[A case of multiple myeloma associated with a large subcutaneous mass in the frontal region]

Abstract

A case of multiple myeloma having plasmacytoma in the frontal bone and clivus is reported. A 68-year-old female was referred to our hospital because of a subcutaneous mass in the frontal region. She was diagnosed as having multiple myeloma 7 years ago and had been treated with chemotherapy. On admission, severe anemia, hyperproteinemia and elevation of serum lambda type immunoglobulin G (IgG) were pointed out. Plain skull X-rays showed numerous punched out lesions with a large bone defect of the frontal bone. CT scan and MRI revealed a mass lesion in the clivus in addition to a large epidural tumor in the frontal region. The encapsulated frontal epidural tumor was totally resected and cranioplasty was performed with resin. Histological diagnosis was plasmacytoma of IgG lambda type. The postoperative course was uneventful, and chemotherapy was continued. There was no tumor recurrence in the frontal region and no neurological deterioration, but she died of DIC 15 months after the operation. Twenty seven cases in the literature of multiple myeloma forming cranial or intracranial plasmacytoma were briefly reviewed. Although the prognosis of such cases is poor, total resection of medullary plasmacytoma is warranted especially in multiple myeloma patients who don't have another extramedullary plasmacytoma or plasma cell leukemia.