Multiple Myeloma Coverage from Every Angle

Case Report: Multiple Myeloma Presenting as Seemingly Benign Scalp Mass

By: Jenna Carter, PhD
Posted: Monday, December 14, 2020

A recent report published in the Journal of Surgical Case Reports highlighted an atypical presentation of multiple myeloma in a 64-year-old male patient. According to Lorenzo K. Sampson, MD, of Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina, and colleagues, “Multiple myeloma is a plasma cell malignancy with variable presentations. Some present with nonspecific symptoms… [whereas]…others will be asymptomatic but present with laboratory abnormalities.”

This report focused on an otherwise healthy patient presenting with a seemingly benign scalp mass. However, upon further screening, the initial mass was found to include bony lesions in the parietal calvarium. Further pathology tests confirmed hypercalcemia and anemia, leading to a differential diagnosis of multiple myeloma, solitary plasmacytoma, and metastatic disease.

The patient presented with a scalp mass that was gradually enlarging over the past 6 months. The initial diagnostic test was a mass aspiration, which revealed no fluid within the mass, suggesting a solid mass and the need for further testing. Dissection was then attempted; however, surgeons encountered soft hemorrhagic tissue and a defect extending through the bone into the cranial cavity. The cavity was packed, and a neurosurgery consultation was requested. Neurosurgeons ordered a noncontrast head CT scan and pathology screenings.

Results from the CT scan revealed a left parietal bone lytic lesion. Further MRI revealed an enhancing mass involving the left lateral side of the scalp and parietal bone extending down to the dura. Additionally, the pathology revealed elevated anemia and hypercalcemia, which led to an expanded differential diagnosis of multiple myeloma.

“This rare presentation of a minimally symptomatic scalp mass as the sole presenting symptom of multiple myeloma serves as a call to providers to consider a wide differential when evaluating typically benign presentations…,” concluded Dr. Sampson and colleagues.

Disclosure: The authors reported no conflicts of interest.

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