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|Year : 2004 | Volume
| Issue : 2 | Page : 262-264
Intracranial plasma cell granuloma
SN Shenoy , A Raja
Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal, India
Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal - 576119, Udupi, India
We report two rare cases of primary intracranial plasma cell granuloma. The tumors probably arose from the dura and involved the cerebral parenchyma. These patients presented with clinical features of raised intracranial pressure and there was focal neurological deficit. The management issues are discussed.
|How to cite this article:|
Shenoy S N, Raja A. Intracranial plasma cell granuloma. Neurol India 2004;52:262-4
| » Introduction|| |
Plasma cell granuloma (PCG) is a rare form of idiopathic inflammatory pseudotumor, characterized by a benign proliferation consisting predominantly of plasma cells and reticuloendothelial elements. Very few cases of primary PCG of the central nervous system are reported.,, We describe two cases of primary intracranial PCG and briefly discuss the literature on the subject.
| » Case Reports|| |
A 48-year-old lady was admitted with history of progressively worsening headache for one month. She had bilateral early papilledema and no other focal neurological deficit. A CT scan revealed an isodense non-enhancing diffuse left temporal lesion causing mass effect. T1-weighted MRI revealed a diffuse hypointense lesion and T2-weighted MRI revealed a hyperintense lesion in the left temporal lobe. The lesion showed heterogeneous contrast enhancement [Figure - 1]. She underwent left temporal craniotomy and excision of the lesion. The lesion was dura-based and infiltrated the underlying brain. The brain was edematous. Histopathological examination showed chronic inflammatory infiltration of the dura, mainly with plasma cells and a few lymphocytes and histiocytes. A few Russell bodies were present. Her investigations for plasma cell dyscrasias were negative. At 36 months follow-up the patient was asymptomatic.
A 30-year-old woman presented with worsening headache and memory disturbance for 2 weeks. For one day she had altered sensorium. She had bilateral papilledema and right hemiparesis. A CT scan showed left temporo-parietal extraparenchymal and minimally enhancing isodense lesion with perilesional edema [Figure:2]. A preoperative diagnosis of subacute subdural hematoma was considered and an emergency left parietal burr hole was done. The dura was markedly thickened and no blood clot was seen. The following day the patient underwent a left temporo-parietal craniotomy. The dura was markedly thickened, nodular and avascular. The lesion arose from the dura and was inseparable from the cortex. A subtotal excision of the lesion was done. Histopathological examination showed the dura to be infiltrated by aggregates of plasma cells with many Russell bodies, lymphocytes and histiocytes. Her investigations for plasma cell dyscrasias were negative. CT scan at 12 month follow-up showed no recurrence of the lesion.
| » Discussion|| |
The term “plasma cell granuloma” is used to describe a localized benign proliferation of mature plasma cells. Only a few cases of primary PCG of the central nervous system have been reported.,, Plasma cell granulomas are known to arise from the meninges, sella, choroid plexus, fourth ventricle, and hypothalamic region.,, Radiologically, the differential diagnosis of PCG includes en plaque meningioma and granulomas. Similarly, it should be differentiated histologically from plasmacytoma and meningioma with plasma cell infiltrate., Solitary intracranial plasmacytoma is a rare neoplastic lesion characterized by typical monoclonal plasma cells. Horten et al reported cases, which revealed mixed populations of proliferating meningothelial cells together with plasma cells and lymphocytes.
Surgical excision is the primary treatment for the intracranial PCG both to confirm the diagnosis and to reduce the raised intracranial tension. Most of the cases reported in the literature were preoperatively believed to be meningiomas.,, In patients with subtotal excision of the lesion, steroid and radiation therapy may be used as PCG are known to recur following subtotal excision. These patients require long-term follow-up not only for detecting recurrence but also to understand the natural history.
| » References|| |
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