Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 14, 2019
Calvarial plasmacytoma as an initial presentation for multiple myeloma
- Background
- Plasmacytomas are clonal proliferation of plasma cells, most commonly in flat bones.
- Identical to plasma cell myeloma but manifest in a localized osseous/extraosseous growth pattern.
- Intracranial plasmacytomas are rare, most frequently in cranial vault or skull base.
- Clinical Information
- May be solitary or associated with multiple myeloma, peak onset between the ages of 65-70.
- Up to 50% of solitary plasmacytomas progress to multiple myeloma.
- Worse prognosis when associated with multiple myeloma.
- Key Diagnostic Features
- Intraosseous or soft tissue expansile mass with varied appearance on MRI.
- Neoplastic tissue may be T1 hyperintense and T2 hypo-/isointense.
- Contrast enhancement and diffusion pattern vary.
- Differential Diagnosis
- Metastasis: May have similar imaging appearance, requires workup to assess for primary malignancy and typical multifocality of metastatic disease.
- Meningioma: May be primarily intraosseous, but usually dural based with associated dural tail of enhancement.
- Lymphoma: Primary lymphoma of the calvarium is rare, but could have a similar appearance with avid enhancement, as well as T2 hypointensity due to tumor cellularity.
- Osteosarcoma: Aggressive mass with periosteal reaction and soft tissue extension.
- Treatment
- Surgical resection should be considered in addition to radiation therapy in solitary plasmacytoma with ongoing monitoring to evaluate for progression to multiple myeloma.
- Systemic treatment for multiple myeloma, if subsequently diagnosed.
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