Cite this article as: Gong JS, Kang WY, Zhu J, Xu JM. A hole in the skull:
CT manifestations of a solitary plasmacytoma in skull. Quant Imaging Med
Surg 2012;2:61-62. DOI: 10.3978/j.issn.2223-4292.2012.01.02
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A hole in the skull: CT manifestations of a solitary plasmacytoma in skull
Plasmacytoma can present as multiple myeloma, solitary plasmacytoma of the bone (SPB), or extramedullary
plasmacytoma. SPB is a rare entity that composes of malignant plasma cells and involves the bone to form only one or two
lesions without evidence of disease dissemination. It accounts for only 4% of malignant plasma cell tumors. We report a
case of SPB in the skull in a 59-year-old male. CT scan revealed an 8 cm × 9 cm osteolytic lesion on the scalp of skull with
a well demarcated margin. A cake-like mass was revealed at CT soft tissue window. The mass was completely excised and
histological examination revealed plasmacytoma. The diagnosis of SPB was established after ruling out multiple myeloma.
Plasmacytoma; multiple myeloma; solitary plasmacytoma of the bone; extramedullary plasmacytoma; skull
Quant Imaging Med Surg 2012;2:61-62. DOI: 10.3978/j.issn.2223-4292.2012.01.02
A 59-year-old man presented a painless palpable soft hollow
on the scalp of skull. The medical history was unremarkable.
Palpation showed a sunken area at the frontal bone. CT scanning
and three-dimension reformation were performed. A large
size osteolytic lesion measured 8 cm × 9 cm was demonstrated
(Figure 1, 2). It was well demarcated with small remaining bone
fragments. CT Soft tissue window revealed a cake-like mass
(Figure 3). Three-dimension reformation showed a big hole at
the frontal bone (Figure 4). The mass was completely removed.
Histological examination showed the tumor was composed of
plasma cells and a diagnosis of plasmacytoma was suggested
(Figure 5). No monoclonal proteins were found in the serum or
urine, and bone marrow biopsy was normal. Skeletal scintigraphy
did not detect any other lesions. Therefore, multiple myeloma was ruled out and the diagnosis of SPB was established.
Figure 1. Transversal CT scan shows a large osteolytic lesion with
small remaining bone fragments (arrows) in it.
Figure 2. CT Sagittal multiplanar reformation shows a well
demarcated osteolytic lesion (arrows).
Figure 3. Transversal CT at soft tissue window depicts a cake-like mass (arrows).
Figure 4. CT three-dimension reformation shows a big bone-lytic
hole (arrows) in the frontal bone with well-defined but irregular
margin, and several small bone fragments (curve arrows).
Figure 5. Photomicrograph (HE, ×100) demonstrates the neoplasm composed of layers of plasma cells.