Intracranial Plasmacytoma

Author: Hannah Thomas, MD; Ashraf Badros, MD; Erika Wheeler, MD, 09/21/2023
Category: Lymphoma: Mature B-cell and Plasma cell Neoplasms > Plasma Cell Neoplasm > Plasma cell myeloma
Published Date: 01/11/2024

The finding of intracranial plasmacytoma with dural enhancement is a rare presentation of multiple myeloma.  A 52-year-old woman presented with headache and a mass on frontal forehead. Magnetic resonance imaging revealed a 10x10x6.3 cm enhancing mass involving the frontal calvarium extending to parietal bones with intracranial extension in the right frontal lobe with vasogenic edema and effacement of the right lateral ventricle, suggestive of atypical meningioma or hemangiopericytoma. She underwent craniectomy and tumor debulking, procedure was aborted after extensive bleeding and blood loss, biopsy revealed kappa restricted plasma cells. PET/CT scan showed multiple lytic lesions involving vertebral bodies and multiple rib fractures. Bone marrow had 15% kappa-restricted plasma cells, IgA-kappa on immunofixation. FISH showed loss of CDKN2C and loss of TP53. She was treated with radiation therapy followed by Daratumumab, lenalidomide, bortezomib and dexamethasone; with planned high-dose melphalan and transplant. She is doing well clinically with decreased size and enhancement of the brain lesion.