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|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 5 | Page : 545-546
Primary plasmacytoma of the anterior skull base: A rare case
Ramesh Ganesan Vengalathur, Karthikeyan Veerasamy Kavindapadi, Balasubramanian Chandramouli
Department of Neurosurgery, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu, India
|Date of Submission||16-Jul-2014|
|Date of Decision||26-Aug-2014|
|Date of Acceptance||03-Oct-2014|
|Date of Web Publication||12-Nov-2014|
Ramesh Ganesan Vengalathur
Department of Neurosurgery, Chettinad Superspeciality Hospital, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vengalathur RG, Kavindapadi KV, Chandramouli B. Primary plasmacytoma of the anterior skull base: A rare case. Neurol India 2014;62:545-6
Skull base plasmacytoma is a rare condition and accounts for 10% of all plasmacytomas. The anterior skull base plasmacytomas are extramedullary plasmacytomas which have better prognosis with surgery and adjuvant therapy. Only about 42 cases of skull base plasmacytomas have been reported till date. We present a case of skull base plasmacytoma without evidence of multiple myeloma.
A 30-year-old man presented with progressive protrusion of the left eye with headache since six months. Examination showed left extra-axial proptosis with displacement of eyeball downwards. Visual acuity and fundus examination were normal. Magnetic resonance imaging (MRI) showed large lesion isointense in T 1 weighted images and slightly hyperintense in T 2 weighted images. It was homogenously enhancing with gadolinium [Figure 1] and [Figure 2]. It was involving the anterior cranial fossa base extending from the frontal and ethmoidal sinuses to the roof of the orbit in the extradural plane. Left fronto-temporal craniotomy was performed. The tumor was soft to firm and was eroding the skull base in the extradural plane and was extending from the frontal and ethmoidal sinuses to the roof of the entire orbit upto the optic canal. The tumor could be excised completely. Histopathological examination showed sheets of neoplastic plasma cells including binucleate forms, suggestive of plasmacytoma [Figure 3]. Bone marrow aspiration did not show evidence of myeloma. Skeletal survey was normal. Patient has undergone post-operative radiotherapy. He is doing fine at 15 months follow-up.
Plasmacytoma is a focal form of plasma cell tumor. Only 36 cases have been documented till 2002 and another six more cases since then. ,,,,, Wein et al. have divided the plasmacytoma of the skull base into anterior (nasopharyngeal) group and central (sphenoid, clivus, petrous apex) group. This is of prognostic importance because in the central group, the rate of progression to multiple myeloma is 63.6%, which is much higher than that in the anterior group (9.5%). Moreover plasmacytomas are also classified as extramedullary plasmacytoma (EMP) or solitary plasmacytoma of bone (SPB).  Most of the anterior group of skull base plasmacytoma fall into EMP group and the central skull base plasmacytoma fall into SPB group. Since solitary plasmacytoma represents only one end of the spectrum of plasma cell tumors and represents a distinct manifestation of a disease continuum, progression to multiple myeloma is almost invariable. Hence adjuvant therapy is essential to arrest further progression of the disease.
This patient had involvement of frontal and ethmoidal sinuses and eroding the floor of the anterior cranial fossa and most probably falls into the group of EMP. Hence, though the tumor had been excised totally adjuvant radiotherapy was given to the patient. The possibility of plasmacytoma has to be kept in mind in any osteolytic tumor of the skull base.
|Figure 1: T1 axial post contrast MRI showing the contrast enhancing tumor involving the anterior cranial fossa base extending from the frontal and ethmoidal sinuses to the roof of the left orbit|
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|Figure 2: T1 coronal post contrast MRI showing the contrast enhancing tumor involving the roof of left orbit in the extradural plane|
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|Figure 3: Histopathology picture of the tumor (H and E, ×400) showing sheets of neoplastic plasma cells including bi-nucleate forms|
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| » Acknowledgement|| |
We thank Prof. K. Ramesh Rao, Department of Pathology, Chettinad Superspeciality Hospital, Chennai, for providing the histopathology pictures.
| » References|| |
Wein RO, Popat SR, Doerr TD, Dutcher PO. Plasma cell tumors of the skull base: Four case reports and literature review. Skull Base 2002;12:77-86.
Ustuner Z, Basaran M, Kiris T, Bilgic B, Sencer S, Sakar B, et al
. Skull base plasmacytoma in a patient with light chain myeloma. Skull Base 2003;13:167-71.
Singh AD, Chacko AG, Chacko G, Rajshekhar V. Plasma cell tumors of the skull. Surg Neurol 2005;64:434-8.
Pancholi A, Raniga S, Vohra PA, Vaidya V, Prajapati A, Mansingani S. Imaging features of extramedullary plasmacytoma of skull base with multiple myeloma-A rare case. Indian J Radiol Imaging 2006;16:29-32.
Yamaguchi S, Terasaka S, Ando S, Shinohara T, Iwasaki Y. Neoadjuvant therapy in a patient with clival plasmacytoma associated with multiple myeloma: A case report. Surg Neurol 2008;70:403-7.
Guinto-Balanzar G, Abdo-Toro M, Aréchiga-Ramos N, Leal-Ortega R, Zepeda-Fernández E, Nambo-Lucio Mde J. Plasma cell tumor of the clivus: Report of two cases. Cir Cir 2012;80:171-6.
[Figure 1], [Figure 2], [Figure 3]
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