Multiple myeloma with pathologically proven skull plasmacytoma after a mild head injury: Case report

Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach’s alpha. Results: Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79–0.92), and the Cronbach’s alpha was 0.93 (95% confidence interval: 0.94–0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72–0.86) and 0.94 (95% C.I.:0.91–0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.

Bone lesions of Langerhans cell histiocytosis triggered by trauma in children

BACKGROUND

Bone lesions of Langerhans cell histiocytosis (LCH) may be triggered by trauma.

METHODS

The characteristics of pediatric patients in the JLSG-02 study cohort who developed a bone lesion at the trauma site at diagnosis of LCH were analyzed retrospectively.

RESULTS

Of the 261 pediatric patients with LCH, 12 (4.6%), of median age 4.9 years, had trauma-triggered bone LCH lesions at diagnosis, making them significantly older than the remaining patients (P = 0.006). Trauma sites included the craniofacial regions in 10 patients and the lumbar spine and pelvis in one patient each. At the time of trauma, six patients had a bump at the site, whereas none had extradural hematomas or bone fractures. The median time from trauma to onset was 4 weeks. Of these 12 patients, three had isolated bone (IB) disease; four had multifocal bone (MFB) disease, including the bone lesion at the trauma site; and five had multisystem disease, including four with lesions in neighboring tissue and one with polyuria (posterior pituitary lesion) more than 1 year before the trauma-triggered bone lesion. Treatment responses were good in all 12 patients and none died, but relapses were observed in two patients, one each with IB and MFB disease.

CONCLUSIONS

About 5% of pediatric patients with LCH developed new trauma-triggered bone lesions at a relatively old age. These lesions can manifest as IB, or, in patients with underlying LCH diseases, as MFB or multisystem. Good clinical outcomes were observed in these patients.

Scalp mass: an atypical presentation of multiple myeloma

A 64-year-old male with no history of trauma presented to the general surgery clinic with a 6-month history of an asymptomatic left parietal scalp mass. The differential included benign etiologies such as lipoma or sebaceous cyst. At surgery, a hemorrhagic soft tissue mass with underlying defect in the parietal calvarium was noted. The initial attempt at resection was abandoned and neurosurgical consultation was requested. Magnetic resonance imaging demonstrated an enhancing scalp mass with a lytic lesion of the parietal calvarium with no intradural extension. Craniectomy with mass resection and mesh cranioplasty were performed. Pathology confirmed plasma cell neoplasm; serum protein electrophoresis and lytic skull lesions confirmed multiple myeloma. This rare presentation of multiple myeloma serves as a call for providers to maintain a broad differential when evaluating a seemingly benign mass, consider rare etiologies when appropriate and maintain vigilance for abnormal findings during any procedure.

Plasmacytoma of the skull mimicking an epidural hematoma: A case report

RATIONALE

Plasmacytoma as the 1st presentation of skull tumors is a rare disorder. When it is combined with brain trauma or dramatic changes in intracranial pressure, patients are more prone to misdiagnosis.

PATIENT CONCERNS

A 67-year-old woman complaining of a headache presented with a history of head trauma for the past 1 hour. Emergency head computed tomography initially suggested an epidural hematoma.

DIAGNOSIS

Emergency surgery was performed to remove the intracranial hematoma, but a tumor-like mass was found during surgery, and pathologic assessment confirmed plasmacytoma. Surgery was difficult because of bleeding. The tumor was radically removed.

INTERVENTIONS AND OUTCOMES

The patient underwent whole-brain radiotherapy and chemotherapy. She died 40 months after the surgery.

LESSONS

Epidural lesions found after a head injury may be assumed to be an epidural hematoma, leading to unnecessary surgery. Diseases such as hematomas, meningiomas, eosinophilic granulomas, bone metastases, and osteosarcomas must be considered.