Case study of intracerebral plasmacytoma as an initial presentation of multiple myeloma
Department of Oncology (A.W., K.Z., N.K.), University Institute of Pathology (A.S.B.), Department of Radiotherapy (M.B.), and Service of Medical Genetics, University Hospital CHUV (D.M., M.J.), Lausanne; Switzerland
Address correspondence to Nicolas Ketterer, Pluridisciplinary Center for Oncology, CHUV, BH-06, Vaud, CH-1011 Lausanne, Switzerland (Nicolas.Ketterer{at}chuv.hospvd.ch).
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Abstract |
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Cerebral involvement is an uncommon complication of multiple myeloma. We report on a 64-year-old man hospitalized for a partial seizure. MRI showed two intracerebral lesions, which proved to be plasmacytomas. After complete staging, we retained the diagnosis of immunoglobulin G lambda-type multiple myeloma with CNS involvement. Cytogenetic analysis of plasma cells detected a deletion in the p53 gene at 17p13.1. Despite cranial radiotherapy and systemic chemotherapy, the patient's disease progressed rapidly and he died five months after diagnosis. What makes this case unusual is that overt multiple myeloma had been absent before cerebral involvement was discovered. It confirms the extremely poor prognosis of patients with CNS myeloma even in the presence of aggressive treatment. Cytogenetic abnormalities could be a marker of chromosomal and genetic instability, conferring to multiple myeloma a more aggressive profile.
Keywords: central nervous system involvement, multiple myeloma, p53 deletion
Received March 22, 2006; Accepted August 7, 2006