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Case Report
A case of incidental multiple myeloma presenting with pathologically proven large frontal skull plasmacytoma and review of therapeutic targets: Case report
1 Department of Internal Medicine, Thomas Hospital, 750 Morphy Avenue, Fairhope, Alabama 36532, USA
2 Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
3 Infirmary Cancer Care, Mobile, Alabama 36604, USA
Address correspondence to:
Gogo-Ogute E Ibodeng
Department of Internal Medicine, Thomas Hospital, 750 Morphy Avenue, Fairhope, Alabama 36532,
USA
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Article ID: 100116Z10GI2022
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Ibodeng GE, Fatola A, Galeas J. A case of incidental multiple myeloma presenting with pathologically proven large frontal skull plasmacytoma and review of therapeutic targets: Case report. J Case Rep Images Oncology 2022;8(2):50–55.ABSTRACT
Introduction: Multiple myeloma and plasmacytoma are both plasma cell malignancies that belong to the family of blood dyscrasias. They are thought to be different entities but can occur simultaneously in some patients.
Case Report: We present a unique case of a large plasmacytoma heralding the diagnosis of multiple myeloma with a preceding history of trauma which makes this case peculiar as this is an important addition to the limited existing scientific literature. The index patient was largely asymptomatic despite having a massive frontal skull/lobe lesion measuring approximately 8 × 6 cm in size alongside a chest wall mass involving the anterior left 6th rib, and a mildly displaced acute pathological fracture of the left clavicle. A primary diagnosis of multiple myeloma was made following serum protein electrophoresis with pathological confirmation of frontal skull plasmacytoma. After multidisciplinary discussion, radiotherapy was administered for plasmacytoma with complete resolution of the frontal skull mass without the need for resection and chemotherapy for multiple myeloma with daratumumab in combination with lenalidomide-dexamethasone—chosen due to anticipated poor outcome at the time of diagnosis. Autologous stem cell transplantation was subsequently instituted for multiple myeloma with a good outcome to date.
Conclusion: Solitary plasmacytoma can co-exist with multiple myeloma and the prognosis remains poor in such circumstance. Patients should be followed up closely with yearly imaging—magnetic resonance imaging (MRI)/computed tomography (CT), and positron emission tomography (PET) scans. A pivotal lesson from this case report emphasizes the atypical presentation of plasmacytoma and multiple myeloma with the peculiarity of a prior history of trauma which is believed to be associated with plasma dyscrasias. Over the last decade, novel therapeutic agents such as chimeric antigen receptor T-cell therapy, which is the first approved cell-based therapy for multiple myeloma, antibody-drug conjugates, and a dozen of bi-specific antibodies/immunotherapy have been developed and shows promising outcome in the future, especially for refractory cases of multiple myeloma.
Keywords: Head trauma, Immunohistochemistry, Multiple myeloma, Plasmacytoma
SUPPORTING INFORMATION
Author Contributions
Gogo-Ogute E Ibodeng - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Ayotola Fatola - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jose Galeas - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Gogo-Ogute E Ibodeng et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
