Dorsum sellae solitary plasmacytoma revealed by neuronavigation-guided biopsy

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Dorsum sellae solitary plasmacytoma revealed by
neuronavigation-guided biopsy

• M. Neroni, G. Ricci, R. Gazzeri, e S. Esposito
• U.O.D. Neurosurgery,
• San Giovanni Addolorata Hospital
• Rome

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• Introduction
• Occurrence of cranio-cervical extramedullary
  solitary plasma cell tumors (EMPs) represent 18
• - Skull base represent a rare case of EMPs
  localization
• We report a case of dorsum sellae EMP

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• Case Report
• A 64 y.o. cauc. man presenting with a complete
  right ophtalmoparesis
• MR showed parasellar lesion involving the CS and
  ICAs
• - Body scan (after the biopsy) was unable to
  demonstrate extracranial localization

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• Trans-sphenoidal neuronav assisted approach
• Biopsy of the anterior intrasellar region of the
  tumor

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• Intra-op histo exam revealed a plasma cell
  tumor
• Plasmacytomas are composed of a proliferation of
  abnormal plasma cells that exhibit monoclonal
  intracellular immunoglobulines with immunological
  staining techniques.
• Plasmacytoma is further classified into two
  groups osseous (solitary plasmacytoma of bone)
  and non osseous (extramedullary plasmacytoma)
  primary lesions (3 Pancholi) .

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• Conclusion
• A local irradiation is the primary mode of
  treatment for extramedullary plasmacytomas, then
  after the biopsy the patient received radiation
  (52 Gy) in association with VAD ( vincristin,
  adriamycine, dexamethasone).
• MRI performed after the therapy showed a
  reduction of the mass and the regression of the
  cranial nerve deficit.
• This case highlights the importance of obtaining
  a biopsy of skull base tumors to determine the
  appropriate treatment
• A plasmacytoma of the skull base has a high risk
  to progress to multiple myeloma over the years.
  (Ustuner, Pancholi).
• At nine months F.U. patient developed diffuse
  mieloma and 2 year after he died