title: Myelomatous meningitis evaluated by multiparameter flow cytometry : report of a case and review of the literature.
abstract: Central nervous system (CNS) involvement in multiple myeloma (MM) is uncommon. Among its possible presentations, leptomeningeal involvement of MM, also termed central nervous system myelomatosis (CNS-MM) is rare and is characterized by the presence of neoplastic plasma cells in the cerebrospinal fluid (CSF). So far, 187 cases of CNS-MM have been reported : the great majority of them were diagnosed by cytological assays and flow cytometry was used in only eight cases. We describe a case of CNS-MM in a 62-year-old woman, previously treated with chemotherapy (VTD) and autologous peripheral blood hematopoietic stem cell transplantation for stage IIIB IgG-λ MM. After achieving a very good partial response, the patient showed progression of disease, with an extramedullary localization. During administration of second-line therapy, the patient showed severe neurological symptoms. MRI resulted negative. Diagnosis of CNS-MM was made by multiparameter flow cytometry, which showed the presence of CD56(+) plasma cells in a CSF sample, in the absence of plasma cell leukemia. In this paper we also present a review of the eight previous cases of CNS-MM diagnosed by flow cytometry. We found that the application of flow cytometry in cases of MM with neurological symptoms allows a rapid diagnosis of CNS-MM and provides useful information about plasma cell phenotype (including CD56 expression). Some cases of CNS-MM are characterized by normal MRI. In addition, some evidences deriving from the review of literature suggest that CSF monitoring by flow cytometry in such cases might be used to evaluate the efficacy of drugs capable of crossing the blood-brain barrier.
authors.affiliation: Laboratory of Clinical Pathology, Versilia Hospital.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carulli
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lari
authors.forename: Gabriele
authors.initials: G
authors.lastname: Buda
authors.forename: Paola
authors.initials: P
authors.lastname: Lambelet
authors.forename: Eugenio M
authors.initials: EM
authors.lastname: Ciancia
authors.forename: Edoardo
authors.initials: E
authors.lastname: Benedetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Caracciolo
authors.forename: Maria Immacolata
authors.initials: MI
authors.lastname: Ferreri
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pesaresi
authors.forename: Martina
authors.initials: M
authors.lastname: Rousseau
authors.forename: Virginia
authors.initials: V
authors.lastname: Ottaviano
authors.forename: Antonio
authors.initials: A
authors.lastname: Azzarà
authors.forename: Mario
authors.initials: M
authors.lastname: Petrini
mesh_terms: D002555:Cerebrospinal Fluid / Q000166:cytology; D017809:Fatal Outcome; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000473:pathology*; D010950:Plasma Cells / Q000378:metabolism / Q000473:pathology