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(A) Radiographs showing multiple compression fractures and a moth-eaten appearance of multiple vertebral bodies (B) Sagittal short T1 inversion recovery (STIR) sequence in the spinal MRI showing a new T11 compression fracture and multiple prior compression fractures. Coronal (C) and axial (D) T1-weighted MRI with gadolinium enhancement showing a diffuse leptomeningeal tumor spreading with extensions into the bilateral L4 and L5 neural foramen and nodularity of the cauda equina.
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T11 compression fracture (Fig. 1A and B). The patient was scheduled for vertebroplasty to treat the new osteoporotic compression fracture, and reduced the patient's back pain significantly. Repeat spinal MRI showed a diffuse leptomeningeal tumor spreading with extensions into the bilateral L4-L5 neural foramen and the L4 body (Fig. 1C and D). The radiography images of our patient showed a moth-eaten appearance in multiple vertebral bodies (Fig. 1A).
(A) Axial brain CT images showing osteolytic lesions in the skull. Brain MRI of the patient at presentation (B) and four months later (C) showing progressive hydrocephalus and prominent skull bone lytic lesions.
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The hydrocephalus also progressed in comparison with the previous brain MRI performed 4 months ago (Fig. 2B and C).
(A) Histological examination of the myeloma showing aggregation of atypical plasma cells with mild cellular pleomorphism, abundant cytoplasm, and binucleation in some of the cells (Hematoxylin and eosin, 400X). Immunohistochemical analysis results of the plasma cells showing positive staining for CD138 (B) and kappa light chain (C), but negative staining for lambda light chain (D).
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Immunohistochemical staining showed the plasma cells to be positive for CD138 and kappa light chain, but negative for lambda light chain (Fig. 3).
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(A) Axial brain CT images showing osteolytic lesions in the skull. Brain MRI of the patient at presentation (B) and four months later (C) showing progressive hydrocephalus and prominent skull bone lytic lesions.
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The hydrocephalus also progressed in comparison with the previous brain MRI performed 4 months ago (Fig. 2B and C).