Oligodendroglioma metastasis to the bone marrow mimicking multiple myeloma: A case report

Abstract

The present study reports a case of a 59-year-old male suffering from oligodendroglioma that metastasized to the bone marrow (BM). The metastasis was detected 5 years after craniotomy was performed for the resection of the primary tumor; however, it manifested as multiple myeloma (MM)-like bone lesions, a small M component and myeloma cell-like morphology in the BM. A brain magnetic resonance imaging scan was performed; evidence from the previously performed oligodendroglioma resection was observed on the scan, but there were no significant findings, which made the diagnosis particularly challenging. The patient exhibited no response to the multiple combination therapies administered targeting MM and oligodendroglioma, and subsequently developed epilepsy and pneumonia, prior to succumbing to multiple organ failure. Among the various tumor types involving the central nervous system, oligodendroglioma is the least likely to metastasize; thus, distant metastases from brain oligodendrogliomas are extremely rare. To the best of our knowledge, this is the first case of metastatic oligodendroglioma presenting with typical MM-like symptoms and without any recurrence in the brain.

Keywords: M component; bone lesions; bone marrow metastasis; multiple myeloma; oligodendroglioma.

Figure 1.

Subcutaneous masses (arrows) on the patient's (A) forehead and (B) left side of the chest.

Figure 2.

Morphology of the abnormal cells found in the bone marrow aspirate highly resembled that of myeloma cells. The cells varied in size; the majority of them were scattered, while some were clustered. Most abnormal cells were large and round or oval-shaped. The cytoplasm was little to moderate. The nuclei were large and round or oval-shaped with thin chromatin fibers. Binuclear and multinuclear cells were observed in the smear. Hematoxylin and eosin staining; magnification, ×1,000.

Figure 3.

MRI of the thoracic spine. (A) T1- and (B) T2-weighted MRI revealed heterogeneous signals in the thoracic vertebrae; (C) axial T2-weighted MRI revealed a soft tissue mass on the left 7th rib. MRI, magnetic resonance imaging.

Figure 4.

Biopsy of a subcutaneous mass found in left side of the chest. (A) Low-power microscopy (H&E staining; magnification, ×100) showed fibrous tissue with tumor cell infiltration, while (B) high-power (H&E staining; magnification, ×400) revealed that these cells had a consistent size and a transparent cytoplasm. H&E, hematoxylin and eosin.

Figure 5.

Brain MRI revealed evidence of prior oligodendroglioma resection without current observable primary malignant tumors. (A-C) T1-weighted MRI; (D-F) T2-weighted MRI; (G-I) diffusion-weighted imaging at various section levels. MRI, magnetic resonance imaging.