Intracranial neoplasms and plasma cell malignancies often present with nonspecific symptoms, leading to delayed diagnosis and unexpected clinical outcomes. This presentation explores two distinct cases—one involving an incidental meningioma discovered during autopsy in a patient with chronic headaches, and another of extramedullary multiple myeloma (EMM) with central nervous system (CNS) involvement, manifesting as a sudden pathological fracture followed by fatal progression.

The first case involves a 25-year-old female who presented with prolonged fever due to Plasmodium vivax malaria and later succumbed to septicemia and pulmonary edema. Autopsy revealed a previously undiagnosed right temporal meningioma, raising concerns about the overlooked role of intracranial tumors in chronic headaches. The absence of neuroimaging in symptomatic individuals underscores the need for proactive neurological assessments in patients with persistent headaches.

The second case details a 35-year-old male with HIV, presenting with progressive neurological deficits and pathological fractures. Imaging detected multiple osteolytic cranial lesions, suggestive of neoplastic infiltration. Despite aggressive supportive care, the patient deteriorated rapidly. Autopsy findings confirmed CNS EMM, characterized by extensive lytic skull lesions and dura-adherent soft tissue masses causing significant brain compression. The case emphasizes the diagnostic challenges and critical need for early detection strategies in multiple myeloma patients at risk for extramedullary progression.

Both cases highlight the practical implications of incidental neoplasms and hematological malignancies, emphasizing the role of autopsy in uncovering silent pathologies and guiding clinical decision-making. This analysis advocates for enhanced screening protocols for headache-associated tumors and early orthopedic and neurological interventions in plasma cell malignancies to improve patient outcomes.

Dr. Jayeshkumar Kanani has over 14 years of experience including 8 years of experience in the field of forensic medicine and Toxicology. Appointed in 2016 as an autopsy medical officer, he has conducted over 4,000 autopsies, providing invaluable medico-legal expertise in death investigations. His expertise extends to histopathological studies, scientific writing, court testimonies, and mentoring students in forensic medicine.

Dr. Kanani has published eight peer-reviewed papers in international journals such as Elsevier, BMC, and SpringerNature, with seven as the first author. He has demonstrated exceptional skill in managing the publication process, and successfully publishing articles with tight deadlines.

His research interests include general medicine, forensic medicine, Toxicology, Surgery, Cardiology, Pathology, Oncology, and Neurology. He is passionate about contributing to the academic and professional community and welcomes opportunities to collaborate on research and editorial endeavours.