Presentation
Painless swelling of the right parietal region in a patient with multiple myeloma.
Patient Data
Age: 65 years
Gender: Female
From the case:
Multiple myeloma with a large skull plasmacytoma
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The MRI sequences demonstrate
- a large mass centered on the right parietal skull with intra-and extracranial extension. It displays an intermediate signal on T1/FLAIR, low signal on T2 with vivid homogeneous enhancement on postcontrast sequences. There is an invasion of the adjacent segment of the superior sagittal sinus well-visualized on both sagittal/coronal postcontrast sequences. A mass effect is noted on the underlying cortex with no cerebral parenchymal involvement.
- numerous well-defined lesions of various sizes scattered throughout the diploe "raindrop skull", clivus and cervical vertebral marrow.
dilated right temporal horn with periventricular high signal probably indicating gliosis. Areas of chronic small vessel change of high signal on FLAIR are noted in the white matter of both cerebral hemispheres.
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Significant improvement with a decrease in size of the right parietal skull mass as well as the size and number of the intradiploic lesions.
Case Discussion
MRI features are most consistent with multiple myeloma with a large skull plasmacytoma.
Apart from multiple myeloma, the main differential diagnosis of such skull mass is an aggressive meningioma, hemangiopericytoma, or metastasis.
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