Pseudofontanelle in Multiple Myeloma

Abstract

To the Editor.— Lytic bone lesions are commonly associated with multiple myeloma. In about 65% of patients, skeletal x-ray films will show bone lesions that are best seen on lateral skull and anteroposterior pelvic films. Less common are palpable plasmacytomas—which grow from areas of underlying bone destruction. These lesions occur in approximately 15% of patients and are usually seen in the skull, sternum, and clavicles where the skin is contiguous to the affected bones. We have seen two patients with palpable plasmacytomas of the skull, who during intensive treatment with high-dose cyclophosphamide for their systemic disease experienced a resolution of the plasmacytomas. The disappearance of the superficial mass resulted in the formation of a fontanelle-like lesion that was easily palpable on the patient's skull. Report of Cases.— Case1.—A 62-year-old woman with nonsecretory multiple myeloma had an elevated, firm, nontender 3×3.5-cm left-sided parietal plasmacytoma developed. On the second day of