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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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Khalil B, Parzer L, Machherndl-Spandl S, Haitchi-Petnehazy S, Etmajer K, Haas K, Reinelt P. [Bilateral orbital affection in multiple myeloma]. DIE OPHTHALMOLOGIE 2023; 120:1037-1041. [PMID: 36847864 PMCID: PMC9969020 DOI: 10.1007/s00347-023-01817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Baran Khalil
- Augenklinik Barmherzige Brüder, Seilerstätte 2, 4020, Linz, Oberösterreich, Österreich.
| | - Laura Parzer
- Augenklinik Barmherzige Brüder, Seilerstätte 2, 4020, Linz, Oberösterreich, Österreich
| | - Sigrid Machherndl-Spandl
- Medizinische Onkologie und Hämatologie, Elisabethinen Barmherzige Schwestern Linz, Linz, Oberösterreich, Österreich
| | | | - Katharina Etmajer
- Hals-, Nasen- und Ohrenheilkunde, Krankenhaus der Barmherzige Schwestern Linz, Linz, Oberösterreich, Österreich
| | - Karl Haas
- Augenklinik Barmherzige Brüder, Seilerstätte 2, 4020, Linz, Oberösterreich, Österreich
| | - Peter Reinelt
- Augenklinik Barmherzige Brüder, Seilerstätte 2, 4020, Linz, Oberösterreich, Österreich
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Shoji MK, Chen Y, Topilow NJ, Abou Khzam R, Dubovy SR, Johnson TE. Orbital Involvement in Multiple Myeloma. Ophthalmic Plast Reconstr Surg 2023; 39:347-356. [PMID: 36661857 DOI: 10.1097/iop.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To characterize clinical and radiographic features, management, and outcomes of patients with orbital involvement of multiple myeloma (MM). METHODS A retrospective chart review identified patients with MM and orbital involvement confirmed by histopathology at a single institution between 1995 and 2021. A comprehensive literature review was performed via PubMed to identify all previously reported cases of orbital MM. RESULTS Retrospective review identified 7 patients (43% male, mean age 68.7 years). Presenting symptoms included proptosis and diplopia. Orbital lesions were primarily located laterally (42.8%) with associated extraocular muscle (57.1%) or lacrimal gland (42.9%) involvement. Five patients (71.4%) had a previous diagnosis of systemic MM. Six patients received chemoradiation (85.7%). All patients had improvement of orbital disease with 2 patients deceased due to disease at follow-up (mean 8.9 months). Literature review identified 111 cases (46.8% male, mean age 58.6 years). 48.6% presented with orbital disease as the first manifestation of systemic MM. Lesions were most commonly located superolaterally (20.2%) with extraocular muscle infiltration (25.2%), lacrimal gland involvement (7.2%), and orbital bony destruction (39.6%). Treatments included chemoradiation, chemotherapy, or radiation alone. Approximately half (51.4%) of patients experienced improvement in orbital disease following treatment, and 48.6% were deceased at follow-up (mean 20.1 months). CONCLUSIONS This study provides a new retrospective study and updated comprehensive literature review regarding orbital MM. Given its poor prognosis, characterization of orbital MM is essential for early diagnosis. Orbital MM is often unilateral, located superolaterally, and may represent the first manifestation of systemic disease. Treatment includes chemotherapy and radiation, which may improve orbital disease; however, the overall prognosis remains poor.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
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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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Abstract
Multiple myeloma is a rare malignancy that exhibits a wide range of possible clinical presentations. In recent years, with the advent of stem cell transplantation, the prognosis of patients with multiple myeloma has been increasing. We searched the literature for reports of atypical myeloma presentations to aid clinicians in formulating differential diagnoses and to increase the number of cases diagnosed early. There have been a number of reports of early ocular symptoms, including, but not limited to, proptosis, optic neuropathy, vision loss, retinal hemorrhage, and detachment. Neurological presentations included cranial nerve palsies, vertigo related to cerebellar involvement, and diabetes insipidus related to pituitary involvement. Among gastrointestinal manifestations, there are a number of reports of multiple myeloma presenting as acute and chronic pancreatitis. Mesenteric ischemia due to amyloidosis, acute abdomen, and hepatosplenomegaly were also among reported presentations. When it comes to renal involvement, while acute renal failure and proteinuria are typical, there are reports of patients presenting with both nephritic and nephrotic forms of glomerular disease, as well as end-stage renal disease requiring dialysis. We believe that it is essential for clinicians to keep reporting atypical multiple myeloma presentations and consider it as a possible diagnosis in a patient with serious, atypical symptoms.
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Affiliation(s)
- Praveena Tathineni
- Internal Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Chicago, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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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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Plasmocytome secondaire orbitaire bilatéral chez un homme de 65 ans. J Fr Ophtalmol 2019; 42:e267-e269. [DOI: 10.1016/j.jfo.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 11/21/2022]
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Affiliation(s)
- K Ghosh
- Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India
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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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Wang Y, Nie L. Use of the anterior chamber maintainer in trabeculectomy following vitrectomy. Curr Eye Res 2011; 36:232-7. [PMID: 21275521 DOI: 10.3109/02713683.2010.543498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To retrospectively observe the effects of anterior chamber maintainer (ACM) placement in glaucoma patients undergoing trabeculectomy following vitrectomy. METHODS Trabeculectomy was performed on 51 secondary glaucoma patients (51 eyes), all of whom had undergone vitrectomy. During trabeculectomy, an ACM was placed in 27 eyes (group A), but not in the remaining 24 (group B). Intra- and post-operative complications were recorded. Intraocular pressure (IOP) measurements were recorded pre-operatively and repeated post-operatively on follow up days 1, 3, and 7, and months 1, 3, 6, 12, 18, and 24. Surgical success rates were recorded. RESULTS Mean pre-operative IOPs of groups A and B were 32.74 ± 11.25 and 34.29 ± 9.68 mmHg, respectively. In group A, anterior chamber bleeding (two cases), and choroidal detachment and/or ciliary detachment (four cases) occurred. In group B, anterior chamber bleeding (five cases), and choroidal detachment and/or ciliary detachment (11 cases) occurred. There was a statistically significant difference between the two groups. There also was statistically significant difference in post-operative IOPs between the two groups at 12 and 24 months. The surgical success rate of group A was higher than that of group B. CONCLUSION ACM is effective in maintaining IOP and reducing complications during trabeculectomy following vitrectomy, thereby increasing surgical success rates.
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Affiliation(s)
- Yuhong Wang
- Department of Glaucoma, Eye Hospital of Wenzhou Medical College, Wenzhou, China.
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