Multiple Extramedullary Plasmacytoma Manifesting Increased Intracranial Pressure Signs: A Case Report

Multiple extramedullary plasmacytoma is a very rare tumor. Its incidence is about 0.74% of all plasma cell tumors. A case of multiple extramedullary plasmacytoma, manifesting intracranial hypertension signs, was presented. The patient was a 53-year-old man and was admitted because of the seizure in bilateral lower extremities, right fronto-temporo-parietal(FTP) swelling and bilateral neck masses. The patient was in confused status upon admission and the neurological examination revealed negative findings except for the bilateral disc margin blurring. Laboratory examinations were within normal limits except for mild anemia. Skull films showed a huge radiolucent area on the right FTP region. Cerebral angiography disclosed tumor stain and mass effect at the FTP area with marked displacement of the middle and anterior cerebral arteries. At surgery a reddish-gray huge nodular mass, attached to the transverse sinus, sigmoid sinus and tentorium, extending into infratentorial and subtemporal regions and eroding the pyramid bone, was found and resected. Microscopic pathology of this tumor revealed a typical plasmacytoma with “cartwheel” chromatin pattern. Postoperative course was relatively well. However, he died from acute renal failure on 35th postoperative day. A short review was provided concerning diagnosis, treatment and prognosis of plasmacytoma. It was emphasized that the negative pressure continuous ventricular drainage(CVD) was effective for controlling the cerebrospinal fluid leak from the wound.