PDF(Pubmed)
Abstract：
Plasmacytomas are a collection of plasma cells that occur as a solitary lesion or in conjunction with multiple myeloma. Intracranial location is uncommon but should be considered as management differs. Plasmacytomas in the suprasellar region are rare but should be considered in the differential diagnosis of suprasellar masses. Clinical presentation and imaging findings have similarities and overlap between pituitary adenomas and plasmacytomas, so the diagnosis depends on biopsy and pathological evaluation. Immunohistological staining is often necessary due to structural similarities to adenomas. Isolated cases may be treated with radiation alone and surgery is reserved for symptoms due to mass effect. Systemic therapy is given if there is evidence of multiple myeloma. In this case report, we present a 52-year-old male who presented with worsening blurry vision associated with headaches and epistaxis of four months duration. CT of the head showed a large mass involving the sella and skull base. Labs showed normal calcium, creatinine, and intact pituitary function. Biopsy of the mass was initially diagnosed as a pituitary adenoma but repeat pathology revealed plasmacytoma. Body imaging revealed diffuse lytic lesions. Bone marrow biopsy and serum electrophoresis were consistent with a diagnosis of multiple myeloma. The patient underwent radiation therapy to the suprasellar mass followed by systemic therapy for multiple myeloma with bortezomib, lenalidomide, and dexamethasone. The patient achieved a very good partial response.
摘要：
浆细胞瘤是作为孤立性病变或与多发性骨髓瘤结合出现的浆细胞的集合。颅内位置并不常见，但应考虑为不同的管理。鞍上区域的浆细胞瘤很少见，但在鉴别诊断鞍上肿块时应予以考虑。临床表现和影像学表现在垂体腺瘤和浆细胞瘤之间有相似性和重叠，所以诊断取决于活检和病理评估。由于与腺瘤的结构相似性，免疫组织学染色通常是必要的。孤立的病例可以单独使用放射治疗，并且由于肿块效应而保留手术治疗症状。如果有多发性骨髓瘤的证据，则给予全身治疗。在这个案例报告中,我们介绍了一名52岁的男性，他表现出与头痛和鼻出血相关的视力模糊恶化，持续4个月。头部CT显示大肿块，累及蝶鞍和颅底。实验室显示钙正常，肌酐,和完整的垂体功能。肿块的活检最初被诊断为垂体腺瘤，但重复病理显示浆细胞瘤。身体影像学显示弥漫性溶解性病变。骨髓活检和血清电泳与多发性骨髓瘤的诊断一致。患者接受鞍上肿块放射治疗，然后用硼替佐米全身治疗多发性骨髓瘤，来那度胺,还有地塞米松.患者获得了非常好的部分反应。
