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Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases

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Abstract

Purpose

Parasellar plasmacytomas are rare tumors localized to the sellar region arising from plasma cells. Knowledge of clinical, imaging, surgical, and pathological characteristics is limited to single case reports.

Methods

A retrospective analysis of five primary cases was conducted, followed by systematic review of English language articles using PubMed in accordance with PRISMA guidelines.

Results

Five primary case patients include four men and one woman, ages 60–77, followed up to 3 years. A systematic review identified 65 additional patients, of whom 65% presented with cranial nerve palsies and 15% with hypopituitarism. Sixteen percent had history of known multiple myeloma (MM) while 37% were diagnosed concurrently with MM on presentation of parasellar plasmacytoma. Imaging showed median tumor size of 38 mm (range, 4–70 mm), with MRI intensity similar to that of other sellar masses. Surgical biopsy with immunohistochemical studies confirmed plasmacytoma diagnosis. Eighty-one percent underwent parasellar radiotherapy, and chemotherapy initiated in 59% of the 69 patients with MM. Overall survival rate was 74% at follow-up (median 12 months), with 18% having parasellar recurrences and 38% progressing to systemic MM after presentation of a solitary plasmacytoma (median 3 months).

Conclusions

Parasellar plasmacytomas are rare tumors that should be considered in the differential diagnosis for lesions involving the sella and arising from the clivus, especially when cranial nerve paresis is apparent, even in the absence of known MM. Although recurrence rates for parasellar plasmacytoma is low, patients should be monitored for progression to MM. Treatment depends on the presence of systemic disease at diagnosis.

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Acknowledgements

We thank Dr. John Carmichael for his advice and support. We thank Shira Berman for her assistance in manuscript preparation.

Funding

This work was supported by the NIH (grant R21 DK105405 awarded to O. Cooper).

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Authors and Affiliations

  1. Pituitary Center, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA

    Jane Lee, Adam Mamelak & Odelia Cooper

  2. Department of Neurosurgery, Keck School of Medicine of USC, 1200 North State Street, Suite 5046, Los Angeles, CA, 90089, USA

    Edwin Kulubya & Gabriel Zada

  3. Department of Radiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite M-335, Los Angeles, CA, 90048, USA

    Barry D. Pressman

  4. Department of Pathology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 8725, Los Angeles, CA, 90048, USA

    Serguei Bannykh

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  1. Jane Lee
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Correspondence to Odelia Cooper.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Jane Lee and Edwin Kulubya shared first authorship.

Gabriel Zada and Odelia Cooper shared senior authorship.

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Lee, J., Kulubya, E., Pressman, B.D. et al. Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases. Pituitary 20, 381–392 (2017). https://doi.org/10.1007/s11102-017-0799-5

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