J Korean Soc Radiol.  2018 Jul;79(1):50-55. 10.3348/jksr.2018.79.1.50.

Central Nervous System Involvement in a Patient with Multiple Myeloma Manifesting as an Intraventricular Mass with Leptomeningeal Spread

• Lee JE
• Lee EJ
• Huh HJ
• Chung JW
• Lee EK
• Lee HJ

• KMID: 2416406
• DOI: http://doi.org/10.3348/jksr.2018.79.1.50

Abstract

Central nervous system involvement in multiple myeloma (CNS-MM) is a rare condition. Various manifestations of CNS-MM have been reported, including dural, parenchymal, and leptomeningeal involvement. Among them, leptomeningeal involvement is less common and intraventricular involvement is exceptional, with only one case reported in the literature. Herein, we report the first case of CNS-MM manifesting as an intraventricular mass with leptomeningeal involvement combined with perineural spread. We also describe characteristic computed tomography and magnetic resonance imaging findings of intraventricular multiple myeloma.

MeSH Terms

Central Nervous System*
Cerebral Ventricles
Chromosome Aberrations
Humans
Magnetic Resonance Imaging
Meningeal Carcinomatosis
Multiple Myeloma*

Figure

• 

  Fig. 1 A 66-year-old female with central nervous system involvement of multiple myeloma manifesting as an intraventricular mass with leptomeningeal spread. A. Non-CE CT scan shows a small ovoid hyperdense mass (50 Hounsfield units) (arrow) in trigone of left lateral ventricle (1). Iso-signal intense mass (arrows) is detected on both T1WI and T2WI (2, 3). CE T1WIs present strong homogeneous enhancement of intraventricular mass (white arrow) and multifocal intermittent leptomeningeal enhancement (black arrows), especially along the left cerebellar folia (4, 5). This intraventricular mass is not revealed in previous FLAIR image performed 8 months ago (6). CE = contrast-enhanced, FLAIR = fluid-attenuated inversion recovery, T1WI = T1-weighted image, T2WI = T2-weighted image B. Cytospin preparation of CSF from a MM patient with leptomeningeal involvement shows abundant malignant plasma cells (Wright stain, × 1000) (1), IFE of CSF demonstrates a monoclonal gammopathy, IgG and lambda type (2). CSF = cerebrospinal fluid, IFE = immunofixation electrophoresis, MM = multiple myeloma C. Follow up MRI of CE T1WI (2 weeks later) demonstrates increased size of leptomeningeal enhancing lesion (arrow) in the posterior fossa (1), multifocal leptomeningeal enhancing nodules (arrows) are noted (2, 3), abnormal enhancement along the cisternal segment of left trigeminal nerve (white arrow) is also noted with focal extension into ipsilateral Meckel's cave (arrowhead) and both cavernous sinuses show bulging contour with strong enhancement (black arrows) (4). These image findings suggest leptomeningeal involvement of MM with perineural spread. CE = contrast-enhanced, MM = multiple myeloma, T1WI = T1-weighted image

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