UNUSUAL MANIFESTATION OF MULTIPLE MYELOMA: FOCAL AFFECTION OF CENTRAL NERVOUS SYSTEM IN A PATIENT WITH CHRONIC LYMPHOCYTIC LEUKAEMIA

Tomas Pika,Jan Hrbek,Jaroslav Bacovsky,Dagmar Spurna,Jaromir Hubacek,Miroslav Vaverka,Vlastimil Scudla

doi:10.5507/bp.2009.045

Abstract

Involvement of the central nervous system as the first manifestation of multiple myeloma is very rare. To present an unusual case of the primomanifestation of a multiple myeloma in the form of a focal affection of the central nervous system in a patient with chronic lymphocytic leukaemia. A female patient diagnosed with chronic B-lymphocytic leukaemia with gradually increasing right-sided cerebellar symptomatology. The CT examination revealed expansion of the cranial vault with significant compression of brain structures. The tumour was extirpated and the histological examination led to a diagnosis of a plasmocytic myeloma. A thorough examination confirmed the diagnosis of multiple myeloma with significant osteolytic involvement of the skeleton. A combined chemo- and radiotherapy resulted in adjustment in the focal neurological finding, and a partial remission of the multiple myeloma was achieved. The above presented case describes two very unusual states: the primomanifestation of a multiple myeloma in form of a focal affection of the central nervous system, and the coincidence of a multiple myeloma as the second haematological malignancy in a patient with chronic B-lymphocytic leukaemia.

Highlights

Involvement of the central nervous system as the first manifestation of multiple myeloma is very rare
Multiple myeloma is a malignant hematologic disease belonging to the group of monoclonal gammopathies
Multiple myeloma is characterised by proliferation and accumulation of clones of neoplastically transformed plasmocytes which produce molecules of monoclonal immunoglobulin detectable in serum and/or urine

Summary

Introduction

Involvement of the central nervous system as the first manifestation of multiple myeloma is very rare. Aim: To present an unusual case of the primomanifestation of a multiple myeloma in the form of a focal affection of the central nervous system in a patient with chronic lymphocytic leukaemia. The tumour was extirpated and the histological examination led to a diagnosis of a plasmocytic myeloma. A thorough examination confirmed the diagnosis of multiple myeloma with significant osteolytic involvement of the skeleton. Conclusion: The above presented case describes two very unusual states: the primomanifestation of a multiple myeloma in form of a focal affection of the central nervous system, and the coincidence of a multiple myeloma as the second haematological malignancy in a patient with chronic B-lymphocytic leukaemia

INTRODUCTION

Findings

DISCUSSION