Isolated solitary plasmacytoma of the frontal region mimicking meningioma: A case report.

BACKGROUND

Plasma cell dyscrasias (PCDs) are a group of plasma cell (PC) disorders displaying heterogeneous clinical presentation. Solitary plasmacytoma (SP) is a unique entity of PCDs as the SP presentation and clinical symptoms are commonly related to the mass compression to adjacent tissue. This case report describes an isolated extramedullary SP on the frontal region in a 20-year-old Javanese male who presented with a palpable rubbery frontal mass and visual disturbances.

CASE DESCRIPTION: A 20-year-old Javanese male presented to the neurosurgery clinic after being referred by the surgery department with a pronounced mass on his face, headache, and progressive visual disturbances. Physical examination revealed a firm palpable mass on the right frontal region with a diameter of 6 × 8 cm with an indefinite border. There was no extremities weakness. Visual acuity of the right and left eye was 6/60 and 6/7.5, respectively. Contrast-enhanced computed tomography scan examination observed an isodense extra-axial mass on the right frontalis region with a diameter of 7.7 × 5.2 × 8.5 cm. The patient underwent a large craniotomy under general anesthesia. An ~18 cm unilateral extended incision was made on from tragus, following the shape of the tumor circumferentially. The tumor was an extracranial mass ~10 × 11.5 cm, with a pink-reddish appearance, soft, highly vascularized, and easily separated from the skull. The tumor was completely resected. The tumor was 10 × 11.5 × 1.5 cm. Histopathological examination showed a PC infiltration with positive MUM1 and CD138, suggesting plasmacytoma. A urine test for Bence Jones protein and a comprehensive cancer panel were negative. Without any systemic symptoms and findings, isolated SP without multiple myeloma was given.

CONCLUSION

Cranial SP is a rare finding in daily practice. Early recognition of neurological symptoms due to a space-occupying lesion plays an important role in appropriate management. Thus, a comprehensive examination helps to identify cranial SP which can mimic another lesion such as meningioma.