Abstract
BACKGROUND
Multiple myeloma (MM) is one of the most common bone cancers in older adults, occurring as a neoplasm that emerges from a clone of differentiated plasma cells, ultimately resulting in proliferation of a monoclonal immunoglobulin. The plasma cells accumulate in the bone marrow, often producing osseous lesions. Although rare, extramedullary proliferation of these plasma cells can occur. Extramedullary proliferation has been identified in 10-16% of MM patients, most often in the lymph nodes, spleen, liver, and kidney, but has been identified in every organ system.
RESULTS
We present a rare case of a 71 year-old female with MM, diagnosed in 2010 and treated with several chemotherapy agents and steroids, found to have metastasis to her pineal gland after initially presenting with altered mentation. Her course was complicated by obstructive hydrocephalus requiring ventriculostomy. Metastasis was confirmed with biopsy from the pineal gland. Metastasis to the pineal gland is rare and typically secondary to primary lung cancer, but other primary lesions including breast, kidney, cervical, esophageal, gastric, colon, and skin have been identified. Literature review has only yielded two case reports of MM metastasis to the pineal gland.
CONCLUSION
Though metastasis to the pineal gland is rare, and MM an unlikely primary source, patients known to have MM presenting with neurologic symptoms should be evaluated for extramedullary lesions in the brain.