index for detection of DNA synthesis were examined in order to predict the clinical course of solitary plasmacytoma of the skull.
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Affiliation(s)
- M Tanaka
- Neurosurgery Division, National Cancer Center Hospital, Tokyo, Japan.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-1998. A 64-year-old man with cranial-nerve palsies and a positive test for antinuclear cytoplasmic antibodies. N Engl J Med 1998; 339:755-63. [PMID: 9742025 DOI: 10.1056/nejm199809103391108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bachmeyer C, Levy V, Carteret M, Laccourreye O, Danel C, Le Tourneau A, Zittoun R, Grateau G. Sphenoid sinus localization of multiple myeloma revealing evolution from benign gammopathy. Head Neck 1997; 19:347-50. [PMID: 9213114 DOI: 10.1002/(sici)1097-0347(199707)19:4<347::aid-hed14>3.0.co;2-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Plasma-cell neoplasms of the head and neck include extramedullary plasmacytoma and solitary plasmocytoma of bone or may represent a local manifestation of multiple myeloma. Involvement of sphenoid sinus has been rarely reported in multiple myeloma. METHODS We present the case of a 77-year-old man with a 3-year-history of benign monoclonal IgG-lambda gammopathy who developed left sixth-nerve palsy and malaise. RESULTS Computed tomography scan and magnetic resonance imaging scan disclosed a large soft-tissue mass of the sphenoid sinus with bone destruction. Sphenoid sinus biopsy revealed an IgG monoclonal plasma cell neoplasm. Diagnosis of multiple myeloma stage IA was then established. CONCLUSIONS Diagnosis of plasma-cell neoplasm should be considered in sphenoid sinus tumors and depends upon histologic examination. This case enlightens the relationships between monoclonal benign gammopathy and plasma-cell neoplasms of the head and neck which constitute a continuum of B-cell lymphoproliferative disorders.
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Affiliation(s)
- C Bachmeyer
- Department of Internal Medicine, Hotel-Dieu Hospital, Paris, France
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Jacobs P, Handler LC, Girdler-Brown B. Myeloma Presenting in the Base of the Skull. Hematology 1997; 2:79-86. [PMID: 27406729 DOI: 10.1080/10245332.1997.11746322] [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: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- P Jacobs
- a University of Cape Town and Croote Schuur Hospital
| | - L C Handler
- b Department of Neuroradiology , University of Cape Town, Groote Schuur Hospital
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Bardales RH, Stanley MW. Subcutaneous masses of the scalp and forehead: diagnosis by fine-needle aspiration. Diagn Cytopathol 1995; 12:131-4. [PMID: 7774492 DOI: 10.1002/dc.2840120208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report our cytologic findings and clinical correlations in benign (N = 2) and malignant (N = 16) subcutaneous masses of the scalp (N = 15) and forehead (N = 3), studied by fine-needle aspiration (FNA). Diagnoses were divided in 3 groups: (1) Scalp plasmacytoma (as a manifestation of multiple myeloma) (6 cases) was the most frequent diagnosis. In one patient it was the presenting manifestation of the disease. (2) Miscellaneous malignancies included 8 carcinomas, 1 melanoma, and 1 malignant lymphoma. The scalp or forehead mass was the initial presentation and FNA was the initial diagnostic approach in five patients. (3) A single case each of pilar-type keratinous cyst and hematoma were the only benign masses encountered. In conclusion, a significant number of subcutaneous masses of the scalp or forehead represent metastatic or systemic malignancies, and they may be the initial manifestation of the disease. Rapid and accurate diagnosis by FNA provides guidelines for appropriate therapy, especially in those patients who present with advanced disease.
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Affiliation(s)
- R H Bardales
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
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