Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 52, Num. 2, 2004, pp. 262-264

Neurology India, Vol. 52, No. 2, April-June, 2004, pp. 262-264

Short Reports

Intracranial plasma cell granuloma

Shenoy SN, Raja A

Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal

Correspondence Address:Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal - 576119, Udupi
shenoysn@yahoo.com

Code Number: ni04081

Abstract

Keywords: Inflammatory pseudotumor, plasma cell granuloma

Introduction

Plasma cell granuloma (PCG) is a rare form of idiopathic inflammatory pseudotumor, characterized by a benign proliferation consisting predominantly of plasma cells and reticuloendothelial elements.[1] Very few cases of primary PCG of the central nervous system are reported.[2],[3],[4] We describe two cases of primary intracranial PCG and briefly discuss the literature on the subject.

Case Reports

Case 2
A 30-year-old woman presented with worsening headache and memory disturbance for 2 weeks. For one day she had altered sensorium. She had bilateral papilledema and right hemiparesis. A CT scan showed left temporo-parietal extraparenchymal and minimally enhancing isodense lesion with perilesional edema [Figure - 2]. A preoperative diagnosis of subacute subdural hematoma was considered and an emergency left parietal burr hole was done. The dura was markedly thickened and no blood clot was seen. The following day the patient underwent a left temporo-parietal craniotomy. The dura was markedly thickened, nodular and avascular. The lesion arose from the dura and was inseparable from the cortex. A subtotal excision of the lesion was done. Histopathological examination showed the dura to be infiltrated by aggregates of plasma cells with many Russell bodies, lymphocytes and histiocytes. Her investigations for plasma cell dyscrasias were negative. CT scan at 12 month follow-up showed no recurrence of the lesion.

Discussion

The term "plasma cell granuloma" is used to describe a localized benign proliferation of mature plasma cells.[1] Only a few cases of primary PCG of the central nervous system have been reported.[2],[3],[4] Plasma cell granulomas are known to arise from the meninges, sella, choroid plexus, fourth ventricle, and hypothalamic region.[2],[3],[4] Radiologically, the differential diagnosis of PCG includes en plaque meningioma and granulomas. Similarly, it should be differentiated histologically from plasmacytoma and meningioma with plasma cell infiltrate.[5],[6] Solitary intracranial plasmacytoma is a rare neoplastic lesion characterized by typical monoclonal plasma cells.[6] Horten et al reported cases, which revealed mixed populations of proliferating meningothelial cells together with plasma cells and lymphocytes.[5]
Surgical excision is the primary treatment for the intracranial PCG both to confirm the diagnosis and to reduce the raised intracranial tension. Most of the cases reported in the literature were preoperatively believed to be meningiomas.[2],[3],[4] In patients with subtotal excision of the lesion, steroid and radiation therapy may be used as PCG are known to recur following subtotal excision.[3] These patients require long-term follow-up not only for detecting recurrence but also to understand the natural history.

References

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