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Agarwal M, Vijayaraghavan M, Muthuvel B, Narayanasamy A. Biochemical Analysis of Aqueous Humor in an Elderly Patient with Multiple Myeloma Presenting First as Bilateral Chronic Uveitis. Ocul Immunol Inflamm 2024; 32:1479-1483. [PMID: 37429027 DOI: 10.1080/09273948.2023.2229416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To study the biochemical analysis of aqueous humor in a patient with multiple myeloma presenting first as chronic uveitis. METHODS Observational case report. RESULTS A 63-year-old healthy woman presented with blurred vision in both eyes for 9 months. Slit-lamp examination showed bilateral conjunctival congestion, corneal oedema, and anterior uveitis. Fundus exam revealed normal optic disc with fine retinal folds in the macula. Serum protein electrophoretogram showed a monoclonal M protein band in the gamma globulin region. The bone marrow biopsy revealed hypercellular marrow with trilineage haematopoiesis and the bone marrow aspirate showed clonal plasma cells >10%, confirming the diagnosis of multiple myeloma. Aqueous fluid showed a differential band in electrophoretic profile of aqueous humor protein that on mass spectrometry analysis was strongly suggestive of immunoglobulin band. CONCLUSION The biochemical analysis of aqueous humor is another diagnostic test to monitor M protein in patients with multiple myeloma.
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Affiliation(s)
- Mamta Agarwal
- Uveitis & Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Bharathselvi Muthuvel
- RS Mehta Jain Department of Biochemistry, Vision Research Foundation, Chennai, India
| | - Angayarkanni Narayanasamy
- Biochemisty Department, Sri Nathella Sampathu Chetty Clinical Laboratory, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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2
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Bergman Z, Mohammed T, Schocket L, Aouchiche R, Johnson MA. Autoimmune retinopathy in a patient with smoldering multiple myeloma: a case report. Doc Ophthalmol 2024; 148:167-171. [PMID: 38363513 DOI: 10.1007/s10633-024-09965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Multiple myeloma (MM) is a plasma cell dyscrasia leading to proliferation of monoclonal plasma cells. Ocular involvement in multiple myeloma is uncommon but can occur. The ocular manifestations of MM may include the cornea, uvea, and retinal vasculature. We present a rare case of autoimmune retinopathy associated with smoldering MM. CASE A 76-year-old female with no significant past medical or ocular history presented with four months of worsening vision, difficulty with night driving, and loss of peripheral vision. Examination was notable for pallor of the optic nerves and vascular attenuation. Visual field testing demonstrated significant and progressive field loss in both eyes. An electroretinogram was extinguished under all conditions. Serum protein electrophoresis showed a significant elevation of IgG with an M-spike, and a subsequent bone marrow biopsy was performed showing 12.5% plasma cells, consistent with the diagnosis of MM. CAR antibody testing was positive for anti-enolase, anti-GAPDH, and anti-Rab6 antibodies, consistent with autoimmune retinopathy. DISCUSSION Autoimmune retinopathy associated with MM is exceedingly rare. Management of this condition is challenging, as treatment of the underlying disease does not often lead to improvement in visual symptoms. Ultimately, visual prognosis is very poor, and both patients and clinicians should be aware of the guarded visual potential. CONCLUSION The association of autoimmune retinopathy with multiple myeloma is rare. It is crucial for physicians to be aware of such manifestations to ensure timely and appropriate diagnosis and management for patients.
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Affiliation(s)
- Zachary Bergman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Taariq Mohammed
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA.
| | - Lisa Schocket
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Rachid Aouchiche
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Mary A Johnson
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
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3
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O’Donovan C, Wu AD, Lim WS. Rare presentation of orbital metastasis in multiple myeloma. Saudi J Ophthalmol 2024; 38:185-187. [PMID: 38988781 PMCID: PMC11232743 DOI: 10.4103/sjopt.sjopt_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 07/12/2024] Open
Abstract
Orbital manifestations are rarely observed in multiple myeloma (MM) and when they occur, they are often the first manifestation. We report a rare occurrence of vision loss in a 51-year-old female from orbital metastases in MM without proptosis or diplopia. The ophthalmic presentation of MM is usually progressive proptosis, pain, diplopia, and visual loss. The presence of metastasis in MM indicates poor prognosis and orbital metastases have worse survival rates. In conclusion, in cases of profound vision loss with no obvious cause, neuroimaging should be performed to evaluate the orbital extent of the disease and exclude intracranial pathology.
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Affiliation(s)
- Charles O’Donovan
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Angela D. Wu
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Wei S. Lim
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
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4
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Singh RB, Singhal S, Sinha S, Cho J, Nguyen AXL, Dhingra LS, Kaur S, Sharma V, Agarwal A. Ocular complications of plasma cell dyscrasias. Eur J Ophthalmol 2023; 33:1786-1800. [PMID: 36760117 PMCID: PMC10472748 DOI: 10.1177/11206721231155974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
Plasma cell dyscrasias are a wide range of severe monoclonal gammopathies caused by pre-malignant or malignant plasma cells that over-secrete an abnormal monoclonal antibody. These disorders are associated with various systemic findings, including ophthalmological disorders. A search of PubMed, EMBASE, Scopus and Cochrane databases was performed in March 2021 to examine evidence pertaining to ocular complications in patients diagnosed with plasma cell dyscrasias. This review outlines the ocular complications associated with smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, plasmacytomas, multiple myeloma, Waldenström's macroglobulinemia, systemic amyloidosis, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes (POEMS) syndrome, and cryoglobulinemia. Although, the pathological mechanisms are not completely elucidated yet, wide-ranging ocular presentations have been identified over the years, evolving both the anterior and posterior segments of the eye. Moreover, the presenting symptoms also help in early diagnosis in asymptomatic patients. Therefore, it is imperative for the treating ophthalmologist and oncologist to maintain a high clinical suspicion for identifying the ophthalmological signs and diagnosing the underlying disease, preventing its progression through efficacious treatment strategies.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Great Ormond Street Institute of Child Health, University College London, London, UK
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, PA, USA
| | - Shruti Sinha
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Junsang Cho
- Department of Ophthalmology, Vanderbilt Eye Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Snimarjot Kaur
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Vasudha Sharma
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, University of Maastricht, Maastricht, the Netherlands
- Department of Ophthalmology, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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5
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Rawicka A, Crasta M, Guandalini A, Peruccio C, Multari D, Rondena M, D’Anna N, Giudice C. Conjunctival Extramedullary Plasmacytoma in Dogs and a Cat: Clinical Characteristics and Histopathological Findings. Animals (Basel) 2022; 12:ani12213015. [PMID: 36359139 PMCID: PMC9653729 DOI: 10.3390/ani12213015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Extramedullary plasmacytoma has been occasionally reported to affect the ocular and periocular (orbit, conjunctiva) region. To better describe the clinical and histopathological features of extramedullary plasmacytoma, we reviewed the records of seven cases (six dogs, one cat). In these cases, extramedullary plasmacytoma was found mostly in the conjunctiva of the third eyelid in the form of salmon-colored nodules with clear borders. All tumors were surgically removed with no additional therapy. No signs of recurrence or systemic involvement (multiple myeloma) were observed in the follow up period. We recommend that extramedullary plasmacytoma should be considered in cases of canine and feline conjunctival masses, followed by investigations to rule out multiple myeloma. Our results suggest that conjunctival extramedullary plasmacytoma is unlikely to recur or spread, and that local surgical excision alone or combined with cryotherapy should be curative. Abstract Background: Extramedullary plasmacytoma (EMP) is a plasma cell tumor that is very rarely reported in ocular and adnexal tissue and is usually solitary and benign. Methods: This study evaluated seven cases from different ophthalmology referrals submitted for histopathological analysis between 2013 and 2022. Results: EMPs were diagnosed in a 9-year-old domestic short-haired cat and in six dogs (median age, 10 years): three English Cocker Spaniels, a Golden Retriever, a Maltese, and a Pinscher. EMPs affected the third eyelid conjunctiva in five cases (5/7), followed by the superior bulbar (1/7) and palpebral conjunctivae (1/7), respectively, and were presented mostly as well-defined, salmon-colored nodules. Histopathologically, the masses were composed of sheets and packets of round cells morphologically consistent with mature plasma cells with mild anisocytosis and anisokaryosis; mitosis and binucleated giant cells were rarely observed. Follow up for 6/7 cases ranged from 6 months to 2 years. No signs of recurrence or systemic involvement (multiple myeloma) were observed. Conclusions: EMP should be included in the differential diagnoses of canine and feline conjunctival masses. Staging recommendations should include multiple myeloma diagnostic evaluation. Our results suggest that primary conjunctival EMP does not appear to be locally aggressive and has low systemic involvement behavior. The local surgical excision alone or combined with cryotherapy should be curative.
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Affiliation(s)
- Aleksandra Rawicka
- Clinica Veterinaria Roma Sud, Via Pilade Mazza 24, 00173 Rome, Italy
- Correspondence: ; Tel.: +39-347-454-15-04
| | - Manuela Crasta
- Anicura VisionVet Eye Clinic, Via Antonio Marzocchi 6, San Giovanni in Persiceto, 40017 Bologna, Italy
| | - Adolfo Guandalini
- Department of Ophthalmology, Centro Veterinario Specialistico, Via Sandro Giovannini 53, 00137 Rome, Italy
| | - Claudio Peruccio
- Veterinary Ophthalmology Referrals Centro Veterinario Torinese, Lungo Dora Colletta 147, 10153 Torino, Italy
| | - Domenico Multari
- Centro Veterinario Oculistico Fontane, Via Donatori del Sangue 1, 31020 Villorba, Italy
| | - Marco Rondena
- Clinica Veterinaria Privata San Marco Srl, Via dell’Industria, 3, 35030 Veggiano, Italy
| | - Nunzio D’Anna
- Clinica Veterinaria Roma Sud, Via Pilade Mazza 24, 00173 Rome, Italy
| | - Chiara Giudice
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26009 Lodi, Italy
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McGrath R, Whitlow S, McCabe GA, McElnea EM. An nusual ocular manifestation of multiple myeloma. BMJ Case Rep 2022; 15:e247863. [PMID: 35868805 PMCID: PMC9315917 DOI: 10.1136/bcr-2021-247863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s with a history of multiple myeloma presented with a 4-day history of right ptosis and a rapidly enlarging upper eyelid mass. On examination, a large, firm, smooth, pink lesion was found to descend from the conjunctiva of the superior fornix. The patient underwent excision biopsy. Histopathological analysis demonstrated monoclonal plasma cells expressing light-chain kappa, consistent with extramedullary plasmacytoma. Clinical ophthalmic manifestations of multiple myeloma are rare but also diverse. Ocular surface manifestations of multiple myeloma are extremely uncommon. Variable examination findings mean those involving the conjunctiva and may be particularly challenging to diagnose. Secondary ocular extramedullary plasmacytoma, despite its rarity, should be considered in patients with multiple myeloma.
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Affiliation(s)
- Robert McGrath
- Ophthalmology Department, University Hospital Galway, Galway, Ireland
| | - Shane Whitlow
- Ophthalmology Department, University Hospital Galway, Galway, Ireland
| | - Grace Anne McCabe
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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7
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Invasive Orbital Squamous Cell Carcinoma in a Patient with Multiple Myeloma. Case Rep Ophthalmol Med 2022; 2022:8585692. [PMID: 35815062 PMCID: PMC9259366 DOI: 10.1155/2022/8585692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/03/2022] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Orbital squamous cell carcinoma (SCC) is a rare entity. It is often a result of local invasion of SCC originating from the skin, nasopharynx, nasal cavity, paranasal sinuses, conjunctiva, lacrimal glands, or sac or less commonly occurs through hematogenous metastasis. Herein, we report a patient with orbital SCC with a history of multiple myeloma (MM). Case presentation. A 45-year-old woman with a history of MM in the past two years presented to our clinic complaining of gradual right eye proptosis for six months. The relative afferent pupillary defect was detected in the right eye on her examination. Ocular movements of the right eye were limited in all directions. Orbital magnetic resonance imaging demonstrated an infiltrative mass in the right orbit extended from the anterior to the orbital apex and the optic canal. The patient underwent debulking, and a histopathology examination revealed SCC results. No other secondary site was found to be the origin of the tumor. Result The patient underwent chemotherapy and subsequent radiotherapy. To our knowledge, this is the first report of concomitant MM and primary orbital SCC.
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8
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Silverman RF, Hanson L, Salahi N, Li Z, Boruk M, Hodgson NM. Case Report: Cavernous Sinus Syndrome as the Initial Presentation of Multiple Myeloma. FRONTIERS IN OPHTHALMOLOGY 2022; 2:849343. [PMID: 38983538 PMCID: PMC11182293 DOI: 10.3389/fopht.2022.849343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 07/11/2024]
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy and most common primary bone malignancy. Ocular manifestations of MM are extremely rare and may be the first presentation leading to diagnosis. Ophthalmologists routinely encounter cavernous sinus syndrome, and there is a wide range of possible etiologies. Here, we present a case of a patient presenting with diplopia, ptosis, and ophthalmoplegia found to have a cavernous sinus plasmacytoma with systemic workup consistent with MM. MM is a rare cause of cavernous sinus syndrome and should be considered in the setting of a skull base mass.
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Affiliation(s)
| | - Lawrence Hanson
- Department of Ophthalmology, SUNY Downstate, Brooklyn, NY, United States
| | - Navid Salahi
- Department of Pathology, SUNY Downstate, Brooklyn, NY, United States
| | - Zhonghua Li
- Department of Pathology, SUNY Downstate, Brooklyn, NY, United States
| | - Marina Boruk
- Department of Otolaryngology, SUNY Downstate, Brooklyn, NY, United States
| | - Nickisa M Hodgson
- Department of Ophthalmology, SUNY Downstate, Brooklyn, NY, United States
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9
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Dursun ME, Erdem S, Karahan M, Ava S, Hazar L, Dursun B, Karakas A, Demircan V, Keklikci U. Retinal Microvascular Changes in Patients with Multiple Myeloma: A Study Based on Optical Coherence Tomography Angiography. Curr Eye Res 2022; 47:874-881. [PMID: 35179416 DOI: 10.1080/02713683.2022.2034886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Ocular microvascular networks and variables were analyzed using optical coherence tomography angiography (OCTA) in patients with multiple myeloma (MM) who had no pathological findings in their routine ophthalmologic examinations. MATERIALS AND METHODS The study included 31 patients with a diagnosis of MM and 30 healthy controls. The ophthalmologic examination findings and OCTA measurements of the participants were prospectively analyzed. We evaluated the superficial capillary plexus (SCP) vessel density (VD) and deep capillary plexus (DCP) VD in macular region, radial peripapillary capillary (RPC) VD, optic nerve head (ONH) VD and the foveal avascular zone (FAZ) area. RESULTS The samples were gender-balanced, and there were no significant differences in age or gender between the MM and control groups. From the OCTA, all the ONH-VD measurements, except for the peripapillary and superotemporal parameters, were found to be significantly lower in MM patients than in the control group; the same was found for the whole image, inferonasal, superonasal, and superotemporal RPC-VD values; for all the SCP-VD values, except for the inferior hemi and temporal; and for all the DCP-VD values. It was also observed that the deep FAZ area was wider in the MM group than in the control group. CONCLUSIONS We detected decreased VD in deep and superficial macular retinal areas, papillary, peripapillary regions, suggesting decreased blood flow and possible ischemia in MM patients. Therefore, obtaining information on ischemia by using a noninvasive and easily measurable method such as OCTA, may be beneficial in terms of follow-up and treatment but this needs to be supported by further, larger studies.
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Affiliation(s)
- Mehmet Emin Dursun
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Seyfettin Erdem
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Mine Karahan
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Sedat Ava
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | | | - Birgül Dursun
- Department Ophthalmology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Abdullah Karakas
- Department of Hematology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Vehbi Demircan
- Department of Hematology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Ugur Keklikci
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
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Xie JS, Donaldson L, Margolin E. Papilledema: A review of etiology, pathophysiology, diagnosis, and management. Surv Ophthalmol 2021; 67:1135-1159. [PMID: 34813854 DOI: 10.1016/j.survophthal.2021.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is usually normal in the acute phase. Papilledema is caused by transmission of elevated ICP to the subarachnoid space surrounding the optic nerve that hinders axoplasmic transport within ganglion cell axons. There is ongoing controversy as to whether axoplasmic flow stasis is produced by physical compression of axons or microvascular ischemia. The most common cause of papilledema, especially in patients under the age of 50, is idiopathic intracranial hypertension (IIH); however, conditions that decrease cerebrospinal fluid (CSF) outflow by either causing CSF derangements or mechanically blocking CSF outflow channels, and rarely conditions that increase CSF production, can be the culprit. When papilledema is suspected clinically, blood pressure should be measured, and pseudopapilledema should be ruled out. Magnetic resonance imaging of the brain and orbits with venography sequences is the preferred neuroimaging modality that should be performed next to look for indirect imaging signs of increased ICP and to rule out nonidiopathic causes. Lumbar puncture with measurement of opening pressure and evaluation of CSF composition should then be performed. In patients not in a typical demographic group for IIH, further investigations should be conducted to assess for underlying causes of increased ICP. Magnetic resonance imaging of the neck and spine, magnetic resonance angiography of the brain, computed tomography of the chest, complete blood count, and creatinine testing should be able to identify most secondary causes of intracranial hypertension. Treatment for patients with papilledema should be targeted toward the underlying etiology. Most patients with IIH respond to weight loss and oral acetazolamide. For patients with decreased central acuity and constricted visual fields at presentation, as well as patients who do not respond to treatment with acetazolamide, surgical treatments should be considered, with ventriculoperitoneal shunting being the typical procedure of choice.
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Affiliation(s)
- Jim Shenchu Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Donaldson
- Faculty of Medicine, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Faculty of Medicine, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
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12
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Mahallati H, Roberts JK, Assal A, Bhutani D, Park DC, Moazami G. Asymmetric optic disc edema in a young patient with POEMS: A rare presentation of a rare disease. Am J Ophthalmol Case Rep 2021; 22:101064. [PMID: 33786404 PMCID: PMC7994727 DOI: 10.1016/j.ajoc.2021.101064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/11/2020] [Accepted: 02/21/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To describe a case of asymmetric optic disc edema presenting as the initial ocular feature of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes) syndrome. Observations A 29-year-old female patient presented with 3 weeks history of blurred vision, proptosis, and peripheral neuropathy as well as hypothyroidism. Fundoscopy revealed optic disc edema associated with visual loss in the left eye. Following a computed tomography (CT) scan and a positron emission tomography/CT (PET/CT) scan which respectively revealed hepatomegaly and multiple osteosclerotic lesions, as well as laboratory findings of monoclonal gammopathy and elevated vascular endothelial growth factor (VEGF) levels, she was diagnosed with POEMS syndrome. After treatment with an autologous stem cell transplant, the optic disc edema and blurred vision resolved. Conclusions and importance The most reported ocular manifestation of POEMS syndrome, a rare and complex multisystem disorder, is bilateral optic disc edema that typically occurs in older males. Therefore, this report presents an uncommon case of asymmetric optic disc edema in a younger, female patient.
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Affiliation(s)
- Hana Mahallati
- Barnard College of Columbia University, 3009 Broadway, New York, NY, USA
| | - James Kirkland Roberts
- Neurological Institute of New York, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, USA
| | - Amer Assal
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, USA
| | - Divaya Bhutani
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, USA
| | - David C Park
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, USA
| | - Golnaz Moazami
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165th Street, New York, NY, USA
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13
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Handa S, Gupta V, Agarwal A. Drusen-like deposits in a patient with multiple myeloma. J Postgrad Med 2021; 67:51-52. [PMID: 33463552 PMCID: PMC8098883 DOI: 10.4103/jpgm.jpgm_461_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Handa
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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14
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Sandor KP, Micieli JA, Peragallo JH. Optic nerve head plasmacytoma as a manifestation of multiple myeloma. Taiwan J Ophthalmol 2021; 11:97-100. [PMID: 33767963 PMCID: PMC7971446 DOI: 10.4103/tjo.tjo_81_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Extramedullary disease in multiple myeloma is uncommon and associated with a poorer prognosis. Extramedullary disease involving the orbit is even more unusual, with optic nerve involvement being rare. We describe an optic nerve head plasmacytoma in a 45-year-old female in the setting of systemic relapsed, refractory IgA kappa multiple myeloma. The case highlights the importance of keeping extramedullary disease spread in the differential for vision loss in a patient with a history of multiple myeloma. In addition, it describes an unusual location for presentation of extramedullary disease, the optic nerve head, which has rarely been described.
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Affiliation(s)
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University, Atlanta, GA, USA.,Department of Pediatrics, Emory University, Atlanta, GA, USA
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15
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Bilateral Secondary Angle Closure During Daratumumab Infusion: A Case Report and Review of the Literature. J Glaucoma 2020; 29:e83-e86. [PMID: 32487951 DOI: 10.1097/ijg.0000000000001562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Daratumumab is an anti-CD38 monoclonal antibody approved for use in multiple myeloma in 2015 and under investigation for use in light-chain amyloidosis. We report a case of a patient with amyloidosis who developed bilateral, acute secondary angle closure during an infusion of daratumumab. Ultrasound biomicroscopy obtained 3 days after the onset of her symptoms demonstrated the cause to be bilateral choroidal effusions. Taken together with several previous case reports, the evidence suggests that, like topiramate, daratumumab is associated with the idiosyncratic reaction of choroidal effusions, resulting in a spectrum of clinical outcomes from myopic shift to acute angle closure. The treating oncologist and eye care provider should be aware of these adverse outcomes in any patient undergoing treatment with this medication, as swift recognition and intervention may be vision-saving.
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Barmas-Alamdari D, Sodhi GS, Shenouda TA. Bilateral Proptosis in a Case of Recurring Multiple Myeloma: Uncommon Orbital Presentation of Plasmacytoma. Int Med Case Rep J 2020; 13:297-301. [PMID: 32884366 PMCID: PMC7434372 DOI: 10.2147/imcrj.s260472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma is a malignant plasma cell dyscrasia that may invade the orbits in extramedullary presentations. Common manifestations of orbital involvement include unilateral proptosis, injection, chemosis, diplopia, and occasionally pain. Additionally, the soft-tissue tumors associated with multiple myeloma typically cause bony destruction of adjacent structures. However, in certain patients, bilateral proptosis and a lack of bony destruction may occur. In these instances, it is important for physicians to consider patient history, presentation, and progression in order to ensure that a potentially fatal diagnosis is not missed. The reason this case is important is two-fold: 1) we describe a case of an individual with relapsing multiple myeloma presenting as bilateral proptosis and lacking bony destruction, highlighting the importance of understanding the disease process and 2) we discuss why patients with multiple myeloma may be more prone to developing tumors of the orbit in recurrent cases.
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Affiliation(s)
| | - Guneet S Sodhi
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Teresa A Shenouda
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
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17
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Scherk A, Khattar A. Periocular amyloid papules as a presenting sign in multiple myeloma. Clin Exp Optom 2020; 103:546-547. [DOI: 10.1111/cxo.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alexandra Scherk
- Ophthalmology Department, BronxCare Health System, Bronx, New York, USA,
| | - Alanna Khattar
- Ophthalmology Department, BronxCare Health System, Bronx, New York, USA,
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18
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Tahiliani N, Kataria P, Patel A, Kendre P. Proptosis and hemiplegia as an initial manifestation of multiple myeloma. J Postgrad Med 2019; 64:243-246. [PMID: 30117481 PMCID: PMC6198690 DOI: 10.4103/jpgm.jpgm_623_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multiple myeloma (MM) is a monoclonal gammopathy, also known as the malignant proliferation of plasma cells, presenting with typical complications such as hypercalcemia, osteolytic bone lesions, anemia, renal insufficiency, and frequent infections. Central nervous system (CNS) involvement in MM in the form of parenchymal involvement is very uncommon and has been reported only in 1% of patients. CNS involvement as an initial presentation is very rare and has poor prognosis. Also specific treatment guidelines do not exist for the treatment of such patients. We present here a case of a 40-year-old female patient, with complaints of headache and left eye proptosis followed by left-sided hemiparesis, who after complete workup was diagnosed as a de novo case of stage III extramedullary MM with CNS involvement. Patient was treated with whole brain radiation followed by BCD regimen (injection of bortezomib, injection of cyclophosphamide, and tablet dexamethasone). After three cycles of chemotherapy, patient succumbed in view of consolidation and renal failure.
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Affiliation(s)
- N Tahiliani
- Department of Medical Oncology, GCRI, Ahmedabad, Gujarat, India
| | - P Kataria
- Department of Medical Oncology, GCRI, Ahmedabad, Gujarat, India
| | - A Patel
- Department of Medical Oncology, GCRI, Ahmedabad, Gujarat, India
| | - P Kendre
- Department of Medical Oncology, GCRI, Ahmedabad, Gujarat, India
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Ben Artsi E, Barkley MR, Khong JJ, Mckelvie PA, McNab AA, Hardy TG. Multiple myeloma manifesting as an ocular salmon patch - a case report. Orbit 2019; 39:379-382. [PMID: 31722590 DOI: 10.1080/01676830.2019.1691608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Multiple myeloma (MM) is the second most prevalent hematologic malignancy after non-Hodgkin lymphoma and is currently considered incurable. Clinical ophthalmic manifestations of MM are rare but at the same time diverse. Ocular surface manifestations of multiple myeloma are uncommon. Conjunctival 'salmon patch' is a typical ocular surface ophthalmological sign with a distinct set of differential diagnoses, including most often ocular adnexal lymphoma. This case report presents a 33-year-old female with a relapse of MM manifesting as a conjunctival 'salmon patch'. The patient initially responded well to medical management including high dose melphalan supported by a third autologous stem cell transplantation (ASCT) and did not require further surgical excision of the ocular lesion. It is suggested that MM should be included in the differential diagnosis of 'salmon patch' conjunctival lesions.
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Affiliation(s)
- Elad Ben Artsi
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Michael R Barkley
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Jwu J Khong
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Penny A Mckelvie
- Department of Anatomical Pathology, St. Vincent's Hospital , Melbourne, Australia
| | - Alan A McNab
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Thomas G Hardy
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia.,Department of Surgery, University of Melbourne , Melbourne, Australia
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20
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Cassol CA, Williams MP, Caza TN, Rodriguez S. Renal and pulmonary thrombotic microangiopathy triggered by proteasome-inhibitor therapy in patient with smoldering myeloma: A renal biopsy and autopsy case report. Medicine (Baltimore) 2019; 98:e17148. [PMID: 31574818 PMCID: PMC6775360 DOI: 10.1097/md.0000000000017148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Thrombotic microangiopathy (TMA) is a group of clinical syndromes characterized by excessive platelet activation and endothelial injury that leads to acute or chronic microvascular obliteration by intimal mucoid and fibrous thickening, with or without associated thrombi. It frequently involves the kidney but may involve any organ or system at variable frequencies depending on the underlying etiology. Among its numerous causes, drug toxicities and complement regulation abnormalities stand out as some of the most common. A more recently described association is with monoclonal gammopathy. Lung involvement by TMA is infrequent, but has been described in Cobalamin C deficiency and post stem-cell transplantation TMA. PATIENT CONCERNS This is the case of a patient with smoldering myeloma who received proteasome-inhibitor therapy due to retinopathy and developed acute renal failure within one week of therapy initiation. DIAGNOSES A renal biopsy showed thrombotic microangiopathy. At the time, mild pulmonary hypertension was also noted and presumed to be idiopathic. INTERVENTIONS Given the known association of proteasome-inhibitor therapy with thrombotic microangiopathy, Bortezomib was discontinued and dialysis was initiated. OUTCOMES Drug withdrawal failed to prevent disease progression and development of end-stage renal disease, as well as severe pulmonary hypertension that eventually lead to the patient's death. LESSONS To our knowledge, this is the first reported case of pulmonary involvement by TMA associated with monoclonal gammopathy which appears to have been triggered by proteasome-inhibitor therapy. Clinicians should be aware of this possibility to allow for more prompt recognition of pulmonary hypertension as a potential manifestation of monoclonal gammopathy-associated TMA, especially in patients also receiving proteasome-inhibitors, so that treatment aiming to slow disease progression can be instituted.
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Affiliation(s)
| | | | | | - Sophia Rodriguez
- Queens Office of the Chief Medical Examiner of the City of New York, New York
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21
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Wang SSY, Lee MB, George A, Wang SB, Blackwell J, Moran S, Francis IC. Five cases of orbital extramedullary plasmacytoma: diagnosis and management of an aggressive malignancy. Orbit 2018; 38:218-225. [PMID: 29985709 DOI: 10.1080/01676830.2018.1490437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: Multiple myeloma is an insidious haematological malignancy characterised by monoclonal proliferation of plasma cells in the bone marrow. Extramedullary plasmacytoma is a rare manifestation of multiple myeloma and usually occurs in the upper respiratory tract. Orbital involvement is particularly uncommon, but may be associated with devastating visual impairment and poor clinical outcomes. Therefore, this article aims to highlight the need for multidisciplinary management of orbital extramedullary plasmacytoma. Methods: This is a retrospective observational case series of five patients. All presented to the authors for management of orbital extramedullary plasmacytomas from 2004 to 2015 at Prince of Wales and Mater Hospitals in Sydney, Australia. Medical records were reviewed for pertinent information including demographics, disease features, management strategy, and clinical progress. The study met Medical Ethics Board standards and is in accordance with the Helsinki Agreements. Results: This case series of five patients underscores the poor prognosis of orbital extramedullary plasmacytoma. Despite aggressive multidisciplinary management, four of these five patients succumbed to their illness during the study period. However, multidisciplinary management did manage to minimise symptoms and preserve quality of life. Conclusions: On a case-by-case basis, patients may derive palliative benefit from orbital surgery in conjunction with radiotherapy and chemotherapy. Orbital surgeons are encouraged to work within a multidisciplinary framework of medical specialists, including haematologists and radiation oncologists, when determining the optimal management plan in cases of orbital extramedullary plasmacytoma.
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Affiliation(s)
- Samuel S Y Wang
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Mitchell B Lee
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | - Adarsh George
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Sarah B Wang
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | | | - Steve Moran
- c Department of Haematology , Mater Hospital , Sydney , Australia
| | - Ian C Francis
- a Faculty of Medicine , University of New South Wales , Sydney, Australia.,d Department of Ophthalmology , Prince of Wales Hospital , Sydney , Australia
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22
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Daicker BC, Mihatsch MJ, Strøm EH, Fogazzi GB. Ocular Pathology in Light Chain Deposition Disease. Eur J Ophthalmol 2018; 5:75-81. [PMID: 7549446 DOI: 10.1177/112067219500500202] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Light-chain deposition disease (LCDD), a rare form of monoclonal gammopathy, is characterized by deposits of amorphous light-chain material, mainly in the kidneys but also in various other organs. Here we present the first report of a light-, electron microscopic and immunohistochemical study of the globes of a patient suffering from LCDD secondary to multiple myeloma. Massive deposits of kappa light chains similar to those typically present in the kidneys were found beneath the basement membrane of the ciliary pigment epithelium, on vessels of the ciliary body, within the collagenous zones of Bruch's membrane, and in the innermost part of the choroid. The choriocapillaris in the macular area was partly obstructed by these deposits, and an exudative retinal detachment was present. Whether this detachment was the consequence of disturbed circulation of the choriocapillaris remains speculative.
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23
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Li N, Zhu Z, Yi G, Li S, Han X. Corneal Opacity Leading to Multiple Myeloma Diagnosis: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:421-425. [PMID: 29632295 PMCID: PMC5912009 DOI: 10.12659/ajcr.908475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patient: Female, 54 Final Diagnosis: Multiple myeloma Symptoms: A 9-month history of blurred vision Medication: Systemic chemotherapy with vincristine • cyclophosphamide • dexamethasone Clinical Procedure: Multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaint Specialty: Ophthalmology and Hematology
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Affiliation(s)
- Naiyang Li
- Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland).,Eye Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China (mainland)
| | - Zhe Zhu
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, School of Medicine, La Jolla, CA, USA
| | - Gengrong Yi
- Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland)
| | - Sheng Li
- Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland)
| | - Xiaotong Han
- Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland)
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Multiple Myeloma Recurrence with Optic Nerve Infiltration Diagnosed by Vitrectomy, Immunohistochemistry, and in Situ Hybridization. Eur J Ophthalmol 2018; 24:446-8. [DOI: 10.5301/ejo.5000392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 11/20/2022]
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25
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Tai E, Sim SK, Haron J, Wan Hitam WH. Orbital multiple myeloma: a diagnostic challenge. BMJ Case Rep 2017; 2017:bcr-2017-220895. [PMID: 28790098 DOI: 10.1136/bcr-2017-220895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Orbital involvement in multiple myeloma is unusual. We describe the case of an 85-year-old woman who presented with right eye proptosis, reduced visual acuity and diplopia. Computed tomography showed a lobulated, enhancing soft tissue mass arising from the right greater wing of the sphenoid with intraconal, lacrimal gland and ocular muscle involvement. Histopathology revealed predominantly atypical plasma cells in a background of reactive lymphocytes, with monoclonality towards kappa light chain protein, suggestive of multiple myeloma. This case illustrates the diagnostic imaging challenge of orbital multiple myeloma.
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Affiliation(s)
- Evelyn Tai
- Department of Ophthalmology, University Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| | - See Khim Sim
- Department of Radiology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia.,Department of Radiology, University Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| | - Juhara Haron
- Department of Radiology, University Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology, University Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
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26
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Chorioretinal folds in a patient with multiple myeloma treated with stem cell transplant. Eur J Ophthalmol 2017; 27:e46-e49. [PMID: 28106236 DOI: 10.5301/ejo.5000928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report an unusual case of bilateral choroidal folds related to multiple myeloma. METHODS In this case report, fundus photography, fundus fluorescein angiography, fundus autofluorescence, and B-ultrasonography were used to assess posterior segment changes. RESULTS A 55-year-old woman with history of multiple myeloma was found to have abnormal fundi. Clinical examination and investigations confirmed chorioretinal folds, which was considered to be related to myeloma. Close monitoring ensued for 2 years with no significant changes. Subsequently, she was treated with stem cell transplant for myeloma, which resulted in remission of her disease. She was also noted to have marked improvement of chorioretinal folds within 1 year. Visual function remained normal throughout the follow-up period. CONCLUSIONS Multiple myeloma can infiltrate choroidal tissue, resulting in chorioretinal folds. Stem cell transplant was associated with significant reduction in paraprotein levels and choroidal folds.
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Vatansever M, Bozkurt FM, Dinç E, Yılmaz EB, Nayir E, Sarı AA, Yıldırım Ö, Kara T. Orbital Metastasis of Multiple Myeloma: Case Report. Turk J Ophthalmol 2016; 46:148-150. [PMID: 27800278 PMCID: PMC5076298 DOI: 10.4274/tjo.73645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/19/2014] [Indexed: 12/01/2022] Open
Abstract
A 68-year-old woman with a history of multiple myeloma presented to the clinic with pain and vision loss in her right eye. Proptosis was observed in her right eye and eye movements were restricted in all directions. Best corrected visual acuity was 3/10 in her right eye. On biomicroscopic examination, hyperemia and subconjunctival hemorrhage were present. Fundus examination of the right eye revealed optic disc edema and choroidal folds. In magnetic resonance imaging two orbital masses were detected. Based on the patient's history and ocular examination, we evaluated the masses as orbital metastasis of multiple myeloma. Palliative radiotherapy was recommended.
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Affiliation(s)
- Mustafa Vatansever
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Fatma Merve Bozkurt
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Erdem Dinç
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Eda Bengi Yılmaz
- Mersin University Faculty of Medicine, Department of Radiation Oncology, Mersin, Turkey
| | - Erdinç Nayir
- Mersin University Faculty of Medicine, Department of Oncology, Mersin, Turkey
| | - Ayşe Ayça Sarı
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Özlem Yıldırım
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Tuba Kara
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
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Kamath S, Patil M, Mendonca N, Nazareth N, Bhat S, Rodrigues FEA, Cestari DM, Randhawa S. Diagnostic and Therapeutic Challenges. Retina 2016; 36:216-20. [DOI: 10.1097/iae.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Resolution of bilateral cystoid macular edema and subfoveal serous retinal detachments after treatment with bortezomib in a patient with "smoldering" multiple myeloma. Retin Cases Brief Rep 2015; 8:348-51. [PMID: 25372546 DOI: 10.1097/icb.0000000000000067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of a patient with multiple myeloma without extraocular end-organ damage but with cystoid macular edema and macular detachments who was treated with bortezomib and dexamethasone. There was a complete resolution of retinal and subretinal fluid and significant improvement of vision. METHODS The patient's ocular disease was monitored with visual acuity, dilated fundus examinations, and optical coherence tomography before, during, and after treatment. The patient in this case report was a 43-year-old African American man with a medical history of untreated, "smoldering" multiple myeloma, hypertension, hyperlipidemia who presented to our clinic with progressive painless loss of vision in both eyes over 6 weeks. RESULTS Before treatment with bortezomib and dexamethasone, the patient had complaints of confusion, muscle stiffness, joint pain, and 20-lb unintentional weight loss; however, he did not have hypercalcemia, renal insufficiency, anemia, or bone lesions typical of active multiple myeloma. The bilateral cystoid macular edema and subfoveal neurosensory retinal detachments, noted on presentation and confirmed by optical coherence tomography, completely resolved over the course of treatment with bortezomib and dexamethasone. CONCLUSION This case of bilateral cystoid macular edema and subfoveal neurosensory retinal detachments is remarkable for both its presentation and response to therapy. The macular edema and macular detachments along with nonspecific complaints of confusion, muscle stiffness, joint pain, and weight loss were the presenting signs and symptoms; signs typically used as guides to initiate treatment for multiple myeloma were not present. Macular edema in the context of paraproteinemia is usually associated with Waldenstrom's macroglobulinemia and has classically been reported as "silent" with respect to fluorescein angiography. Our patient has multiple myeloma and demonstrated leakage on fluorescein angiography. The case is also notable in that there was improvement in visual acuity and restoration of normal macular anatomy after receiving eight cycles of bortezomib and dexamethasone. Bortezomib, a chemotherapeutic agent used to treat refractory or rapidly advancing multiple myeloma, had been used previously to treat similar maculopathy in Waldenstrom disease along with plasmapheresis with resolution of macular edema and improvement in visual acuity. Our patient with multiple myeloma did not require plasmapheresis for significant clinical improvement. Treatment with bortezomib and dexamethasone alone was sufficient to clear the bilateral cystoid macular edema and subretinal fluid.
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Dogan B, Erol MK, Toslak D, Coban DT, Bulut M, Cengiz A, Sari ES. Serous macular detachment, yellow macular deposits, and prominent middle limiting membrane in multiple myeloma. Ther Clin Risk Manag 2015; 11:683-9. [PMID: 25995641 PMCID: PMC4425312 DOI: 10.2147/tcrm.s79232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bone marrow-derived multiple myeloma is a type of plasma cell tumor that may be associated with ocular complications. A 52-year-old male patient was admitted to our eye clinic with the complaint of sudden visual loss and a visual acuity of 20/50 in the right eye and 20/800 in the left eye. Fundus examination revealed common flame-shaped hemorrhages, venous dilatation and tortuosity, Roth spots, serous macular detachment, and yellow macular deposits in both eyes. Evaluation with fundus fluorescein angiography, fundus autofluorescence, and spectral-domain optical coherence tomography resulted in suspicion of hyperviscosity retinopathy and referral to the hematology clinic. After hematology consultation confirmed a diagnosis of multiple myeloma, chemotherapy and plasmapheresis were initiated. Four months after presentation, best-corrected visual acuity was 20/20 in both eyes and improvement in hyperviscosity retinopathy, serous macular detachment, and yellow macular deposits was observed.
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Affiliation(s)
- Berna Dogan
- Antalya Training and Research Hospital, Eye Clinic, Antalya, Turkey
| | | | - Devrim Toslak
- Antalya Training and Research Hospital, Eye Clinic, Antalya, Turkey
| | | | - Mehmet Bulut
- Antalya Training and Research Hospital, Eye Clinic, Antalya, Turkey
| | - Ayse Cengiz
- Antalya Training and Research Hospital, Eye Clinic, Antalya, Turkey
| | - Esin Sogutlu Sari
- Balıkesir University Medicine Faculty, Eye Clinic, Balıkesir, Turkey
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31
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Bilateral macular detachments, venous stasis retinopathy, and retinal hemorrhages as initial presentation of multiple myeloma: a case report. Retin Cases Brief Rep 2014; 8:240-4. [PMID: 25372517 DOI: 10.1097/icb.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present the case of a patient with bilateral macular detachments, venous stasis retinopathy, and retinal hemorrhages as the initial manifestation of multiple myeloma. METHODS Case report. RESULTS A 59-year-old woman presented with complaints of photopsias and decreased vision and was found to have bilateral macular detachments, venous stasis retinopathy, and retinal hemorrhages. Fluorescein angiography revealed an angiographically silent fundus in both eyes, indicating no fluorescein leakage was found in the macula. Workup revealed multiple myeloma as the cause of the retinal findings. CONCLUSION Macular detachment or subretinal fluid, retinal venous dilation or congestion, and retinal hemorrhages may be presenting signs of multiple myeloma.
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Sharma P, Madi HA, Bonshek R, Morgan SJ. Cloudy corneas as an initial presentation of multiple myeloma. Clin Ophthalmol 2014; 8:813-7. [PMID: 24812487 PMCID: PMC4010642 DOI: 10.2147/opth.s49283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Summary We report a case of previously unsuspected myeloma, presenting with cornea verticillata due to intracorneal paraprotein deposition. History An 85-year-old female presented via her optician with a 4-month history of cloudy vision. She had undergone an uneventful bilateral phacoemulsification surgery 7 years earlier. Extensive spiraling corneal epithelial opacification was noted on slit-lamp examination. On further investigation, she was found to have a previously unsuspected low-grade multiple myeloma. We established the nature of the corneal deposits with corneal epithelial biopsy histopathology and electron microscopy. It is very rare for multiple myeloma to present in this fashion. Ophthalmologists should be aware that such a presentation may rarely be due to systemic multiple myeloma.
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Affiliation(s)
| | | | - Richard Bonshek
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Manchester Royal Infirmary, Manchester, UK
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Subepithelial Corneal Immunoglobulin Deposition as a Manifestation of Multiple Myeloma: A Case Report and Literature Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e39-42. [DOI: 10.1016/j.clml.2013.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022]
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Galea M, McMillan N, Weir C. Diplopia and variable ptosis as the sole initial findings in a case of orbital plasmacytoma and multiple myeloma. Semin Ophthalmol 2013; 30:235-7. [PMID: 24164055 DOI: 10.3109/13506129.2013.839807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Plasmacytomas are monoclonal plasma cell tumors. They represent 3% of all orbital tumors. We present an unusual case of orbital plasmacytoma and advanced multiple myeloma where the sole presenting symptoms were those of diplopia and ptosis. Clinical examination revealed right hypertropia and variable left upper lid ptosis but no proptosis. The visual acuity and the rest of the ocular examination were normal in both eyes. An MRI scan of the brain and orbits revealed a frontal bone lesion consistent with a plasmacytoma. A bone marrow biopsy showed a light chain multiple myeloma with free lambda light chains. Although the literature reports diplopia and ptosis as being clinical features of orbital plasmacytomas, to our knowledge this is the first reported case where these symptoms were the only presenting features, despite widespread disease.
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Affiliation(s)
- Martin Galea
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , UK and
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35
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Mazzotta C, Caragiuli S, Caporossi A. Confocal microscopy in a case of crystalline keratopathy in a patient with smouldering multiple myeloma. Int Ophthalmol 2013; 34:651-4. [DOI: 10.1007/s10792-013-9838-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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36
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Shen M, Ng SC. Multiple Myeloma Masquerades as Rheumatic Diseases. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michael Shen
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Swee Cheng Ng
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
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37
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Felici S, Villivà N, Balsamo G, Andriani A. Efficacy of lenalidomide in association with cyclophosphamide and dexamethasone in multiple myeloma patient with bilateral retro-orbital localisation. Ecancermedicalscience 2013; 7:331. [PMID: 24723969 PMCID: PMC3965188 DOI: 10.3332/ecancer.2013.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 12/19/2022] Open
Abstract
Extramedullary localisation is an uncommon manifestation in multiple myeloma (MM). Ocular involvement is rare. Here, we describe a relapse of MM with bilateral retro-orbital localisation without any bone involvement with good and rapid response to therapy with lenalidomide, dexamethasone, and cyclophosphamide.
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Affiliation(s)
- S Felici
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
| | - N Villivà
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
| | - G Balsamo
- Histopathology Complex Unit, Santo Spirito Hospital, 00193 Rome, Italy
| | - A Andriani
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
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38
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Do DV, Dhaliwal RS, Schachat AP. Leukemias and Lymphomas. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Intraocular collision tumour: case report and literature review. Graefes Arch Clin Exp Ophthalmol 2012; 251:1383-8. [PMID: 23232651 DOI: 10.1007/s00417-012-2216-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/13/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND "Collision" tumours consist of different neoplasms coexisting within a single lesion. Whilst quite common in the skin, the gastrointestional tract, and the ovaries, intraocular collision tumours are exceedingly rare. We describe an exceptional case of a combined uveal melanoma and intraocular plasmacytoma. METHODS Observational case report. A 61-year-old woman underwent enucleation for rubeotic glaucoma and cells in the anterior chamber after proton-beam radiotherapy of a cilio-choroidal melanoma of the right eye. Examination of the enucleated eye was performed with immunohistochemistry, multiplex ligation dependent probe amplification (MLPA), and polymerase chain reaction (PCR) for immunoglobulin heavy- and light-chain gene rearrangements. A review of the literature on ocular collision tumours and uveal involvement by plasma cell neoplasms was also performed. RESULTS Morphological, immunophenotypical, and genotypical examination of the tumour revealed the co-existence of both a melanoma and a plasmacytoma within the choroid and ciliary body. The glaucoma was caused by extensive infiltration of the iris and trabecular meshwork by the plasmacytoma cells. Review of the literature revealed only four collision tumours involving the eyelid and three involving the choroid. All three intraocular collision tumours consisted of uveal melanoma and choroidal non-Hodgkin lymphoma. Uveal involvement by plasma cell neoplasms is also extremely rare, with only six reported cases. CONCLUSIONS This is the first documented intraocular collision tumour consisting of a uveal melanoma and isolated plasmacytoma. If a patient presents with 'uveitis' after proton-beam radiotherapy of a cilio-choroidal melanoma, there may be scope for performing biopsies to determine whether the lymphoid infiltrate is reactive or neoplastic.
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40
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Spectral-domain optical coherence tomography of Roth spots in multiple myeloma. Eye (Lond) 2012; 26:1588-9. [PMID: 22995939 DOI: 10.1038/eye.2012.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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41
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Felipe AF, Nottage JM, Rapuano CJ. Recurrent bilateral subconjunctival hemorrhage as an initial presentation of multiple myeloma. Oman J Ophthalmol 2012; 5:133-4. [PMID: 22993476 PMCID: PMC3441025 DOI: 10.4103/0974-620x.99384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anthony F Felipe
- Cornea Service, Wills Eye Institute, Department of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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42
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Vázquez FJ, Sobenko N, Schutz N, Altszul M, Lagruta I, Mateos MV, Fantl D. Acute loss of vision as the initial symptom of multiple myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2012; 12:148-50. [PMID: 22277575 DOI: 10.1016/j.clml.2011.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/30/2011] [Accepted: 11/14/2011] [Indexed: 11/19/2022]
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43
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Affiliation(s)
- Phoebe Lin
- Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710, USA
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44
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Lim LT, Ramamurthi S, Collins CE, Mantry S. Peripheral Ulcerative Keratitis Associated with Multiple Myeloma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n12p550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lik Thai Lim
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Cian E Collins
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Sanjay Mantry
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
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45
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Chin KJ, Kempin S, Milman T, Finger PT. Ocular manifestations of multiple myeloma: Three cases and a review of the literature. ACTA ACUST UNITED AC 2011; 82:224-30. [DOI: 10.1016/j.optm.2010.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/09/2010] [Accepted: 10/06/2010] [Indexed: 12/21/2022]
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46
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Khan JM, McBain V, Santiago C, Lois N. Bilateral 'vitelliform-like' macular lesions in a patient with multiple myeloma. BMJ Case Rep 2010; 2010:2010/nov22_1/bcr0520103049. [PMID: 22797204 DOI: 10.1136/bcr.05.2010.3049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old woman was referred to the eye clinic in February 2005 with reduced vision in both eyes. On examination, her visual acuity was 20/40, N6 right eye and 20/64, N6 left eye. Bilateral unusual 'vitelliform-like' lesions at the macula (accumulation of yellow material in the subretinal space), which demonstrated blocked fluorescence on fluorescein angiography and a lack of increased autofluorescence signal on fundus autofluorescence imaging, were detected. The patient was followed-up until April 2007 when retinal haemorrhages were detected and blood work-up was undertaken; during this follow-up period the material present at the macula progressively disappeared. As a result of the blood work-up, the diagnosis of multiple myeloma was established; the macular lesions were thought to relate to the latter disease and represent subretinal deposition of immunoglobulin.
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Affiliation(s)
- Javeed M Khan
- Department of Ophthalmology, Grampian University Hospitals-NHS Trust, Foresterhill, Aberdeen, UK
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47
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Brown G, Shapeero LG, Weiss BM, Roschewski M. Multiple myeloma with lacrimal gland amyloidosis and sarcoidosis. Am J Hematol 2010; 85:506-9. [PMID: 20575017 DOI: 10.1002/ajh.21695] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory Brown
- Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA
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48
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Yumori JW, Ilsen P, Bright DC. Conjunctival plasmacytoma. ACTA ACUST UNITED AC 2010; 81:234-9. [DOI: 10.1016/j.optm.2009.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 11/22/2009] [Indexed: 11/29/2022]
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49
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Malik A, Narang S, Handa U, Sood S. Multiple myeloma presenting as bilateral orbital proptosis. Indian J Ophthalmol 2009; 57:393-5. [PMID: 19700882 PMCID: PMC2804132 DOI: 10.4103/0301-4738.55069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 58-year-old-man presented with painful rapidly progressive bilateral proptosis with restricted ocular movements of 15 days duration. There was history of significant weight loss in the recent past. Computed tomography scan of the head and orbit revealed bilateral multiple, well-defined, round, soft tissue masses, isointense with muscles in intraconal and extraconal space. Fine needle aspiration cytology and incision biopsy from the lesion, urine for Bence-Jones proteins and immunofixation clinched the diagnosis of multiple myeloma. Skeletal survey did not reveal any bony involvement. The diagnosis of multiple myeloma should be kept in mind in cases of bilateral proptosis. Bony involvement is not universal in cases of orbital myeloma. Early diagnosis can be established with extensive biochemical and histopathological investigations and timely treatment is life saving for these patients.
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Affiliation(s)
- Archana Malik
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh - 160 032, India.
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50
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Burkat CN, Van Buren JJ, Lucarelli MJ. Characteristics of orbital multiple myeloma: a case report and literature review. Surv Ophthalmol 2009; 54:697-704. [PMID: 19709708 DOI: 10.1016/j.survophthal.2009.04.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/06/2009] [Accepted: 04/07/2009] [Indexed: 12/16/2022]
Abstract
Multiple myeloma is a plasma cell malignancy that destroys skeletal, renal, and neurological function. Orbital involvement is rare, but has been considered an initial presentation for the malignancy. Furthermore, an association between the subtype of multiple myeloma and the likelihood of orbital infiltration has been suggested. We present a case of an orbital mass that was a recurrence of multiple myeloma. A literature search was performed to evaluate the presentation characteristics of orbital multiple myeloma, plasmacytoma and primary (or solitary) extramedullary plasmacytoma. Past reports were analyzed for age, sex, symptoms at presentation, time from symptom onset to presentation, prior diagnosis before presentation for orbital symptoms, radiological characteristics, immunoglobulin subtype, and survival times. Less than half of published cases had orbital multiple myeloma as the primary presentation. Proptosis is the major presenting sign of orbital multiple myeloma, and radiological evaluation shows that the majority of masses originate in the superotemporal quadrant. The dominant immunoglobulin subtype was IgG.
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Affiliation(s)
- Cat N Burkat
- Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin 53792-3284, USA.
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