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A 65-year-old otherwise healthy man presented to the emergency department with complaints
of headache, aphasia, confusion and partial vision loss. He had presented to his primary
care physician with a nodule on the left parieto-occipital region of his head, 4 months
prior. The lesion had been excised in the emergency department. However, the sample
had not been sent for pathologic analysis as it was believed to be a lipoma. In the
emergency department, physical examination revealed a large soft-tissue mass as depicted
in Figure A. Magnetic resonance imaging (T2-weighted image) of the head revealed a large tumor
with erosion into the cranium accompanied by mass effect (Figure B). He was admitted to our solid tumor service where biopsy revealed proliferation
of plasma cells with CD-138 immunostaining and kappa antibody immunoreactivity. The
diagnosis of plasmacytoma was made, and the patient received 5 fractions of 2,000 cGy radiation therapy. He furthermore received chemotherapy with lenalidomide and
dexamethasone. Response to therapy was successfully achieved, and the patient was
referred to surgery for cranioplasty. Extramedullary plasmacytoma is a rare tumor
that usually arises from the head and neck, and is predominantly seen in men with
a median age of 55 years.
