Characteristics of orbital multiple myeloma: a case report and literature review

Plasmacytoma associated with canaliculitis

Plasmacytomas are plasma cell neoplasms that rarely involve ocular adnexal tissues as a primary lesion or secondary manifestation of plasma cell myeloma. Only one case of plasmacytoma involving the lacrimal drainage system, to our knowledge, is described in the literature. The clinical presentation of ocular adnexal primary plasmacytoma typically relates to its mass effect. In this clinicopathologic report, we describe an unusual presentation of primary plasmacytoma of the lacrimal canaliculus as infectious canaliculitis.

Recurrence of multiple myeloma with soft tissue plasmacytoma presenting as unilateral proptosis

PURPOSE

To describe a rare case of soft tissue plasmacytoma of the orbit presenting with proptosis.

RESULTS

A 57 year-old Malay lady presented with right eye proptosis of 3 weeks' duration. It was associated with pain, redness and progressive blurring of vision. The patient was diagnosed to have multiple myeloma a year previously when she was investigated for backache, and had been treated with eight cycles of Pamidronate chemotherapy. On examination visual acuity was 6/60 in the right eye with impaired optic nerve function. Severe proptosis with chemosis and complete ophthalmoplegia were found. The corneal and anterior chamber examinations were normal. Fundoscopy revealed a slightly hyperaemic disc with presence of choroidal folds infero-temporally. The left vision and eye examination findings were normal. Fine needle biopsy and MRI showed recurrence of multiple myeloma with soft tissue plasmacytoma of the extraconal region compressing the right optic nerve. She was managed with orbital radiotherapy, resulting in resolution of proptosis, but without improvement in vision.

CONCLUSION

Proptosis may be an indicator of recurrence of multiple myeloma in patients thought to be in remission.