title: Solitary clival plasmocytomas: Misleading clinical and radiological features of a rare pathology with a specific biological behaviour.
abstract: BACKGROUND
  Tumours of the clivus are exceptionally rare, representing a diagnostic and a therapeutic challenge. Clival solitary plasmocytomas have been described only as single case reports or included in small clinical series with other intracranial location.
  
  
  METHODS
  Authors report clinical, radiological, and survival data of four patients, who underwent surgery for clival plasmocytomas between 1989 and 2012 in a single centre. Current knowledge about solitary plasmocytomas of the clivus are reviewed.
  
  
  RESULTS
  Follow-up time was 54 months (range: 9-165). Mean age of patient was 57 years, no gender predilection was observed. Main symptoms were headache (75 %) and double vision (75 %), due to third or sixth cranial nerve palsy. Mean time to diagnosis was 8.2 months. All patients underwent surgery as primary treatment, through either a transsphenoidal (75 %) or a transmaxillary approach (25 %). In all cases adjuvant conventional radiotherapy was performed with a median delivered dose of 45 Gy. Only one case of progression into multiple myeloma was observed 13 months after surgery, and the patient died 9 months later. No other recurrences or progression were observed. Mean overall survival and progression free survival time were, respectively, 54 and 51.7 months.
  
  
  CONCLUSIONS
  Although extremely rare, clival plasmocytomas have to be considered in the differential diagnosis of a solitary clival lesion. Biological and clinical features of these tumours strongly differ from those of similar lesions in other part of the body. Early diagnosis, extensive tumour removal, opportune indication of adjuvant treatment with radiotherapy and chemotherapy are the keys to manage these cases.
authors: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy, gagliardi.filippo@hsr.it.
authors: Filippo
authors: F
authors: Gagliardi
authors: Marco
authors: M
authors: Losa
authors: Nicola
authors: N
authors: Boari
authors: Alfio
authors: A
authors: Spina
authors: Michele
authors: M
authors: Reni
authors: Maria Rosa
authors: MR
authors: Terreni
authors: Pietro
authors: P
authors: Mortini
mesh_terms: D000328:Adult; D000368:Aged; D002817:Chordoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy; D010954:Plasmacytoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome