Giant solitary plasmacytoma of the skull: Management of a rare differential diagnosis

Abstract

Background: Solitary plasmacytoma of the skull (SPS) is a condition arising from the pathological proliferation of plasma cells. It is a rare condition, especially giant ones and may often mimic many conditions. Total excision may be curative. However, in some cases, chemotherapy or radiotherapy or chemoradiation may be necessary post-excision. Case summary: S.S. was a 44-year-old male with a rapidly growing swelling in the middle of his forehead for eight months. Physical examination revealed an otherwise healthy-looking young man, an obvious forehead mass covered with normal intact skin, sessile with a base circumference of 31cm, non-tender, mixed consistency (hard with cystic areas), fixed to the frontal bone but skin over it was freely mobile. No pulsation and no bruit. A clinical diagnosis of osseous meningioma was made. Fine Needle Aspirate Cytology (FNAC) revealed features consistent with a plasmacytoma. Urinary Bence jones protein and bone marrow biopsy were negative for Myeloma. Surgical excision was via a craniectomy and a cranioplasty was done. Clinical condition one year after surgery remained satisfactory with no evidence of recurrence or development of myeloma. No chemotherapy or radiotherapy was administered. Conclusion: Giant solitary plasmacytoma of the scalp is a very rare condition and may clinically be misdiagnosed. May be managed with a total wide excision with or without chemotherapy or radiotherapy.