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      Novel case of primary intracranial solitary plasmacytoma presenting with significant intratumoral hemorrhage

      case-report

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          Abstract

          Background:

          Solitary plasmacytoma is a localized lesion comprising monoclonal neoplastic proliferation of plasma cells. This disease is rarely encountered and few reports have described primary intracranial solitary plasmacytoma (PISP).

          Case Description:

          We report a case of PISP that presented initially as status epilepticus and exhibited massive intratumoral hemorrhage at the subcortical area. To the best of our knowledge, this is the first recorded presentation of this pathology in this manner. Following evacuation of the hematoma and decompressive craniectomy, the patient underwent radiation therapy and showed no sign of tumor recurrence at 3 years after diagnosis.

          Conclusion:

          This case reveals that PISP can present as subcortical intraparenchymal hemorrhage. It should be emphasized that the precise diagnosis of this disease is of utmost importance, because solitary plasmacytoma without a background of multiple myeloma responds well to radiation therapy.

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          Most cited references33

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          International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.

          S Vincent Rajkumar, Meletios A. Dimopoulos, Antonio Palumbo … (2014)
          This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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            Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study.

            Luis R. Vilanova-Vélez, Sigurður Y. Kristinsson, Ola Landgren … (2010)
            PURPOSE Randomized multiple myeloma (MM) studies show improved response rates and better progression-free survival for newer therapies. However, a less pronounced effect has been found for overall survival (OS). Using population-based data including detailed treatment information for individual patients, we assessed survival patterns for all patients diagnosed with MM in Malmö, Sweden from 1950 to 2005. PATIENTS AND METHODS We identified 773 patients with MM (48% males). On the basis of the age limit used for treatment with high-dose melphalan with autologous stem-cell support (HDM-ASCT; < or = 65 years old) in Sweden, we constructed Kaplan-Meier curves and used the Breslow generalized Wilcoxon test to evaluate OS patterns (diagnosed in six calendar periods) for patients 65 years old or younger and patients older than 65 years. Results Including all age groups, patients diagnosed from 1960 to 1969 had a better survival than patients diagnosed from 1950 to 1959. In subsequent 10-year calendar periods, median OS increased from 24.3 to 56.3 months (P = .036) in patients < or = 65 years old. In contrast, OS did not improve among patients older than age 65 years (21.2 to 26.7 months, P = .7). CONCLUSION With the establishment of HDM-ASCT as the standard therapy for younger patients with MM, OS has improved significantly for this age group in the general MM population. With novel therapies being commonly used at disease progression, presumably it becomes increasingly difficult to confirm survival differences between defined induction, consolidation, and maintenance therapies in the future. Consequently, in the era of novel MM therapies, population-based studies will serve as a necessary complement to randomized trials.
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              Solitary bone plasmacytoma and extramedullary plasmacytoma.

              Meletios A. Dimopoulos, George Hamilos (2002)
              Solitary bone and extramedullary plasmacytomas are rare plasma cell proliferative disorders. Their diagnosis is based on histologic confirmation of monoclonal plasma cell infiltration of a single disease site and on the exclusion of systemic myeloma. For both entities, the treatment of choice is localized radiotherapy. With modern radiotherapy and with a total dose of at least 4000 cGy, the risk for local recurrence is less than 5%. There is no role for systemic chemotherapy in the management of these disorders. Approximately 30% of patients with solitary bone plasmacytoma (SBP) remain disease-free for several years; some of these patients may be cured. Patients with the best prognosis are those in whom the monoclonal protein disappears by 1 year after radiotherapy. The prognosis of patients with solitary extramedullary plasmacytoma (SEP) appears to be better than for patients with SBP because approximately 70% of patients with SEP remain disease-free at 10 years. With more sensitive staging procedures, the diagnosis of SBP and SEP may become less common, but the number of patients with prolonged stability and cure may increase.
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                Author and article information

                Contributors
                Daisuke Sato
                Shunsaku Takayanagi
                Hirokazu Takami
                Tetsuaki Iwamoto
                Masashi Nomura
                Shohei Nambu
                Masako Ikemura
                Shota Tanaka
                Nobuhito Saito
                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Title: Surgical Neurology International
                Publisher: Scientific Scholar (USA )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2022
                Publication date (Electronic): 22 April 2022
                Volume: 13
                Electronic Location Identifier: 157
                Affiliations
                [1 ]Department of Neurosurgery, The University of Tokyo Hospital, Tokyo,
                [2 ]Department of Neurosurgery, Higashi Yokohama Hospital, Yokohama,
                [3 ]Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan.
                Author notes
                [* ] Corresponding author: Shunsaku Takayanagi, Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan. takayanagi-nsu@ 123456umin.ac.jp
                Article
                Publisher ID: 10.25259/SNI_66_2022
                DOI: 10.25259/SNI_66_2022
                PMC ID: 9062931
                PubMed ID: 35509594
                SO-VID: 12b6d999-9795-4386-bfa0-9cf7aa9cbd40
                Copyright © Copyright: © 2022 Surgical Neurology International
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 16 January 2022
                Date accepted : 24 March 2022
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: decompressive craniectomy,intratumoral hemorrhage,primary intracranial solitary plasmacytoma,radiotherapy
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: decompressive craniectomy, intratumoral hemorrhage, primary intracranial solitary plasmacytoma, radiotherapy

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