López-Elizalde Ramiro, Lemus-Rodríguez Yazmín, Godínez-Rubí Marisol, Madrigal-Saray Arturo, Muñoz-Serrano José Antonio, Velásquez-Santana Héctor
Departamento de Neurocirugía, Hospital Civil Dr. Juan I. Menchaca, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
Cir Cir. 2013 Sep-Oct;81(5):431-5.
Multiple myeloma is a plasmatic cell neoplasm that is characterized by skeletal destruction, renal failure, anemia and hypercalcemia. The skull plasmacytomas represent less than 1% of the head and neck tumors, they can be the primary lesion or occur as a secondary manifestation of multiple myeloma in 20-30% of the patients, or they can even manifest several years later after the diagnosis of plasmacytoma. Although some of the lesions may be surgically accessible, the aggressive natural behavior will complicate the evolution of the patients. We present two cases of Mexican women with intracranial plasmacytomas, one of them associated with multiple myeloma.
The first case was a 24 year-old woman diagnosed with a multiple myeloma with plasmacytic-plasmablastic bone infiltration that was removed in 90%. She presented a local recurrence that required a second intervention for removal. The second case was a 62 year-old female with a malignant intracranial tumor of plasma cells that was totally resected. Both patients received adjuvant treatment based on chemotherapy and radiation therapy with favorable results. The patients died at 5 and 1.5 years respectively due to renal failure secondary to systemic disease.
We propose chemotherapy and radiation therapy as an essential part of treatment for this condition, as the aggressive behavior of the neoplasms can complicate the evolution, despite being surgically accessible.
多发性骨髓瘤是一种浆细胞肿瘤,其特征为骨骼破坏、肾衰竭、贫血和高钙血症。颅骨浆细胞瘤占头颈部肿瘤的比例不到1%,它们可以是原发性病变,或在20%-30%的患者中作为多发性骨髓瘤的继发性表现出现,甚至可在浆细胞瘤诊断数年之后才表现出来。尽管部分病变可通过手术切除,但肿瘤的侵袭性自然行为会使患者病情发展复杂化。我们报告两例患有颅内浆细胞瘤的墨西哥女性病例,其中一例与多发性骨髓瘤相关。
首例病例为一名24岁女性,诊断为多发性骨髓瘤伴浆细胞-浆母细胞性骨浸润,90%的病灶已切除。她出现了局部复发,需要再次手术切除。第二例病例为一名62岁女性,患有恶性颅内浆细胞瘤,肿瘤已完全切除。两名患者均接受了基于化疗和放疗的辅助治疗,效果良好。两名患者分别于5年和1.5年后因全身性疾病继发肾衰竭死亡。
我们建议化疗和放疗作为这种疾病治疗的重要组成部分,因为尽管肿瘤可通过手术切除,但肿瘤的侵袭性行为会使病情发展复杂化。