Leptomeningeal metastasis of multiple myeloma

Cristiane Máximo da Silva; Jamison Menezes de Souza; Roberto Queiroz dos Santos; Mariana Spitz

doi:10.1590/0004-282X-anp-2020-0139

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(02): 179-180
DOI: 10.1590/0004-282X-anp-2020-0139

Images in Neurology

Leptomeningeal metastasis of multiple myeloma

Metástases leptomeníngeas de mieloma múltiplo

Cristiane Máximo da Silva

¹Hospital Federal dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brazil

,

Jamison Menezes de Souza

²Hospital Federal dos Servidores do Estado, Serviço de Hematologia, Rio de Janeiro RJ, Brazil

,

Roberto Queiroz dos Santos

³Hospital Federal dos Servidores do Estado, Serviço de Radiologia, Rio de Janeiro RJ, Brazil

⁴Americas Medical City, Rio de Janeiro RJ, Brazil

,

Mariana Spitz

¹Hospital Federal dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brazil

⁵Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Serviço de Neurologia, Rio de Janeiro RJ, Brazil

› Author Affiliations

Abstract

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A 65-year-old female with multiple myeloma diagnosed one year before developed tonic-clonic seizures. She had a good initial response to chemotherapy. Brain magnetic resonance imaging (MRI; [Figure 1]) and cerebrospinal fluid (CSF; [Figure 2]) analysis showed central nervous system myelomatous infiltration. Intrathecal chemotherapy and dexamethasone were prescribed and a follow-up CSF sample was negative for plasmocytes. Neurologic manifestations of multiple myeloma are not uncommon and include spinal compression and peripheral neuropathy[1]. Central nervous system myelomatosis, on the other hand, is rare. The workup for the diagnosis includes brain MRI and CSF analysis. CSF cytology has a sensitivity of 50–60% and a specificity over 95%[2]. Prognosis is poor.

Figure 1 Sagital postcontrast T1-weighted image (1A) shows mixed pachymeningeal and leptomeningeal thickening forming nodules and intense gadolinium enhancement. Axial T2-weighted image (1B) and coronal T1-weighted image (1C) show one of these nodules extending into subjacent brain parenchyma with perilesional edema.

Figure 2 Cerebrospinal fluid specimen with myelomatous cells (arrow). The stain employed was May-Grunwald-Giemsa. Atypical plasmocytes found in the cerebrospinal fluid were subsequently confirmed by immunophenotyping.

References

References
1 Brum M, António AS, Guerreiro R. Myelomatous meningitis: a rare neurological involvement in complete remission of multiple myeloma. J Neurol Sci. 2014 May;340(1-2):241-2. https://doi.org/10.1016/j.jns.2014.03.015
2 Bommer M, Kull M, Teleanu V, Schwarzwälder P, Feuring-Buske M, Kroenke J, et al. Leptomeningeal myelomatosis: A rare but devastating manifestation of multiple myeloma diagnosed using cytology, flow cytometry, and fluorescent in situ hybridization. Acta Haematol. 2018 Aug;139(4):247-54. https://doi.org/10.1159/000489484

Figures

Figure 1 Sagital postcontrast T1-weighted image (1A) shows mixed pachymeningeal and leptomeningeal thickening forming nodules and intense gadolinium enhancement. Axial T2-weighted image (1B) and coronal T1-weighted image (1C) show one of these nodules extending into subjacent brain parenchyma with perilesional edema.

Figure 2 Cerebrospinal fluid specimen with myelomatous cells (arrow). The stain employed was May-Grunwald-Giemsa. Atypical plasmocytes found in the cerebrospinal fluid were subsequently confirmed by immunophenotyping.