Solitary plasmacytoma with amyloid – An unusual dural-based lesion

Pooja Gajaria; Asha Shenoy; Jayashri Chaudhari; Naina Goel

doi:10.4103/ajns.AJNS_184_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 997-1002
DOI: 10.4103/ajns.AJNS_184_20

Case Report

Solitary plasmacytoma with amyloid – An unusual dural-based lesion

Pooja Gajaria

Department of Pathology, Seth G S Medical College, KEM Hospital, Mumbai, Maharashtra

,

Asha Shenoy

Department of Pathology, Seth G S Medical College, KEM Hospital, Mumbai, Maharashtra

,

Jayashri Chaudhari

Department of Pathology, Seth G S Medical College, KEM Hospital, Mumbai, Maharashtra

,

Naina Goel

Department of Pathology, Seth G S Medical College, KEM Hospital, Mumbai, Maharashtra

› Author Affiliations

Abstract

Solitary plasmacytoma of the dura without systemic involvement are extremely rare lesions, with <15 cases reported in the literature. Among these, ours is the second case to show the presence of amyloid. Fifty-year-old male had presented with headache, sudden onset right-sided weakness, and vomiting. Magnetic resonance imaging revealed an extra-axial mass in the left fronto-parietal region measuring 10 cm × 8.7 cm × 3.9 cm, suggestive of meningioma. The left fronto-parietal craniotomy was performed and multiple tissue bits aggregating to 10 cm × 8.5 cm × 2 cm along with thinned out membrane-like bit of calvarium was sent for pathologic examination. H and E stained sections showed sheets of plasmacytoid cells along with amyloid, which showed apple-green birefringence on Congo red staining. On immunohistochemistry, tumor cells were positive for CD38, CD138, showed kappa light chain restriction and were negative for CD45, CD34. Hence, it was diagnosed as a plasma cell neoplasm. Further work-up with whole-body positron-emission tomography scan revealed no systemic involvement. Dural-based lesions can mimic meningioma radiographically as well as intraoperatively. Histopathological examination unveils the diagnosis, to guide appropriate therapeutic regimens.

Key-words:

Amyloid - dura - immunohistochemistry - plasmacytoma - solitary

Full Text

References

References
1 Johnson MD, Powell SZ, Boyer PJ, Weil RJ, Moots PL. Dural lesions mimicking meningiomas. Hum Pathol 2002;33:1211-26.
2 Lyndon D, Lansley JA, Evanson J, Krishnan AS. Dural masses: Meningiomas and their mimics. Insights Imaging 2019;10:11.
3 Krumholz A, Weiss HD, Jiji VH, Bakal D, Kirsh MB. Solitary intracranial plasmacytoma: Two patients with extended follow-up. Ann Neurol 1982;11:529-32.
4 Olarinoye-Akorede SA, Jimoh AO, Chom ND, Akano AO, Hamidu AU, Abdullahi K. Solitary craniocerebral plasmacytoma mimicking a meningioma. J Biomed Graph Comput 2012;2:110-4.
5 Dimopoulos MA, Hamilos G. Solitary bone plasmacytoma and extramedullary plasmacytoma. Curr Treat Options Oncol 2002;3:255-9.
6 Dores GM, Landgren O, McGlynn KA, Curtis RE, Linet MS, Devesa SS. Plasmacytoma of bone, extramedullary plasmacytoma, and multiple myeloma: Incidence and survival in the United States, 1992-2004. Br J Haematol 2009;144:86-94.
7 McKenna RW, Kyle RA, Kuehl WM, Harris NL, Coupland RW, Fend F. Plasma cell neoplasms. In: Swerdlow SH, editor. Who Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised. 3rd ed. Lyon: IARC; 2017. p. 241-53.
8 Rajkumar SV. Updated diagnostic criteria and staging system for multiple myeloma. Am Soc Clin Oncol Educ Book 2016;35:e418-23.
9 Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B, et al. Extramedullary plasmacytoma: Tumor occurrence and therapeutic concepts. Cancer 1999;85:2305-14.
10 Galieni P, Cavo M, Pulsoni A, Avvisati G, Bigazzi C, Neri S, et al. Clinical outcome of extramedullary plasmacytoma. Haematologica 2000;85:47-51.
11 Castillo JJ, Bibas M, Miranda RN. The biology and treatment of plasmablastic lymphoma. Blood 2015;125:2323-30.
12 Sun SQ, Hawasli AH, Huang J, Chicoine MR, Kim AH. An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas. Neurosurg Focus 2015;38:E3.
13 Perry A, Louis DN, Budka H, von Deimling A, Sahm F, Rushing EJ. Meningioma. In: Louis DN, editor. Who Classification of Tumours of the Central Nervous System, Revised. 4th ed. Lyon: IARC; 2016. p. 232-45.
14 Kim DJ, Choi YS, Song YJ, Kim KU. Intracranial plasma cell granuloma. J Korean Neurosurg Soc 2009;46:161-4.
15 Kaneko D, Irikura T, Taguchi Y, Sekino H, Nakamura N. Intracranial plasmacytoma arising from the dura mater. Surg Neurol 1982;17:295-300.
16 Roddie P, Collie D, Johnson P. Myelomatous involvement of the dura mater: A rare complication of multiple myeloma. J Clin Pathol 2000;53:398-9.
17 Rahmah N, Brotoarianto H, Andor E, Kusnarto G, Muttaqin Z, Hongo K. Dural plasmacytoma mimicking meningioma in a young patient with multiple myeloma. Biomed Imaging Interv J 2009;5:e5.
18 Gascón N, Pérez-Montero H, Guardado S, D'Ambrosi R, Cabeza MÁ, Pérez-Regadera JF. Dural plasmacytoma with meningeal myelomatosis in a patient with multiple myeloma. Case Rep Hematol 2018;2018:6730567.
19 Haegelen C, Riffaud L, Bernard M, Carsin-Nicol B, Morandi X. Dural plasmacytoma revealing multiple myeloma. Case report. J Neurosurg 2006;104:608-10.
20 Morgenstern P, Pisapia D, Ramakrishna R. Calvarial plasmacytoma mimicking meningioma as the initial presentation of multiple myeloma. Cureus 2017;9:e1126.
21 Dincer C, Mustafa B, Yuceer N. Solitary intracranial plasmacytoma in a child report of a 7-year-old girl. Turk Neurosurg 1994;4:47-50.
22 Atweh GF, Jabbour N. Intracranial solitary extraskeletal plasmacytoma resembling meningioma. Arch Neurol 1982;39:57-9.
23 Manabe M, Kanashima H, Yoshii Y, Mukai S, Sakamoto E, Iwai Y, et al. Extramedullary plasmacytoma of the dura mimicking meningioma. Int J Hematol 2010;91:731-2.
24 Azarpira N, Noshadi P, Pakbaz S, Torabineghad S, Rakei M, Safai A. Dural plasmacytoma mimicking meningioma. Turk Neurosurg 2014;24:403-5.
25 Mancilla-Jimenez R, Tavassoli FA. Solitary meningeal plasmacytoma: Report of a case with electron microscopic and immunohistologic observations. Cancer 1976;38:798-806.
26 Mancardi GL, Mandybur TI. Solitary intracranial plasmacytoma. Cancer 1983;51:2226-33.
27 Lebrun C, Chanalet S, Paquis P, Frenay M, Lagrange JL, Chatel M. Solitary meningeal plasmacytomas. Ann Oncol 1997;8:791-5.
28 Vujovic O, Fisher BJ, Munoz DG. Solitary intracranial plasmacytoma: Case report and review of management. J Neurooncol 1998;39:47-50.
29 Devoe CE, Li JY, Demopoulos AM. The successful treatment of a recurrent intracranial, dural-based plasmacytoma with lenalidomide. J Neurooncol 2014;119:217-20.
30 Khalili RP, Mokhtari M, Fard SA, Neshat A, Norouzi R. Solitary dural plasmacytoma with parenchymal invasion. Asian J Neurosurg 2015;10:102-4.
31 Provenzale JM, Schaefer P, Traweek ST, Ferry J, Moore JO, Friedman AH, et al. Craniocerebral plasmacytoma: MR features. AJNR Am J Neuroradiol 1997;18:389-92.
32 Weidenheim KM, Campbell WG Jr, Goldman HW. Atypical monoclonal plasma cell hyperplasia of the central nervous system: Precursor of plasmacytoma with evolutionary considerations. Neurosurgery 1989;24:429-34.