Dorsum sellae solitary plasmacytoma revealed by neuronavigation guided biopsy
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Dorsum sellae solitary plasmacytoma revealed by neuronavigation-guided biopsy . M. Neroni, G. Ricci, R. Gazzeri, e S. Esposito U.O.D. Neurosurgery, San Giovanni – Addolorata Hospital Rome. Introduction

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Dorsum sellae solitary plasmacytoma revealed by neuronavigation guided biopsy

Dorsum sellae solitary plasmacytoma revealed by neuronavigation-guided biopsy

M. Neroni, G. Ricci, R. Gazzeri, e S. Esposito

U.O.D. Neurosurgery,

San Giovanni – Addolorata Hospital

Rome


Introduction

Occurrence of cranio-cervical extramedullary solitary plasma cell tumors (EMPs) represent 18%

- Skull base represent a rare case of EMPs localization

We report a case of dorsum sellae EMP


Case Report

A 64 y.o. cauc. man presenting with a complete right ophtalmoparesis

MR showed parasellar lesion involving the CS and ICAs

- Body scan (after the biopsy) was unable to demonstrate extracranial localization


Trans sphenoidal neuronav assisted approach biopsy of the anterior intrasellar region of the tumor

Trans-sphenoidal neuronav assisted approach

Biopsy of the anterior intrasellar region of the tumor


Intra-op histo exam revealed a plasma cell tumor

Plasmacytomas are composed of a proliferation of abnormal plasma cells that exhibit monoclonal intracellular immunoglobulines with immunological staining techniques.

Plasmacytoma is further classified into two groups: osseous (solitary plasmacytoma of bone) and non osseous (extramedullary plasmacytoma) primary lesions (3 Pancholi) .


Conclusion

A local irradiation is the primary mode of treatment for extramedullary plasmacytomas, then after the biopsy the patient received radiation (52 Gy) in association with VAD ( vincristin, adriamycine, dexamethasone).

MRI performed after the therapy showed a reduction of the mass and the regression of the cranial nerve deficit.

This case highlights the importance of obtaining a biopsy of skull base tumors to determine the appropriate treatment

A plasmacytoma of the skull base has a high risk to progress to multiple myeloma over the years. (Ustuner, Pancholi).

At nine months F.U. patient developed diffuse mieloma and 2 year after he died


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