Primary plasmacytoma in the cerebellum: A case report and literature review.
Primary plasmacytoma in the cerebellum: A case report and literature review.
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小脑原发性浆细胞瘤：病例报告和文献综述。
DOI：
10.1016/j.wneu.2019.10.036
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Ogasawara K.
中科院分区：
文献类型：
--
作者：
Yanagihara W;Beppu T;Ogasawara Y;Ito S;Sato Y;Sugai T;Ogasawara K.
背景：大多数浆细胞瘤起源于骨髓（髓内），是多发性骨髓瘤（MM）的一部分。相比之下，不伴MM的髓外浆细胞瘤是罕见的，浆细胞瘤主要发生在脑实质是极其罕见的。脑原发浆细胞瘤的临床表现尚不清楚。我们报告一例原发性小脑浆细胞瘤并复习相关文献。病例描述患者是一名33岁的女性，表现为眩晕和周围面神经麻痹。在小脑中上皮层白质下发现肿瘤。磁共振成像未见特异性病变。由于肿瘤侵袭性生长，手术切除肿瘤。病理诊断为浆细胞瘤。术后对肿瘤床进行放射治疗。虽然骨髓组织学显示少量非典型浆细胞（1%-2%），但低于MM诊断标准的阈值，我们开始化疗以预防MM的发生。术后16个月未发现肿瘤复发或MM发展。结论组织学对原发性脑浆细胞瘤的诊断具有重要意义，因为神经影像学缺乏特异性的表现。骨髓中少量非典型浆细胞的发现可能支持髓外浆细胞瘤是MM后续发展的先兆的假设。除了适当的治疗结合最大限度的肿瘤切除和脑放射治疗外，严格的血液学管理可能有助于良好的结果。
BackgroundMost plasmacytomas arise in the bone marrow (intramedullary), as part of multiple myeloma (MM). In contrast, extramedullary plasmacytoma without MM is rare, and plasmacytoma primarily occurring in the brain parenchyma is extremely rare. Clinical behaviors of primary plasmacytoma in the brain have remained unclear. We report a case of primary plasmacytoma in the cerebellum and review the literature.Case DescriptionThe patient was a 33-year-old woman, displaying vertigo and peripheral facial nerve palsy. A tumor was identified in the subcortical white matter of the middle-upper cerebellum. Magnetic resonance imaging showed no specific findings for this lesion. Tumor was surgically resected because of aggressive tumor growth. Pathologic diagnosis of the tumor was plasmacytoma. The patient was treated with irradiation to the tumor bed after surgery. Although histology of the bone marrow showed a few atypical plasma cells (1%–2%), below the threshold of the diagnostic criterion for MM, we started chemotherapy to prevent occurrence of MM. Neither tumor recurrence nor development of MM was found for 16 months after surgery.ConclusionsHistology is essential for diagnosis of primary plasmacytoma in the brain because of the lack of specific findings on neuroimaging. A finding of a few atypical plasma cells in the bone marrow might support the assumption that extramedullary plasmacytoma represents a harbinger of subsequent development of MM. In addition to appropriate therapies combining maximum tumor removal and radiotherapy to the brain, rigorous hematological management might have contributed to favorable outcomes.
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