Calvarial Plasmacytoma, an Unusual Manifestation of Multiple Myeloma
Sarah Castillo-Jorge, MD; Christian Fauria-Robinson, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Ronnie Self II, MD, MS; Philip Daroca, MD
The case presented is that of a 63-year-old female with an unusually large solitary calvarial plasmacytoma as an initial manifestation of a multiple myeloma. We were able to follow the progression of the disease clinically and with diagnostic imaging.
INTRODUCTION Plasmacytomas are manifestations of plasma cell tu- mors that may arise in any part of the body from the plasma cells in the bone marrow or from the mucosal surfaces when extramedullary. Gammopathy of unknown significance (MGUS), a condition that leads to moderately elevated levels of immunoglobulin protein in the blood, may be asymptomatic; but is precancerous and in rare instances,
may progress to multiple myeloma. 1 Primary amyloidosis and plasma cell leukemia can also present as an isolated lesion termed solitary plasmacytoma, which can present as an intra- or extra-medullary tumor. Although rarely seen in the head and neck, when encountered, they are described as extramedullary skull base lesions. However, medullary plasmacytomas can and do arise from the skull. These rapidly growing masses can present a diagnostic dilemma with significant co-morbidity and consequences for delayed
Figure 1: CT axial section in the upper portion of the calvarium. (Left) Soft tissue window and (Right) bone window revealed a large soft tissue mass arising from the calvarium in the left parietal region with significant bone erosion and remodeling.
J La State Med Soc VOL 166 July/August 2014 149
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