A case of multiple myeloma presenting clinically as a solitary tumour of the skull

This case of multiple myeloma (plasmacytoma) in a Bantu woman presenting clinically as a solitary tumour of the skull is interestin': on clinical, pathological and radiological grounds. ' => Plasmacytoma occurs mainly in bone but occasionally in soft tissue. when it is confined to the submucosa of the air-passages and gastro-intestinal traC!. Solitary plasmacytoma is rare, most 'solitary' cases proving to be multiple on follow-up. The patient is a Bantu woman of 49 with a history of a gradually
more » ... tory of a gradually increasing swelling over the left parieto-occipital region for 6 months (Figs. 1 and 2). On examination a sw6l1ing is ap-parent over the left parieto-occipital area, 4 x 6 inches in size, irregularly lobulated and of the consistency of soft rubber mainly, but variable in parts. A plaque of bone is palpable in the centre, and defects in the skull margin at the edges. X-ray Examination A large bony defect is seen over the left parieto-occipital region (Figs. 3 and 4 ). There is fair definition of the edges, with scalloping. A plaque of the outer table has also lifted up. Generally small areas of sclerotic bone are surrounded hy areas of diminished density. X-rays of the vertebrae and pelvis show small osteolytic deposits. Cerebral arteriograms show no evidence of excessive vascularization or intracranial shift. Oiher Examinaiions Blood picture: Hb. 62%. White blood cells 17,400 per c.rnm. (neutrophils 84 %, monocytes 2 %, lymphocyres 13 %, eosinophils 1%). PCY 26 %. ESR 30 mm. Westergren. Serum albumen 3· 3 g. %, globulin 6· 7 g. %, A/G O' 5 : 1. W.R. negative. Bence Jones protein negative (3 occasions). Plasma electrophoresis-,B globulin fraction increased. Bone marrow-no abnormal cells detected. Serum alkaline phosphatase 19 K.A. units. Serum calcium 8·8 mg. %. Serum phosphorus 1· 9 mg. %. Histology On biopsy, the mass was found to be plasmacytoma, with clnsters of plasma cells situated in a stroma of small round cells.
pmid:14402411 fatcat:fwj3va5rejg7vbbjkk7tdmvsmi