Commentary

Ustuner and colleagues report a 39-year-old male who presented with left face and arm paresthesia, intermittent diplopia, dysphagia, and hoarseness, which had progressed for 2 years. After a trans-sphenoidal biopsy was performed, he was diagnosed with a plasma cell tumor involving the clivus and nasopharynx. Finally, multiple myeloma was diagnosed after a bone marrow biopsy. The patient was treated with radiotherapy for the skull base disease and with chemotherapy for the systemic component of the pathology. After he underwent radiotherapy, MRI showed a dramatic response at the skull base and the patient's neurological deficits resolved. Unfortunately, his long-term oncological outcome was not provided.

Plasma cell neoplasms are divided into multiple myelomas, solitary plasmocytomas of bone, and extramedullary plasmocytomas. Whereas multiple myelomas represent systemic disease without the potential for cure, solitary plasmocytomas of bone and extramedullary plasmocytomas represent local forms of plasma cell neoplasms. Their prognosis depends on their likelihood of progressing to multiple myeloma. The potential for malignant systemic progression is higher for solitary plasmocytomas of bone than for extramedullary plasmocytomas. Local plasma cell neoplasms can involve skull base structures. They may occur at the clivus or petrous apex where they represent a solitary plasmocytoma of bone, or they may originate within the submucosa of the sinu-nasal and nasopharyngeal tracts where they represent an extramedullary plasmocytoma. In the present case, the lesion involving the clivus and nasopharynx was part of disseminated disease, and multiple myeloma was diagnosed.

Before considering major skull base resection, the authors appropriately obtained a tissue biopsy. As this case documents, excellent clinical and radiological results can be obtained with radiation of plasma cell tumors of the skull base. These tumors are known to be radiosensitive. Therefore, surgical resection should be reserved for salvaging unresponsive local plasma cell tumors involving the skull base. Chemotherapy is the treatment of choice for systemic disease. This case again highlights the importance of obtaining a biopsy of skull base tumors to determine the appropriate treatment.