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Xiong J, Tong JY, Hyer J, O'Donnell B, Selva D, Hardy T, McNab A, Sullivan TJ, Taylor S, Figueira E, Allende A, Tumuluri K. Orbital Myeloma and Plasmacytoma: An Australian Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00468. [PMID: 39254970 DOI: 10.1097/iop.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE The purpose of this study was to provide Australian data on the clinical and radiological features and outcomes in patients with orbital plasmacytomas. METHODS Multicentre retrospective review of orbital plasmacytoma and orbital involvement in multiple myeloma (MM) from 2005 to 2022 in Australia. RESULTS Twenty-one participants were identified. The median age was 62 years (range 34-88 years), and 11 (52%) were females. Eighteen (84%) had a known diagnosis of MM prior to their orbital presentation, with all patients eventually being diagnosed with systemic MM. Thirteen (72%) were receiving active treatment for systemic myeloma on presentation, while 3 (17%) were in remission. All but 1 had unilateral orbital involvement (n = 20, 95%). Common presenting symptoms and signs were decreased visual acuity (n = 13, 62%), proptosis (n = 11, 52%), limited motility (n = 15, 71%), and optic neuropathy (n = 5, 24%). Radiologically, 15 (71%) involved the superotemporal orbit, 7 (33%) inferotemporal orbit, and 16 (76%) involved ≥1 extraocular muscle. Sixteen (76%) were biopsied and confirmed orbital plasmacytoma on histopathology. Treatment modalities included intravenous and oral steroids (n = 7, 33%), chemotherapy (n = 9, 43%), radiotherapy (n = 13, 62%), stem cell transplant (n = 3, 14%), and surgical debulking and decompression (n = 3, 14%). Mortality was high, with 15 (71%) having MM-related mortality. CONCLUSIONS This is the largest cohort of Australian data on orbital plasmacytomas. Most patients have a diagnosis of systemic MM at presentation. It is crucial to recognize and treat these patients early due to a poor systemic prognosis.
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Affiliation(s)
- Jessica Xiong
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Sydney Eye Hospital
| | - Jessica Y Tong
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Jonathan Hyer
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
| | - Brett O'Donnell
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Thomas Hardy
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville
- Centre for Eye Research, East Melbourne
| | - Alan McNab
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
- Centre for Eye Research, East Melbourne
- Department of Ophthalmology, University of Melbourne, Victoria
| | - Timothy J Sullivan
- Department of Ophthalmology, University of Queensland, Royal Brisbane and Women's Hospital
| | - Simon Taylor
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Edwin Figueira
- Department of Ophthalmology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales
| | | | - Krishna Tumuluri
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Sydney Eye Hospital
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia; and
- Department of Ophthalmology, Liverpool Hospital, New South Wales, Australia
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Jadnanansing AI, Martinez Ciriano JP, van Droogenbroeck J, Spielberg L, Vanhonsebrouck E. Perifoveal exudative vascular anomalous complex (PEVAC) resembling lesion in a patient with multiple myeloma. Am J Ophthalmol Case Rep 2024; 34:101891. [PMID: 38572297 PMCID: PMC10987793 DOI: 10.1016/j.ajoc.2023.101891] [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: 01/17/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose To report a case of a perifoveal exudative vascular anomalous complex (PEVAC) resembling lesion in a patient with multiple myeloma. Observations A 56-year-old male with multiple myeloma presented with sudden moderate vision loss in the right eye. Best-corrected visual acuity was 20/25 in his right eye. Fundus examination showed a vascular irregularity in the perifoveal region. Fluorescein angiography (FA) revealed an isolated perifoveal aneurysmal lesion with minimal leakage. On optical coherence tomography (OCT) examination, a large oval structure with a hyperreflective wall and exudation was visualised. Three weeks later, spontaneous improvement of the intraretinal fluid was observed on OCT without treatment. However, 3 months later the macular edema recurred. The appearance of the aneurysmal lesion is similar to a PEVAC lesion, which is an isolated well-defined perifoveal intraretinal vascular abnormality presenting on OCT as a round hyperreflective structure with a dark lumen containing variably reflective material and is commonly associated with cystic intraretinal fluid. Conclusions and Importance PEVAC was originally described as occurring in healthy patients, but recent observations suggest that it also appears in association with other retinal/choroidal vascular abnormalities or underlying cardiovascular abnormalities. Our case supports this hypothesis by demonstrating a PEVAC resembling lesion in a patient with multiple myeloma.
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Affiliation(s)
| | | | | | - Leigh Spielberg
- Department of Ophthalmology, AZ Sint-Jan, Ruddershove 10, Bruges, Belgium
| | - Eva Vanhonsebrouck
- Department of Ophthalmology, AZ Sint-Jan, Ruddershove 10, Bruges, Belgium
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3
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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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4
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Thareja J, Minj A, Samal P, Panigrahi PK. Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India. Indian J Ophthalmol 2024; 72:659-663. [PMID: 38189493 PMCID: PMC11168555 DOI: 10.4103/ijo.ijo_815_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. METHODS This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. RESULTS A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. CONCLUSION Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.
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Affiliation(s)
- Japesh Thareja
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Anita Minj
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Priyanka Samal
- Department of Haematology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
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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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6
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Geraldes C, Roque A, Sarmento-Ribeiro AB, Neves M, Ionita A, Gerivaz R, Tomé A, Afonso S, Silveira MP, Sousa P, Bergantim R, João C. Practical management of disease-related manifestations and drug toxicities in patients with multiple myeloma. Front Oncol 2024; 14:1282300. [PMID: 38585008 PMCID: PMC10995327 DOI: 10.3389/fonc.2024.1282300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Multiple myeloma (MM) is a very heterogeneous disease with multiple symptoms and clinical manifestations. MM affects mainly elderly patients and is difficult to manage in the presence of comorbidities, polypharmacy, frailty and adverse events of disease-targeted drugs. The rapid changes in MM treatment resulting from constant innovations in this area, together with the introduction of numerous new drugs with distinct mechanisms of action and toxicity profiles, have led to an increased complexity in the therapeutic decision-making and patient management processes. The prolonged exposure to novel agents, sometimes in combination with conventional therapies, makes this management even more challenging. A careful balance between treatment efficacy and its tolerability should be considered for every patient. During treatment, a close monitoring of comorbidities, disease-related manifestations and treatment side effects is recommended, as well as a proactive approach, with reinforcement of information and patient awareness for the early recognition of adverse events, allowing prompt therapeutic adjustments. In this review, we discuss various issues that must be considered in the treatment of MM patients, while giving practical guidance for monitoring, prevention and management of myeloma-related manifestations and treatment-related toxicities.
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Affiliation(s)
- Catarina Geraldes
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Adriana Roque
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Bela Sarmento-Ribeiro
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Manuel Neves
- Hemato-Oncology Unit, Champalimaud Foundation, Lisboa, Portugal
| | - Alina Ionita
- Hematology Department, Portuguese Institute of Oncology Francisco Gentil, Lisboa, Portugal
| | - Rita Gerivaz
- Serviço de Hemato-oncologia, Hospital Garcia de Orta, Lisboa, Portugal
| | - Ana Tomé
- Serviço de Hemato-oncologia, Hospital Garcia de Orta, Lisboa, Portugal
| | - Sofia Afonso
- Serviço de Hematologia Clínica, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maria Pedro Silveira
- Serviço de Imuno-Hemoterapia, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Patrícia Sousa
- Serviço de Imuno-Hemoterapia, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Rui Bergantim
- Serviço de Hematologia Clínica, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Instituto de Investigação e Inovaçáo em Saúde, Universidade do Porto, Porto, Portugal
- Institute of Pathology and Molecular Immunology, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Cristina João
- Hemato-Oncology Unit, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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7
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Veisi A, Daneshvar K, Hooshmandi S, Najafi M, Mohammadi Torbati P, Hassanpour K. Superior Oblique Muscle Extramedullary Plasmacytoma in a Patient with Multiple Myeloma and a Review of Literature. Case Rep Ophthalmol 2024; 15:265-272. [PMID: 38529002 PMCID: PMC10963055 DOI: 10.1159/000538120] [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: 02/28/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Multiple myeloma (MM), a plasma cell malignancy, is a systemic disease affecting various body organs. Plasmacytoma of bone and extramedullary disease (EMD) are presentations of MM. EMD is usually the sign of a more aggressive form of the disease. Herein, we report a patient with refractory MM presenting with extramedullary plasmacytoma in the superior oblique (SO) muscle. Case Presentation A 51-year-old female presented complaining of gradual protrusion of the left eye and ocular pain from 20 days prior. She received bone marrow transplantation 1 year prior and was on a chemotherapy regimen for MM for the past 1 year. Ocular examination revealed proptosis of the left eye and mild limitations of adduction and elevation. Orbital magnetic resonance imaging demonstrated remarkable enlargement of the left SO muscle with focal contrast enhancement. The patient underwent a biopsy and mass debulking. The histopathologic exam revealed fibromuscular tissue containing a neoplasm composed of sheets of plasmacytoid cells in a varying degree of differentiation with intervening scantly vascularized stromal components. The plasmacytoid cells were diffusely positive for a cluster of differentiation 138 (CD138), leading to a diagnosis of EMD involving the EOM and soft tissue of the orbit. The patient underwent palliative radiotherapy and a systemic workup. The PET-CT scan revealed involvement of the pelvic bone and left calf. Accordingly, the chemotherapy regimen was upgraded to reflect the aggressive nature of the disease. In the last follow-up, there was no sign of tumor reactivation in the orbital soft tissues. Unfortunately, the patient succumbed to her illness 7 months following her most recent presentation. Conclusion Early recognition of disease recurrence is lifesaving in MM patients; ophthalmic manifestations should be seriously considered as a sign of MM activity.
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Affiliation(s)
- Amirreza Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Daneshvar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Najafi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Mohammadi Torbati
- Department of Pathology, Shahid Labbafnejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Koenig LR, Biran N, Francis JH, Abramson DH. Localized Recurrence of Multiple Myeloma in the Lacrimal Gland. Ophthalmic Plast Reconstr Surg 2023; 39:e182-e183. [PMID: 37326495 PMCID: PMC11322982 DOI: 10.1097/iop.0000000000002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors report the case of a multiple myeloma recurrence isolated to the lacrimal gland. The patient is a 54-year-old man with a medical history of IgA kappa multiple myeloma status post multiple lines of chemotherapy and stem cell transplantation (×2) who was presumed to be without evidence of disease. Six years following the transplant, he presented with a lacrimal gland tumor with a biopsy consistent with multiple myeloma. Systemic disease evaluation at that time, including positron emission tomography scan, bone marrow biopsy, and serum analysis, were negative. To the best of the authors' knowledge, no prior reports exist describing an isolated lacrimal gland recurrence of multiple myeloma with ultrasound and MRI imaging.
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Affiliation(s)
- Lisa R. Koenig
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, United States
| | - Noa Biran
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey, United States
| | - Jasmine H. Francis
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, United States
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - David H. Abramson
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, United States
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
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Hu WL, Song JY, Li X, Pei XJ, Zhang JJ, Shen M, Tang R, Pan ZY, Huang ZX. Clinical features and prognosis of multiple myeloma and orbital extramedullary disease: Seven cases report and review of literature. World J Clin Cases 2022; 10:12365-12374. [PMID: 36483807 PMCID: PMC9724521 DOI: 10.12998/wjcc.v10.i33.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) complicated with extramedullary disease (EMD) has a poor prognosis and is a limiting factor in the treatment of MM, and no standard treatment is recommended in international guidelines. Few studies have reported MM with periorbital EMD.
CASE SUMMARY In this paper, the clinical characteristics and survival of seven patients with multiple myeloma and orbital are described and analyzed. The common ocular symptoms were blurred vision, proptosis and/or eye movement disorders, IgG type MM may be a risk factor for orbital involvement. Of them, six patients were treated with bortezomib-based regimens. The median overall survival (OS) and progression free survival for the entire cohort were 48 and 33 mo, respectively, which was much worse than the OS reported for MM patients without orbital EMD.
CONCLUSION Orbital MM may have significantly shortened survival for the entire cohort, so multidisciplinary collaboration is emphasized and recommended in the diagnosis and treatment of these difficult cases.
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Affiliation(s)
- Wan-Li Hu
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jia-Yin Song
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Xin Li
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Xiao-Jiao Pei
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jia-Jia Zhang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Man Shen
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Ran Tang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Zhen-Yu Pan
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Zhong-Xia Huang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
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Bouazza M, Youssefi H, Bouanani N. Ocular Manifestations in Hematological Disorders. Cureus 2022; 14:e27941. [PMID: 36120241 PMCID: PMC9468511 DOI: 10.7759/cureus.27941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Ophthalmic manifestations are a common feature in hematological malignancies and may be divided into two groups: those attributable to the disease's infiltration of the eye, and the ocular consequences due to blood abnormalities. This study aims to determine the prevalence of ocular manifestations and their association with the different hematological disease subgroups. Materials and methods We conducted a retrospective and observational study enrolling 137 consecutive patients on active treatment or follow-up for hematological malignancies from January 2016 to January 2020 at the Cheikh Khalifa International University Hospital. All patients underwent a standardized and comprehensive ophthalmic evaluation. Results Ocular involvement was primarily disclosed in acute myeloid leukemia (AML), non-Hodgkin's lymphoma (NHL), and multiple myeloma (MM). We herein report the different ocular changes divided into anterior segment manifestations, posterior segment manifestations, dry eye disease, and ocular adnexa findings. Patients with leukemia had a significantly higher rate of lesions in the ocular posterior segment (p < 0.001). Despite the high prevalence of anterior segment and ocular adnexa findings in lymphoma patients, no significant association emerged between these lesions and the aforementioned condition. In addition, dry eye disease was found in all instances without any association with the disease itself. Conclusions Awareness of ocular pathology in hematological malignancies is important as it may precede systemic diagnosis or be a sign of recurrence. We should also be concerned about the side effects of treatments, predominantly, dry eye disease. Therefore, periodic ophthalmic assessment throughout the disease's course, as well as interdisciplinary coordination of care, is crucial to promote early diagnosis and treatment, hence improving long-term outcomes.
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11
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Sokolenko E, Johansson P, Ting S, Bechrakis NE, Fiorentzis M. Choroidal Manifestation of Smoldering Myeloma: Case Report. Klin Monbl Augenheilkd 2022. [PMID: 35901808 DOI: 10.1055/a-1838-5027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This case illustrates clinical, histopathological, immunohistochemical, and molecular pathological diagnostic testing of smoldering myeloma with atypical ophthalmic manifestations. In our case, the choroidal lesion presented as a solitary manifestation of a systemic disease. Choroidal lesions of monoclonal plasma cells are extremely rare and should be included in the differential diagnosis of amelanotic choroidal lesions, even if the histopathological examination of the primary lesion is not informative. Clinical course, immunohistochemistry, and molecular pathology are essential components of the diagnostic pathway.
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Affiliation(s)
- Ekaterina Sokolenko
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patricia Johansson
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Saskia Ting
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Oyemade KA, Stafford SL, Gertz MA, Patel SV, Baratz KH, Dalvin LA. Intraocular plasmacytoma: A case of iris involvement and a review of the literature. Am J Ophthalmol Case Rep 2022; 26:101533. [PMID: 35479520 PMCID: PMC9035397 DOI: 10.1016/j.ajoc.2022.101533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/09/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Describe a case of intraocular plasmacytoma in a patient with multiple myeloma successfully treated with photon irradiation. Observations A 61-year-old man with a history of relapsing/refractory multiple myeloma and left frontal bone plasmacytoma treated with monthly belantamab mafodotin salvage chemotherapy developed bilateral treatment-related corneal keratopathy. An iris mass was incidentally noted in the right eye during a follow-up examination. The mass was amelanotic with diffuse intrinsic vasculature involving the pupillary margin from 1:30 to 10:30. Fundus examination showed an irregularly shaped amelanotic superotemporal scleral lesion in the right eye and two smaller amelanotic scleral lesions in the left eye. Given known systemic multiple myeloma and history of left frontal bone plasmacytoma, a presumed diagnosis of iris and scleral plasmacytoma was made. Due to rapid progression of the iris plasmacytoma despite systemic chemotherapy, the patient was treated with 20 Gy photon irradiation to the anterior and posterior segments of both eyes. One month after photon irradiation, there was complete regression of the iris plasmacytoma, and the scleral lesions in both eyes also appeared to be regressing despite systemic progression of multiple myeloma. Conclusions and importance Intraocular plasmacytoma is rare and can occur in isolation but typically occurs as a manifestation of systemic multiple myeloma. Intraocular plasmacytoma can be successfully treated with photon irradiation in patients with multiple myeloma who progress on systemic chemotherapy.
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Affiliation(s)
- Kafayat A. Oyemade
- Alix School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Scott L. Stafford
- Department of Radiation Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Morie A. Gertz
- Department of Hematology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Sanjay V. Patel
- Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Keith H. Baratz
- Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Lauren A. Dalvin
- Department of Ophthalmology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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13
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Denier M, Tick S, Dubois R, Dulery R, Eller AW, Suarez F, Burroni B, Maurage CA, Bories C, Konopacki J, Puech M, Bouscary D, Cantalloube A, Héron E, Marçais A, Habas C, Theillac V, Keilani C, Bonhomme GR, Gallagher DS, Boumendil J, Abarah W, Sedira N, Bertin S, Choquet S, Sahel JA, Merabet L, Brignole-Baudouin F, Putterman M, Errera MH. Hidden in the Eyes—Recurrence of Systemic Hemopathies Reportedly “In Remission”: Six Cases and Review of Literature. Medicina (B Aires) 2022; 58:medicina58030456. [PMID: 35334633 PMCID: PMC8950814 DOI: 10.3390/medicina58030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient’s progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient’s ocular symptoms after treatment.
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Affiliation(s)
- Margot Denier
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Sarah Tick
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Romain Dubois
- Institut de Pathologie, CHRU de Lille, 59000 Lille, France;
| | - Remy Dulery
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Sorbonne Université, INSERM UMRs938, 75012 Paris, France;
| | - Andrew W. Eller
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Felipe Suarez
- Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
| | - Barbara Burroni
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, 75006 Paris, France;
| | - Claude-Alain Maurage
- Centre de Recherche Jean-Pierre Aubert INSERM: U837, Université du Droit et de la Santé—Lille II, Faculté de Médecine 1, Place de Verdun, CEDEX, 59045 Lille, France;
- Institut de Pathologie—CHRU de Lille, 59000 Lille, France
| | - Claire Bories
- France Department of Hematology, CHRU, 59000 Lille, France;
| | - Johanna Konopacki
- Department of Hematology, Hôpital D’instruction des Armées Percy, 92140 Clamart, France;
| | | | - Didier Bouscary
- Department of Hematology, Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Hôpital Cochin, AP-HP, 75014 Paris, France;
| | - Alberte Cantalloube
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Emmanuel Héron
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Ambroise Marçais
- Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
| | - Christophe Habas
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Vincent Theillac
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Chafik Keilani
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Gabrielle R. Bonhomme
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Denise S. Gallagher
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Julien Boumendil
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Wajed Abarah
- Department of Hematology, Hôpital de Meaux, 77100 Meaux, France;
| | - Neila Sedira
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Stéphane Bertin
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Sylvain Choquet
- Department of Hematology, Hôpital Pitié-Salpêtrière, 75013 Paris, France;
| | - José-Alain Sahel
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Lilia Merabet
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Françoise Brignole-Baudouin
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Sorbonne Universités, 75006 Paris, France
| | - Marc Putterman
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Marie-Hélène Errera
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
- Correspondence:
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14
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Huge Lateral Rectus Solitary Plasmacytoma Causing Shunt Extrusion. Case Rep Ophthalmol Med 2021; 2021:5563514. [PMID: 34194858 PMCID: PMC8181099 DOI: 10.1155/2021/5563514] [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: 01/18/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
A 54-year-old man with a history of radiotherapy for right maxillary sinus plasmacytoma 3 years previously was referred to an orbital clinic with progressive proptosis in his right eye. His vision had deteriorated after an initial improvement after phacoemulsification 2 years before. He had undergone shunt implantation and later shunt removal following plate extrusion with the diagnosis of neovascular glaucoma following CRVO. His vision remained at no light perception afterwards, despite a controlled IOP with topical medications. In his CT scan, a large orbital mass was seen with lateral rectus involvement. He underwent deep orbitotomy for tumor resection following worsening of symptoms, and his symptoms were improved afterwards. Pathology report was consistent with plasmacytoma with anaplastic features. After tumor resection, he underwent another course of radiotherapy with complete remission of symptoms afterwards.
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15
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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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16
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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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17
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Kuo HH, Shen EP. Hyperviscosity retinopathy as the initial presentation of aggressive multiple myeloma. Tzu Chi Med J 2020; 32:401-403. [PMID: 33163389 PMCID: PMC7605289 DOI: 10.4103/tcmj.tcmj_214_19] [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: 09/17/2019] [Revised: 11/15/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
Multiple myeloma (MM) is a hematologic malignancy resulting from the uncontrolled proliferation of neoplastic plasma cells and the excessive production of monoclonal immunoglobulins, both of which may lead to hyperviscosity retinopathy. Here, we present a 56-year-old male who had progressive painless loss of vision for 1 month. Ophthalmic examination revealed hyperviscosity retinopathy with bilateral central retinal vein occlusion-like appearance. Hematologic assessment revealed immunoglobulin A MM. Although the patient was treated with chemotherapy and autologous stem cell transplantation soon after referral, he did not survive due to the aggressive course of the disease. We highlight the importance of the ophthalmic presentation of MM. Early recognition and referral to an oncologist can lead to timely diagnosis and appropriate management.
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Affiliation(s)
- Hua-Hsuan Kuo
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Elizabeth P Shen
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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18
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Atteinte conjonctivale chez une patiente atteinte de myélome multiple : à propos d’un cas. J Fr Ophtalmol 2020; 43:967-969. [DOI: 10.1016/j.jfo.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022]
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19
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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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20
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Mani M, Kasturi N, Sravya R, Kaliaperumal S, Gochhait D. Orbital plasmacytoma as the presenting feature in multiple myeloma. Eur J Ophthalmol 2020; 31:NP1-NP4. [PMID: 32493136 DOI: 10.1177/1120672120929959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein electrophoresis revealed hypergammaglobulinemia, and bone marrow biopsy revealed 6% plasma cells. The patient was started on chemotherapy with bortezomib, dexamethasone and lenalidomide by the medical oncologist. Significant improvement in proptosis and extraocular movements noted on follow-up. Orbital myeloma may be the first manifestation of systemic disease.
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Affiliation(s)
- Malavika Mani
- The Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- The Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rekha Sravya
- The Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- The Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- The Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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21
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Dušek O, Fichtl M, Rezková L, Dubská Z, Heissigerová J, Růžičková E, Vráblík M, Špička I, Svozílková P. Acute elevation of intraocular pressure in patient with hyperlipidemic myeloma. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:172-180. [PMID: 33297702 DOI: 10.31348/2020/27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To introduce a rare case of patient with hyperlipidemic myeloma and ocular manifestation in form of masquerade syndrome with acute elevation of intraocular pressure (IOP) and hyperviscous retinopathy. RESULTS 55-year-old man with newly diagnosed hyperlipidemic myeloma and hyperviscous syndrome was acutely referred to our glaucoma outpatient clinic due to problems with his left eye: sudden pain, blurred vision, redness of the eye and IOP of 44 mm Hg. We excluded attack of angle closure glaucoma and found presence of whitish material in the anterior chamber and blood obstructing the iridocorneal angle. Glaucoma therapy was initiated and lavage of the anterior chamber of the left eye with sampling of the aqueous humour for biochemical and cytological examination was performed. Identification of trace amount of cryoprotein in the samples of humour proved diagnosis of masquerade syndrome. Finding of the hyperviscous retinopathy and nonperfusion of wide peripheral areas of retina in both eyes was indicated to laser coagulation of these areas. The patient underwent in the meantime three times plasmapheresis, four cycles of biological therapy and autologous stem cell transplantation reaching complete remission of the myeloma. Local and systemic therapy led to significant clinical finding improvement on the anterior segment and fundus of both eyes. CONCLUSIONS Masquerade syndrome can be complicated by acute elevation of IOP. Diagnostic lavage of the anterior chamber, local therapy, systemic therapy and close interdisciplinary cooperation contributed to right diagnosis, IOP normalisation, ocular and general condition improvement.
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22
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Nahon-Esteve S, Martel A, Maschi C, Caujolle JP, Baillif S, Lassalle S, Hofman P. The Molecular Pathology of Eye Tumors: A 2019 Update Main Interests for Routine Clinical Practice. Curr Mol Med 2019; 19:632-664. [DOI: 10.2174/1566524019666190726161044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
Over the last few years, we have seen constant development of molecular
pathology for the care of patients with cancer. The information obtained from molecular
data has transformed our thinking about the biological diversity of cancers, particularly in
the field of ophthalmic oncology. It has reoriented the way in which therapeutic decisions
and decisions concerning patient surveillance are made, both in the area of pediatric
cancers, including rhabdomyosarcoma and retinoblastoma, and adult cancers, such as
uveal melanoma and lymphomas. A better definition of the molecular classification of
these cancers and of the different biological pathways involved is essential to the
understanding of both the pathologist and the onco-ophthalmologist. Molecular tests
based on targeted or expanded analysis of gene panels are now available. These tests
can be performed with tumor tissue or biofluids (especially blood) to predict the
prognosis of tumors and, above all, the benefit of targeted therapies, immunotherapy or
even chemotherapy. Looking for the BAP1 mutation in uveal melanoma is essential
because of the associated metastatic risk. When treating retinoblastoma, it is mandatory
to assess the heritable status of RB1. Conjunctival melanoma requires investigation into
the BRAF mutation in the case of a locally advanced tumor. The understanding of
genomic alterations, the results of molecular tests and/or other biological tests predictive
of a therapeutic response, but also of the limits of these tests with respect to the
available biological resources, represents a major challenge for optimal patient
management in ophthalmic oncology. In this review, we present the current state of
knowledge concerning the different molecular alterations and therapeutic targets of
interest in ophthalmic oncology.
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Affiliation(s)
| | - Arnaud Martel
- Department of Ophthalmology, University Cote d'Azur, Nice, France
| | - Célia Maschi
- Department of Ophthalmology, University Cote d'Azur, Nice, France
| | | | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, University Cote d'Azur, Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, University Cote d'Azur, Nice, France
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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25
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Epibulbar Plasmacytoma Masquerading as Subconjunctival Hemorrhage in a Patient With Multiple Myeloma. Cornea 2017; 36:249-251. [PMID: 28060076 DOI: 10.1097/ico.0000000000001071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We report a 75-year-old woman with a history of multiple myeloma immunoglobulin D (IgD) variant, who presented with an epibulbar plasmacytoma masquerading as a subconjunctival hemorrhage. METHODS Magnetic resonance imaging of the brain and orbits with and without contrast was obtained and surgical biopsy of the subconjunctival lesion was performed; histopathology confirmed the diagnosis of plasmacytoma. RESULTS Subconjunctival biopsy revealed a plasma cell neoplasm infiltrate in the episcleral layer. The subconjunctival biopsy stained positive for CD138 and lambda-immunohistochemistry in the majority of plasma cells. Histologic findings were consistent with involvement by known IgD plasma cell myeloma where previous bone marrow biopsy demonstrated myeloma cells which stained monoclonally for IgD-lambda light chains. CONCLUSIONS Although plasma cell neoplasms seldom present with ocular manifestations, it is crucial to recognize that these tumors may be associated with multiple myeloma. In patients with known multiple myeloma who present with subconjunctival hemorrhage, close follow-up is highly recommended, as this may be the initial presentation of an ocular plasmacytoma. Although a plasmacytoma is a rare subconjunctival lesion, it should not be immediately excluded from the differential diagnosis of such lesions.
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Bouchaala W, Dammak M, Bouzidi N, Bellaj H, Gorbel M, Elloumi M, Mhiri C. [Orbital apex syndrome revealing multiple myeloma]. Presse Med 2017; 46:449-452. [PMID: 28233702 DOI: 10.1016/j.lpm.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/06/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wafa Bouchaala
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie.
| | - Mariem Dammak
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
| | - Nouha Bouzidi
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
| | - Hatem Bellaj
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Manel Gorbel
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Moez Elloumi
- CHU Hédi Chaker, service d'hématologie, rue El-Ferdaous, 3029 Sfax, Tunisie
| | - Chokri Mhiri
- CHU Habib Bourguiba, service neurologie, 7, rue El-Ferdaous, 3029 Sfax, Tunisie; Université de Sfax, faculté de médecine, laboratoire de recherche en neurogénétique, maladie de Parkinson et maladies cérébro-vasculaires, LR-12-SP-19, boulevard Majida-Boulila, 3029 Sfax, Tunisie
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Abstract
A 63 year old woman with surgically controlled primary open-angle glaucoma developed sudden visual field deterioration and subjective visual loss despite stable intraocular pressure in both eyes. An extensive systemic workup was performed which revealed a diagnosis of monoclonal gammopathy of undetermined significance. Further work-up should be considered when the extent of a patient's vision changes is not consistent with a known preexisting disease such as glaucoma.
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Day A, Abramson AK, Patel M, Warren RB, Menter MA. The spectrum of oculocutaneous disease. J Am Acad Dermatol 2014; 70:821.e1-19. [DOI: 10.1016/j.jaad.2013.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/18/2013] [Accepted: 12/29/2013] [Indexed: 11/27/2022]
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Intravitreal bevacizumab for ocular metastasis of multiple myeloma. Optom Vis Sci 2014; 90:e236-40; discussion 1028. [PMID: 23811608 DOI: 10.1097/opx.0b013e31829caaf7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Multiple myeloma is the most common plasma cell tumor; however, ocular plasmacytomas are rare. Few cases of binocular metastasis have been reported. The authors review a case study using intraocular bevacizumab to treat secondary glaucoma and binocular metastasis from multiple myeloma. CASE REPORT A 59-year-old woman with a 13-month history of multiple myeloma was found to have a suspected masquerade syndrome OS and subsequently developed a neovascular glaucoma within 2 months. Intravitreal bevacizumab injection OS controlled the intraocular pressure and inhibited ocular metastasis. The methods of therapy administration in this case are consistent with procedures commonly used in clinical practice when using bevacizumab to treat other etiologies, such as choroidal neovascular membranes. Lost to follow-up until 2 months later, the patient presented with ocular metastasis OD with the same changes as observed OS. Conjunctival biopsy revealed subconjunctival plasmoma OD. After intravitreal bevacizumab injection, neovascular glaucoma OD was partly controlled. CONCLUSIONS Secondary ocular plasmacytoma, despite its rarity, should be considered in patients with multiple myeloma. Intravitreal bevacizumab injection may be a promising treatment for ocular metastases and associated secondary or neovascular glaucoma.
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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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Rospond-Kubiak I, Brązert A, Kocięcki J, Bręborowicz J. Poststreptococcal syndrome mimicking conjunctival lymphoma. BMC Infect Dis 2013; 13:149. [PMID: 23530852 PMCID: PMC3620925 DOI: 10.1186/1471-2334-13-149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 03/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Poststreptococcal syndrome (PSS) can be a consequence of nonpurulent primary infection with group A streptococci (GAS). Postreptococcal uveitis is a well recognized entity with quite a few descriptions in the literature, but so far no conjunctival involvement has been reported. The aim of the study is to present a rare case of postreptococcal conjunctival lesions mimicking a lymphoma. Case presentation 19-years-old Caucasian female presented with pink, nodular infiltrates in the right conjunctiva that occurred a few months after upper respiratory tract infection and tonsillectomy. Histopathological examination of collected lesion samples revealed inflammatory reaction with lymphocytes proliferation and failed to rule out a myeloma. Complementary flow-cytometry did not show monoclonal proliferation of lymphocytes B. During follow-up we observed the complete regression of conjunctival lesions after the benzyl penicillin treatment prescribed by ENT specialist due to elevated plasma ASO levels. Therefore, we suppose that those lesions must have represented a part of poststreptococcal syndrome. Conclusions To conclude, this is, to the best of our knowledge, the first report of conjunctival involvement in the course of PSS related to group A streptococci.
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Affiliation(s)
- Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznań University of Medical Sciences, 1/2 Długa St., Poznań 61-848, Poland.
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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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33
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Abstract
The authors report a case of a 62-year-old female with history of multiple myeloma who presents with complains of swelling and pain in her right eye. On examination, it was found that she has proptosis, chemosis, and diplopia along with decreased vision. Initial workup and treatment did not yield significant results, eventually she was found to have myelomatous changes in her right orbit on MRI and was diagnosed with multiple myeloma of the orbit which resolved solely with radiation. This case tends to highlight the importance of considering myeloma of the orbit as a very important and early differential diagnosis in a patient with a history of multiple myeloma presenting with a swollen and painful eye.
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