Sphenoidal Plasmacytoma Associated With Multiple Myeloma Mimicking Meningeal Tumor In A Geriatric Patient

A 76-year-old woman without any neurological symptoms or discomfort was revealed to have a sphenoidal lesion with erosion, destruction of the adjacent bone structure, and extension to the middle left cranial fossa via neck computed tomography (CT). The lesion characteristics resembled a meningioma and she was advised to undergo surgery, which she refused. At the 3-month follow-up, the lesion was seen to have enlarged, and a new osteolytic lesion was found in the frontal skull vault. She was diagnosed as having skull plasmacytoma after frontal bone biopsy. Later, immunofixation test, bone marrow smear, and bone survey revealed multiple myeloma (MM). The patient received systemic chemotherapy and responded well after seven months of treatment. The case is unusual as sphenoidal plasmacytoma is rarely present in MM, and the patient presented neither neurological symptoms nor discomfort. The skull lesion was found incidentally. Moreover, the initial neuroradiological finding mimicked that of meningioma, but the diagnosis of a plasmacytoma associated with MM was made later. Although intracranial plasmacytoma is rarely associated with MM, the neuroradiological findings lack specificity and do not differ from those of meningioma, metastasis, etc. Proof based on tissue analysis was extremely important for ensuring accurate diagnosis before proceeding with therapy. Copyright (C) 2019, Taiwan Society of Geriatric Emergency & Critical Care Medicine.