硬脑膜浆细胞瘤 (Dural Plasmacytoma )MRI病例图片影像诊断分析脑脊膜 2010-10-22
【临床病史】：74岁女性，头痛。74-year-old female with history of headache.
【影像改变】：There is an extra-axial, dural based mass predominantly in the high left posterior parietal region which is relatively isointense signal on TI (yellow arrow in Figure 1) and T2 (yellow arrow in Figure 2) sequences. 图示左侧后顶部的以脑膜为基底的脑外肿块，在T1和T2序列上呈相对的等信号。
The lesion demonstrates homogeneous contrast enhacement on post contrast sequences, (yellow arrow in Figure 3). Extension along the interhemispheric fissure (yellow arrow in Figure 4), encasement of the superior sagittal sinus (red arrow inFigure 4) and extension across midline to the right (blue arrow in Figure 4) is demonstrated.
【影像诊断】：硬膜浆细胞瘤 Dural Plasmacytoma
【讨论】：Plasmacytomas of the dura are uncommon plasma cell tumors that may occur as a solitary neoplasm or, more commonly, in association with multiple myeloma. The latter is usually accompanied by multiple lytic lesions of the skull. In distinction, solitary craniocerebral plasmacytomas are relatively benign and potentially curable. Therefore, distinction between the two has important clinical consequences. The differential diagnosis for dural plasmacytoma includes metastasis, lymphoma, dural sarcoma, plasma cell granuloma and meningioma.
Dural plasmacytomas are often confused with meningiomas (the most common extra-axial neoplasm found in adults) as the two have similar features and imaging characteristics. Both occur more commonly in women during the 5th decade of life with a predilection for similar sites of involvement including the cerebral convexities, sphenoid ridge, falx, and tentorium. On MR both may appear nearly isointense to brain on T1W images and iso- to hyperintense on T2W images with marked contrast enhancement. A characteristic "dural tail" and intratumoral calcifications may be seen in both lesions. Other manifestations of intracranial plasmacytoma may include diffuse leptomeningeal disease and rarely, intracerebral lesions with vasogenic edema.
These patients may present with intracranial hypertension and/or focal neurological signs from the dural origin of the tumor. Clinically, individuals with solitary dural plasmacytomas can be distinguished from those with multiple myeloma by the absence of hypercalcemia, renal insufficiency, anemia, lytic osseoues lesions, bone marrow plasmacytosis, and elevated serum or urinary paraprotein. Following surgical decompression and/or local radiotherapy for a solitary dural plasmacytoma, the prognosis is fairly good. This is in contrast to patients with plasmacytoma and multiple myeloma who typically have a much poorer prognosis.
这些病变可以表现为颅高压和/或局部神经定位体征，临床上，可以通过是否有高血钙、肾功能不全、贫血、多发性囊性骨病变、骨髓浆细胞增多以及血浆或尿液副蛋白增高等特征来鉴别究竟是孤立性浆细胞瘤，还是多发性骨髓瘤相关的浆细胞瘤。通过外科减压术和/或局部的放疗，孤立性浆细胞瘤预后可以相对良好，而多发性骨髓瘤的预后通常更糟糕。(参考来源:,ACR Thursday, December 3, 2009,作者:freemanpyw)