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. 2013 Oct;1(2):103-6.
doi: 10.14791/btrt.2013.1.2.103. Epub 2013 Oct 31.

A case of multiple myeloma with brain parenchyme involvement

Ho Jun Yi  1 , Hyung Sik Hwang  1 , Seung-Myung Moon  1 , Il Young Shin  1 , Young Hee Choi  2
Affiliations

A case of multiple myeloma with brain parenchyme involvement

Ho Jun Yi et al. Brain Tumor Res Treat. 2013 Oct.

Abstract

Multiple myelomas (MM) are characterized by monoclonal proliferation of immunoglobulin (Ig)-secreting plasma cells. Central nervous system involvement is a rare complication of MM, and it can present as either an intraparenchymal or a leptomeningeal lesion. A 77-year-old woman was transferred from the dementia clinic in July 2012. She had a large heterogeneous signal mass with central necrosis and with pial involvement in the left frontal lobe with destruction of the frontal bone that was observed on computed tomography and magnetic resonance imaging. Multiple punched out radiolucent lesions were also noted on the skull X-ray. Serum protein electrophoresis revealed an IgA-kappa monoclonal gammopathy. External lumbar drainage was helpful for treating the fluid collection underneath the scalp after an orbitozygomatic craniotomy with duroplasty.

Keywords: Monoclonal gammopathy; Multiple myeloma; Plasma cell.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Image study of the patient. A: Skull X-ray. Multiple punch out lesion was noted. B: T2 weighted magnetic resonance image (axial). Large heterogeneous signal mass with central necrosis and pial involvement is noted in left frontal lobe. Adjacent bony destruction and parenchymal edema are also noted. After contrast media injection, the mass shows strong enhancement. And multiple other smaller well-enhancing nodular or lobulating contoured nodules in both frontal and parietal bones are noted. C: Pre-operation brain computed tomography (CT). Relatively wall marginated bone destruction is noted in left frontal and parietal bones. D: Post-operation brain CT (bone setting image). Post-operative state, left frontal tumor removal and cranioplasty state with orbitozygomatic approach.
Fig. 2
Fig. 2
Electrophoresis and Immunofixations. A: Serum electrophoresis. B: Urine electrophoresis. C: Serum Immunofixation. D: Urine Immunofixation, Serum and urine protein electrophoresis revealed monoclonal gammopathy, IgA kappa type, free kappa light chains.
Fig. 3
Fig. 3
The biopsy shows diffuse infiltration of atypical plasma cell with prominent nucleoli and mitosis at bone, skeletal muscle, brain parenchyma. A: Bone involvement. B: Skeletal muscle involvement. C: Neoplastic cell (H&E, ×40). D: Neoplastic cell (H&E,×400).
See this image and copyright information in PMC

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