Differential Diagnosis and Treatment Modality of Parasellar Plasmacytoma: Clinical Series and Literature Review

BACKGROUND: Parasellar plasmacytomas are rare tumors arising from the sellar region that should be considered in the differential diagnosis of lesions involving the sella and clivus. Before surgical pathologic examination, parasellar plasmacytomas have often been misdiagnosed as invasive pituitary adenomas or chordomas owing to the similarity of the clinical presentation and imaging findings. METHODS: We retrospectively reviewed the data from 5 patients with parasellar plasmacytoma who underwent endonasal endoscopic tumor resection in Beijing Tiantan Hospital from January 2008 to January 2018. Their clinical symptoms, radiological features, and treatment modalities and outcomes were summarized. RESULTS: We enrolled a total of 5 patients (3 men and 2 women; median age at diagnosis, 54 years; range, 47-61) with parasellar plasmacytoma in the present clinical series. The presenting symptoms mainly included diplopia, headache, and blurred vision. All the patients had undergone endonasal endoscopic surgery combined with adjuvant therapy. After postoperative radiotherapy, complete remission was achieved within a median follow-up period of 41 months (range, 15-120). CONCLUSIONS: The differential diagnosis of parasellar plasmacytoma with pituitary adenoma and chordoma should include a thorough endocrine workup, neurological examination, and radiological assessment. Our findings support radiotherapy as the main treatment of choice for parasellar plasmacytoma, given its typical feature of relatively high radiosensitivity. Tumor resection through the endonasal endoscopic approach combined with adjuvant radiotherapy could be the optimal initial treatment strategy in long-term control of the lesion and alleviation of neurological symptoms.