PMC5364899_01
Abdominal CT (A) Osteolytic lesion was detected in right pelvis. (B) Pelvic tumor became smaller and changed into osteosclerotic lesion.
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F1
Abdominal computed tomography (CT) showed a pelvic tumor (Fig. 1A), hepatomegaly, splenomegaly, para-aortic lymph node swelling and ascites. POEMS syndrome, she underwent radiation therapy (46 Gy delivered in 23 fractions) for pelvic plasmacytoma. Pelvic plasmacytoma gradually became smaller and changed into osteosclerotic lesion (Fig. 1B).
Pathological features of plasmacytoma (A) Diffuse proliferation of plasma cells (Hematoxylin and eosin 40x) (B) CD138 positivity (40x) (C) Lambda light-chain positivity (40x).
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F2
CT-guided biopsy of the tumor revealed plasmacytoma (Fig. 2).
(A) MR angiography revealed narrowing of the proximal portion of the bilateral middle cerebral artery and the terminal portion of the internal carotid artery. (B) Brain CT scan demonstrating left putaminal hemorrhage. (C-E) MR angiography and cerebral angiography revealed occlusion of the proximal portion of the bilateral middle cerebral artery and narrowing at the terminal portion of the bilateral internal carotid artery. Note Moyamoya vessels. (F) Cerebral angiography demonstrated collateral circulation via leptomeningeal anastomoses in the posterior circulation. (G) SPECT (
123
I-IMP) showed reduction of the CBF in the left frontoparietal cortex, left regional temporo-occipital cortex, and right cerebellum.
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F3
During this period, magnetic resonance (MR) angiography taken for headache revealed a narrowing of the proximal portion of the bilateral middle cerebral artery and the terminal portion of the internal carotid artery (Fig. 3A). A brain CT scan showed left intracranial hemorrhage (Fig. 3B). MR angiography and cerebral angiography revealed progression of vessel stenosis, development of leptomeningeal anastomosis and moyamoya vessels (Fig. 3C-F). Single photon emission tomography (SPECT) using N-isopropyl-4 iodoamphetamine (123I-IMP) obtained on the 13th hospital day showed reduction of the cerebral blood flow (CBF) in the left frontoparietal cortex, left regional temporo-occipital cortex, and right cerebellum (Fig. 3G).