48 y/o man known case of MM, proved on biopsy

 

Doctor's Information

Name : Mona
Family :Malekzadeh Moghani
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Soudeh Jorjani

 

Patient's Information

Gender : Male
Age : 48

 

Case Section

Muskuloskeletal System

 

Clinical Summary

48 y/o man known case of MM, proved on biopsy of bony lesion, presenting with petosis due to occulomotor nerve palsy

 

Images

 

Imaging Procedures and Findings

On MRI there is a mass lesion originating from clivus with low signal intensity on T1 and T2 images, with extension to right parasellar and cavernus sinus region, passing through skull base and envolvement of petrygopalatin fossa

 

Discussion

Multiple myeloma is a multifocal malignant proliferation of plasma cells and is the most common primary malignant tumor of the skeleton. There is a male predominance, with a male-to-female ratio of 1.5:1. It is common after age 50 years and rare before 30 years. Because this neoplasm derives from bone marrow elements, it involves bones containing red marrow: skull, ribs, sternum, pelvis, proximal humeral metaphysis, and proximal femoral metaphysis. At the time of diagnosis it is often disseminated throughout the red marrow of the axial skeleton. Infiltration of bone marrow has two forms: diffuse and focal. In the diffuse form, myeloma cells are mixed with hematopoietic cells. This form is difficult to image; the only MRl manifestation is an inhomogeneous bone marrow signal intensity that is subjective and difficult to quantitate. CT, plain radiographs, and scintigraphy may result in negative findings. In the focal form, normal bone marrow is displaced by nodules composed entirely of myeloma cells. Untreated myelomatous lesions have decreased signal intensity on Tlweighted images and increased signal intensity on T2weighted images when compared to the surrounding bone marrow. CT demonstrates purely osteolytic lesions in the trabecular bone, which occasionally extend to involve the cortex. Multidetector CT is able to demonstrate smaller lesions than MRI can.46 After irradiation, these lesions show low signal intensity on both Tl- and T2-weighted images, and a sderotic border develops, as seen on CT. The skull base, like any bone, may be affected by myeloma.

 

Final Diagnosis

Multiple myeloma of clivus

 

References

CT and MRI of the whole body. John R. Haaga. P 2141

 

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