Endocrine Abstracts

Introduction: The sellar plasmacytoma, an exceptional localization that can be solitary or associated with a multiple myeloma. We report the case of a sellar mass wrongly diagnosed as an invasive non-functional pituitary adenoma, the diagnosis was rectified postoperatively by the anatomopathological study.

Case description: A 44 year old female patient, with history of cholecystectomy and megaloblastic anemia, was referred to our center for management of a sellar mass initillay diagnosed as a pituitary adenoma. The patient had galactorrhea for 3 years and than she developped severe hedeache with worsening visual impairement. The physical examination revealed bilateral blindness, with galactorrhea, without neurological abnormalities. Magnetic resonance imaging (MRI) of the brain revealed an Iso intense mass in T1 and T2 sequences with intra and supra sellar development strongly enhanced after injection of gadolinium. The tumor compressed the optic chiasma and the right optic nerve in its intracranial portion, invading the cavernous cavity bilaterally (KNOSP 3), measuring 44X36X37 mm suggesting an invasive macroadenoma; however the endocrine assessment did not show any abnormalities. She underwent an emergency transphenoidal surgery. Immunophenotypic analysis of tissues showed that all tumor cells were positive for CD1389 and confirmed the diagnosis of plasmacytoma. The hematological examination revealed a medullar plasmacytosis of 32% without blood desemination in favor of a multiple myeloma. She underwent radiation therapy centered on the sella turcica, followed by chemotherapy. There was a slight regression of the osteolytic tumor process, which currently measures 38.5 X 32.6 X 27.5 mm.

Conclusion: Plasmacytomas of the skull base revealing multiple myeloma represent a rare entity. However, solitary or multiple, plasmacytoma should be considered in the differential diagnosis of any invasive lesion of the sphenoidal sinus. The clinical presentation is aspecific, histological certainty must be obtained.