Dorsum sellae solitary plasmacytoma revealed by neuronavigation-guided biopsy M. Neroni, G. Ricci, R. Gazzeri, e S. Esposito U.O.D. Neurosurgery, San Giovanni Addolorata Hospital Rome M. Neroni, G. Ricci, R. Gazzeri, e S. Esposito U.O.D. Neurosurgery, San Giovanni Addolorata Hospital Rome Introduction - Occurrence of cranio-cervical extramedullary solitary plasma cell tumors (EMPs) represent 18% - Skull base represent a rare case of EMPs localization - We report a case of dorsum sellae EMP Introduction - Occurrence of cranio-cervical extramedullary solitary plasma cell tumors (EMPs) represent 18% - Skull base represent a rare case of EMPs localization - We report a case of dorsum sellae EMP Case Report - A 64 y.o. cauc. man presenting with a complete right ophtalmoparesis - MR showed parasellar lesion involving the CS and ICAs -Body scan (after the biopsy) was unable to demonstrate extracranial localization Case Report - A 64 y.o. cauc. man presenting with a complete right ophtalmoparesis - MR showed parasellar lesion involving the CS and ICAs -Body scan (after the biopsy) was unable to demonstrate extracranial localization Trans-sphenoidal neuronav assisted approach - Biopsy of the anterior intrasellar region of the tumor Trans-sphenoidal neuronav assisted approach - Biopsy of the anterior intrasellar region of the tumor Intra-op histo exam revealed a plasma cell tumor - Plasmacytomas are composed of a proliferation of abnormal plasma cells that exhibit monoclonal intracellular immunoglobulines with immunological staining techniques. - Plasmacytoma is further classified into two groups: osseous (solitary plasmacytoma of bone) and non osseous (extramedullary plasmacytoma) primary lesions (3 Pancholi). Intra-op histo exam revealed a plasma cell tumor - Plasmacytomas are composed of a proliferation of abnormal plasma cells that exhibit monoclonal intracellular immunoglobulines with immunological staining techniques. - Plasmacytoma is further classified into two groups: osseous (solitary plasmacytoma of bone) and non osseous (extramedullary plasmacytoma) primary lesions (3 Pancholi). Conclusion - A local irradiation is the primary mode of treatment for extramedullary plasmacytomas, then after the biopsy the patient received radiation (52 Gy) in association with VAD ( vincristin, adriamycine, dexamethasone). - MRI performed after the therapy showed a reduction of the mass and the regression of the cranial nerve deficit. - This case highlights the importance of obtaining a biopsy of skull base tumors to determine the appropriate treatment - A plasmacytoma of the skull base has a high risk to progress to multiple myeloma over the years. (Ustuner, Pancholi). - At nine months F.U. patient developed diffuse mieloma and 2 year after he died Conclusion - A local irradiation is the primary mode of treatment for extramedullary plasmacytomas, then after the biopsy the patient received radiation (52 Gy) in association with VAD ( vincristin, adriamycine, dexamethasone). - MRI performed after the therapy showed a reduction of the mass and the regression of the cranial nerve deficit. - This case highlights the importance of obtaining a biopsy of skull base tumors to determine the appropriate treatment - A plasmacytoma of the skull base has a high risk to progress to multiple myeloma over the years. (Ustuner, Pancholi). - At nine months F.U. patient developed diffuse mieloma and 2 year after he died