Multiple myeloma with intracranial and spinal intradural metastasis: A case report

Abstract

Multiple myeloma is a hematopoietic cancer that is multicentric and most commonly involves the spine. Multiple myeloma with extraosseous and intradural involvement is an extremely rare condition. Here we present a rare case of spinal multiple myeloma with intracranial and spinal intradural metastasis causing lumbar spinal nerve compression. We present a 60-year-old woman with progressive weakness of the lower limbs for several weeks. Spinal magnetic resonance imaging (MRI) showed a leptomeningeal tumor with nodularity spreading within the cauda equina. Examination of the brain using MRI showed a lytic skull bone lesion and leptomeningeal enhancement. The patient underwent L3-5 laminectomy. Immunohistological staining confirmed a diagnosis of multiple myeloma of the IgA kappa subtype. After surgery, the patient underwent chemotherapy and rehabilitation exercises. Multiple myeloma has a median survival of 2.5 years, while 75% of patients with spinal involvement die within 1 year of diagnosis. Unfortunately, our patient died 3 months after the diagnosis of multiple myeloma with spinal and intracranial involvement. Intracranial and spinal intradural multiple myeloma invasions are quitely rare. Spine biopsies and cerebrospinal fluid cytology can aid in the diagnosis. Early surgical decompression is necessary, especially when neurological deficits occur.

Keywords: hydrocephalus; intracranial; intradural; multiple myeloma; spine.

Fig. 1

(A) Radiographs showing multiple compression fractures and a moth-eaten appearance of multiple vertebral bodies (B) Sagittal short T1 inversion recovery (STIR) sequence in the spinal MRI showing a new T11 compression fracture and multiple prior compression fractures. Coronal (C) and axial (D) T1-weighted MRI with gadolinium enhancement showing a diffuse leptomeningeal tumor spreading with extensions into the bilateral L4 and L5 neural foramen and nodularity of the cauda equina.

Fig. 2

(A) Axial brain CT images showing osteolytic lesions in the skull. Brain MRI of the patient at presentation (B) and four months later (C) showing progressive hydrocephalus and prominent skull bone lytic lesions.

Fig. 3

(A) Histological examination of the myeloma showing aggregation of atypical plasma cells with mild cellular pleomorphism, abundant cytoplasm, and binucleation in some of the cells (Hematoxylin and eosin, 400X). Immunohistochemical analysis results of the plasma cells showing positive staining for CD138 (B) and kappa light chain (C), but negative staining for lambda light chain (D).