MENINGEAL INVOLVEMENT IN MULTIPLE-MYELOMA - REPORT OF A CASE WITH CYTOLOGIC AND IMMUNOCYTOCHEMICAL DIAGNOSIS

BACKGROUND: Multiple myeloma (MM) with meningeal involvement is a very rave phenomenon. Only 37 cases of plasma cell neoplasia (MM and plasm a cell leukemia) with meningeal involvement have been reported. CASE: A 60-year-old male with stage IIIA light lambda chain MM returned Mine months after the diagnosis with back pain, lower right extremity pare sthesias and gait disturbance. A lumbar puncture revealed atypical pla sma cells in the cerebrospinal fluid (CSF), and immunocytochemical stu dies showed a cytoplasmic monoclonal light lambda chain. A diagnosis o f myelomatous meningitis was made, and the patient received intratheca l chemotherapy and craniospinal irradiation. He died six months after the diagnosis of meningeal disease. CONCLUSION: The present case and a review of the literature show that clinical manifestations of meninge al myeloma are non-specific. MM with meningeal involvement is accompan ied frequently by circulating atypical plasma cells or plasma cell leu kemia. Atypical plasma cells in the CSF are an important finding for t he diagnosis of meningeal myeloma, and their neoplastic nature can be best identified by immunocytochemical analyses. Patients with meningea l myelomatosis can have a good response to treatment initially, but th eir prognosis is poor.