Highly vascular solitary plasmacytoma of the calvarium

Abstract

A 50-year-old woman with an unremarkable medical history presented with a painless soft swelling in the midline of the forehead present for the previous year. A surgical removal was attempted without morphological investigations in an outside institution. Intractable bleeding occurred at the incision site so she was referred urgently to our institution. Cranial computerised tomography (top left, 3D image) demonstrated an osteolytic contrast-enhanced median mass involving the whole layer of the frontal bone, the ethmoidal bone and the left orbital roof. Cerebral angiography revealed a massive vascular tumour blush fed by vessels originating from the right and left (bottom, lateral view) ophthalmic arteries and from the right and left (top right, antero-posterior view) middle meningeal arteries. The feeding arteries originating from the middle meningeal arteries were embolised before partial surgical removal, which significantly reduced the vascular blush. Histological examination confirmed a malignant plasmacytic proliferation with CD138-positive cells. General investigations including complete blood count, serum and urine protein electrophoresis and immunoelectrophoresis, quantitative immunoglobulin analysis, bone marrow aspiration and radiological skeletal survey, excluded multiple myeloma. Solitary plasmacytoma of the frontal bone was proposed as a diagnosis. The postoperative management consisted of local radiotherapy to the skull. Solitary plasmacytomas of the calvaria are uncommon highly vascular tumours that are easily misdiagnosed preoperatively. If a surgical approach is required, the preoperative management of such a plasmacytoma should include cerebral angiography.