Osseous metaplasia associated with amyloid-producing plasmacytoma of bone: a report of two cases

 Amyloid-producing plasmacytoma of bone is a rare myeloma variant. We describe two patients with plasmacytomas of bone with extensive amyloid deposition and metaplastic bone formation which can be confused on imaging with osteosarcoma. Histologic confirmation was obtained in both cases. Metaplastic new bone formation was identified within these lesions and appears to be responsible for the radiographic appearances.     

Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay

Introduction  The purpose of this pictorial essay is to increase awareness of the clinical presentation, neuroradiological findings, treatment options, and neuroradiological follow-up of plasmacytomas and multiple myeloma with intracranial growth. Methods  This pictorial essay reviews the clinical features and neuroradiological findings in seven patients (four women, three men; age range at diagnosis 62–82 years) followed in two institutions. Six patients, one with IgG-κ plasmacytoma, and five with IgG-κ (n = 3), IgG-λ (n = 1), and nonsecretory (n = 1) multiple myeloma, had been seen over a period of 9 years in one institution, and the other patient with IgG-κ plasmacytoma had been seen over a period of 3.5 years in the other. Results  Intracranial involvement is rare, most frequently resulting from osseous lesions in the cranial vault, skull base, nose, or paranasal sinuses. Primary dural or leptomeningeal involvement is rarer. Some typical findings of a dural and/or osseous plasmacytoma include iso- to hyperdensity on CT scan, T1 equal to high signal intensity and T2 markedly hypointense signal on MRI, and high vascularity possibly documented on intraarterial digital subtraction angiography. However, the neuroradiological findings generally lack specificity, since they are generally no different from those of meningioma, metastasis, lymphoma, dural sarcoma, plasma cell granuloma, infectious meningitis, and leptomeningeal carcinomatosis. Conclusion  The spectrum of clinical and neuroradiological evaluation shows that intracranial involvement from plasmacytoma and multiple myeloma must be taken into account in the differential diagnosis of cranial osseous and meningeal disease. This paper was presented as a Scientific Poster at the 23rd Congress of the Associazione Italiana di Neuroradiologia 2007, the 32nd Congress of the European Society of Neuroradiology 2007, and the Annual Conference of the British Society of Neuroradiologists 2007.     

Plasmacytoma of the breast

Multiple myeloma and solitary extramedullary plasmacytoma of the breast are exceedingly rare lesions, with only 22 cases previously described. Most reported cases represent secondary involvement or initial manifestation of the multiple myeloma. We report a new case with extraskeletal plasmacytomas of the breast without systematic disease, and describe the mammographic and ultrasonographic features of the lesion. Correspondence to: A. Memis     

Extraosseous calcified plasmacytoma causing thoracic myelopathy

We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis. Received: 12 February 1999 Revision requested: 18 March 1999 Revision received: 19 April 1999 Accepted: 20 April 1999     

抗血小板药物诱导颅内多发出血1例

临床资料 患者女54岁.以“突发剧烈头痛6h余”主诉急诊入院,发病后2h头CT示:蛛网膜下腔出血;术前Hunt-Hess分级3级;查体:神志清,双侧外展神经受限,左侧面舌瘫,左侧肢体肌力Ⅳ级,右侧Ⅴ级,双侧Babinski征阳性,脑膜刺激征阳性;既往高血压史3年.入院当天在全麻下行“脑血管造影术+右侧颈内动脉脉络膜前动脉起始处动脉瘤支架辅助栓塞术”,术中造影可见右侧颈内动脉动脉瘤,瘤颈约5 mm,深4 mm,长度约7mm,瘤体上可见脉络膜前动脉发出及1个子囊,术中植入1枚4.5 min×22 mm Enterprise支架辅助栓塞,复查造影显示动脉瘤栓塞良好,载瘤动脉通畅;术后即刻头CT未见颅内新发出血.     

The “mini brain” appearance of plasmacytoma in the appendicular skeleton

We report on the case of a 70-year-old woman presenting with right hip pain. Radiographs of the right hip demonstrated a well-defined large lytic lesion in the proximal right femur, with prominent trabeculae situated peripherally and extending into the lesion in a "spoke-wheel" pattern. Magnetic resonance imaging (MRI) demonstrated solid enhancing marrow-replacing lesion, with intervening linear nonenhancing areas of low T2 signal intensity. The MRI appearance resembled that of a small brain or "mini brain". Biopsy specimen demonstrated predominantly mature plasma cells, with occasional admixed immature forms. A diagnosis of plasmacytosis, consistent with myeloma, was made. This case illustrates a rare but seemingly characteristic "mini brain" appearance of plasmacytoma, which, to date, has only been reported in the spine and has not been observed in other bony lesions.     

经肱动脉颅内血管支架成形术二例

病例资料 病例1.患者男,52岁.因高血压病史5年,头晕伴嗜睡半个月入院,入院查MRA示基底动脉中段狭窄,遂住院口服肠溶阿司匹林300 mg、波力维75 mg/d,准备接受颅内支架成形术.     

Intracranial histiocytosis X: a case report

A case of intracranial histiocytosis X that presented radiologically with thickening of the pituitary stalk is presented. The radiologic findings, including a blush seen on angiography, are described.     

原发颅内纤维肉瘤一例

患者女,23岁,2006年8月31日突发头痛伴呕吐4 h入院,既往体健.体检:颅神经未见异常,右肢肌力Ⅳ~+级,右侧Babinski征阳性.     

颅内神经内分泌癌一例

患者女,68岁.因头晕、行为迟缓、反应迟钝、懒言少语、右上肢抖动于2009年5月17日就诊. CT检查:平扫左额部大脑镰旁见团块状稍高密度病灶,大小约4.7 cm×6.7 cm,边界清楚,密度均匀,病灶宽基底贴于大脑镰左侧,部分经大脑镰下伸向对侧半球,左侧脑室额角及体部受压变形,中线结构向右移位,灶周水肿不明显.     

VHEP方案治疗多发性骨髓瘤的初步报告

目的：观察含羟基喜树碱和鬼臼乙叉甙的VHEP方案治疗多发性骨髓瘤（MM）的疗效、毒副反应。方法：16例患者经临床及各项实验室检查确诊为MN,采用VHEP方案化疗1～3疗程,观察其疗效及不良反应。结果：VHEP方案化疗后部分缓解（PR）率是43．75％,达到PR的中位时间为72d。M蛋白下降50％以上为43．75％,瘤细胞下降80％的患者占43．75％,治疗前后血钙、血肌酐、谷丙转氨酶无明显变化,sLDH及血清β2-微球蛋白治疗后较治疗前明显减低。结论：VHEP方案提高了MM患者的部分缓解率,发挥明显疗效的时间较长,对骨髓抑制作用较轻,无明显毒性,是一种安全有效的治疗方案。     

MR imaging of hepatic plasmacytoma: a case report.

A case of kappa light chain multiple myeloma with space-occupying hepatic plasmacytoma is presented. Magnetic resonance (MR) imaging shows an eccentric multiple-layer pattern of the liver mass and suggests malignancy. Differential diagnosis concerning the MR appearance of this rare hepatic tumor is discussed.     

额骨浆细胞瘤1例

患者老年女性,65岁。外伤后在当地医院诊断为额部头皮血肿,近自觉额部疼痛明显,且肿物进行性增大,热敷治疗后较前缩小,但变硬,遂来我院。查体：额部略凸出,余未见异常。影像学检查：MSCT表现：VR像额骨右侧内外板骨质破坏（图1）,相应部位可见大小约3.4cm×4.2cm肿物,     

颅内硬脑膜外恶性纤维组织细胞瘤一例

患儿 男，4岁。因左耳听力下降伴鼻唇沟变浅1个月入院，无头痛、头晕、恶心、呕吐及四肢抽搐等症状。体检：神志清楚，对答切题，检查合作，双侧瞳孔等大等圆，对光敏感。左枕部颅骨局部稍隆起，质硬，左侧鼻唇沟变浅，张口偏右，左眼睑不能闭合，伸舌偏左，左耳听力下降，四肢肌力正常，病理反射未引出.     

Solitary osteosclerotic plasmacytoma: association with demyelinating polyneuropathy and amyloid deposition

A 51-year-old man presented with a 1-year history of polyneuropathy necessitating the use of a wheelchair. Initial diagnosis was idiopathic chronic inflammatory demyelinating polyneuropathy (CIDP) and associated monoclonal gammopathy. Investigations for multiple myeloma, including bone marrow aspiration and biopsy, were negative. What was initially felt to be an incidental osteosclerotic focus noted on the radiographic bone survey was eventually shown to be a solitary osteosclereotic plasmacytoma with associated amyloid. This dramatically altered treatment. This case emphasizes the importance of including osteosclerotic plasmacytoma in the differential diagnosis of a focal sclerotic bone lesion in the clinical setting of polyneuropathy. These lesions are less likely to progress to multiple myeloma than lytic plasma cell neoplasms, and the presence of polyneuropathy often results in earlier diagnosis and treatment with enhanced prospect of cure. The finding of amyloid deposition within the osteosclerotic lesion may be of prognostic importance. Received: 30 November 2000 Revision requested: 15 January 2001 Revision received: 16 April 2001 Accepted: 18 April 2001     

颅内神经梅毒树胶肿1例

患者男性．36岁。因“左侧肢体运动障碍伴头痛呕吐2天”入院。四年前有类似病史．在家休息1天后自行好转,否认不洁性生活史和皮肤病．患者人院前2天无明显诱因下出现左侧肢体麻木伴乏力．伴头晕．恶心．呕吐．头痛．因患者四年之前有类似症状．休息1天后好转．     

颅内间变性血管外皮细胞瘤伴骨转移一例

笔者报道了1例颅内间变性血管外皮细胞瘤（AHPC）伴骨转移的病例,从临床表现、影像学检查尤其是全身骨显像检查以及术后病理综合分析了该病特点。并通过文献复习加深了对AHPC骨转移的认识。多数恶性肿瘤常见骨转移,而颅内AHPC是一种少见的中枢神经系统肿瘤,较少发生骨转移。通过全身骨显像发现了该例患者多处骨骼病变,术后病理提示颅内AHPC骨转移,因此提示恶性肿瘤尤其是少见骨转移者应把骨显像检查作为随访的一个重要检查,对于早期发现骨转移、确定临床分期及治疗方案的选择等都是至关重要的。     

颅内生殖细胞瘤33例临床分析

目的了解颅内生殖细胞瘤患者一般情况、临床表现、辅助检查和治疗的特点。方法对2000年1月至2011年1月海军总医院放射肿瘤科收治的33例颅内生殖细胞瘤进行回顾性分析。结果 33例患者中,男26例,女7例;发病部位：单发18例,多发15例;鞍区12例（36.4%）,松果体区13例（39.4%）,基底节区5例（15.2%）,脑室9例。临床表现：颅内高压症状21例（63.7%）、视力下降及视野缺损10例（30.3%）、尿崩症11例（33.3%）、肢体无力7例（21.2%）。影像学检查：MRI显示长T1长T2或等T1等T2异常信号影,多数病变增强后明显强化。诊断方法：经病理诊断确诊17例,经诊断性放疗确诊16例。治疗：3例行肿瘤部分或全部切除术;4例合并梗阻性脑积水,行脑室分流术,10例行立体定向手术,患者均行放疗联合化疗,症状均有不同程度缓解,2例出现脊髓转移。结论颅压增高、多尿、复视是颅内生殖细胞瘤最常见的临床症状,病变常见位置为鞍区和松果体区,通过全脑＋局部放疗联合化疗的治疗方式能使大部分患者病变缩小和临床症状缓解,获得长时间的生存。