Sahin Fahri, Saydam Guray, Ertan Yesim, Calli Cem, Dönmez Ayhan, Tombuloglu Murat
Department of Hematology, Ege University School of Medicine, Bornova 35100, Izmir, Turkey.
J Clin Neurosci. 2006 Feb;13(2):259-61. doi: 10.1016/j.jocn.2005.03.033. Epub 2006 Feb 3.
Apart from calvarial infiltration, intracranial involvement in multiple myeloma is uncommon. Diffuse leptomeningeal invasion with or without parenchymal involvement is most common. Dural infiltration without involvement of the parenchyma, leptomeninges or skull is rare. The differential diagnosis of a dural plasmacytoma includes meningioma, which has a similar MRI appearance, metastasis, lymphoma and sarcoma of the dura mater. We present a patient with multiple myeloma presenting with an intracerebral mass mimicking a meningioma on MRI. Multiple myeloma had been diagnosed seven years previously. The patient presented with headache and speech disturbance 12 months after autologous peripheral stem cell transplantation for recurrence of multiple myeloma. MRI revealed a left temporal extra-axial mass with a dural tail mimicking meningioma. Histopathological examination of the mass after excision showed multiple myeloma immunopositive for IgG, kappa light chain and CD38. There was no recurrence after postoperative radiotherapy. Plasmacytoma should be considered in the differential diagnosis of a solitary dural mass, particularly in a patient with multiple myeloma.
除颅骨浸润外，多发性骨髓瘤累及颅内的情况并不常见。最常见的是伴有或不伴有实质受累的弥漫性软脑膜侵犯。未累及实质、软脑膜或颅骨的硬脑膜浸润很少见。硬脑膜浆细胞瘤的鉴别诊断包括脑膜瘤（其MRI表现相似）、转移瘤、淋巴瘤和硬脑膜肉瘤。我们报告1例多发性骨髓瘤患者，其脑内肿块在MRI上酷似脑膜瘤。该患者7年前已诊断为多发性骨髓瘤。患者在自体外周干细胞移植治疗多发性骨髓瘤复发12个月后出现头痛和言语障碍。MRI显示左侧颞叶轴外肿块伴硬脑膜尾征，酷似脑膜瘤。肿块切除后的组织病理学检查显示多发性骨髓瘤对IgG、κ轻链和CD38免疫阳性。术后放疗后无复发。对于孤立性硬脑膜肿块的鉴别诊断，应考虑浆细胞瘤，尤其是在多发性骨髓瘤患者中。
