[Orbital involvement in IgD Kappa myeloma]

INTRODUCTION

IgDkappa myeloma accounts for less than 2% of all myeloma cases. Orbital involvement is uncommon in myeloma and the authors suggest a possible predilection for IgD myeloma to involve the orbit.

CASE REPORT

A 67-year-old women was admitted for diffuse bone pain and painful ptosis of the right eye. The symptoms had progressed over approximately 1 year and were associated with a severe decline in general health. The biochemical, hematological, and radiological investigations suggested the diagnosis of an IgD kappa myeloma. Orbital x-ray showed destruction of the greater and lesser right wing of the sphenoid bone. Treatment was polychemotherapy. The course of the disease was very rapid and death occurred within 17 months from renal failure and amyloidosis.

DISCUSSION

Orbital involvement by myeloma occurs in 0.3% of cases and the majority are unilateral. The typical orbital symptoms include ptosis, diplopia, loss of vision, and pain. This was not considered to contribute to poor prognosis but may affect the functional prognosis.

ENT pathology and diplopia

ENT pathology causes diplopia in a minority of patients. Because the various ENT conditions that can produce diplopia are relatively unusual they often escape early detection. We describe the various ENT disorders that can produce diplopia and illustrate this with our experience between 1992 and 1998. We wish to emphasise the benefit which can be obtained from undertaking an ENT history and examination in arriving at the correct diagnosis.

Orbital manifestations of plasmacytic lymphoproliferations

Orbital involvement by plasmacytic lymphoproliferative disorders is rare. Presented are four cases, with different clinical onsets and courses, demonstrating the diversity of expression of lymphoproliferative plasma cell lesions of the orbit. The first patient presented with a slowly developing palpable mass in the upper and anterior orbit. This localized lesion proved to be a reactive plasma cell proliferation. The second case had a 3-month history of proptosis, diplopia, and droopy eyelid and a pulsatile temporal mass with bone destruction. Results of biopsy and systemic investigations showed a solitary plasmacytoma of bone. In the third case, a patient with a known multiple myeloma for 2 years presented with a progressive osteolytic mass which proved on biopsy to be a plasmacytoma. At the time, she also had other active bone lesions. The fourth case presented as a possible orbital cellulitis in a man with known multiple myeloma for 2 years. He proved to have disseminated myeloma, the orbital infiltrate being secondary to sinus involvement. The differential diagnosis for each case can be quite involved. Each case required a biopsy for an accurate diagnosis in addition to a complete clinical, radiographic, and laboratory workup. The pathologic features of each tumor can be misleading. These will be discussed as well as the use of ancillary diagnostic methods such as electron microscopy and immunohistochemistry to further characterize each lesion. The clinical course and treatment modalities will be discussed.

IgDK multiple myeloma presenting as unilateral proptosis

A 72-year-old woman presented with painful proptosis of the right eye and a large destructive tumour of the middle cranial fossa. A diagnosis of IgDK multiple myeloma was made, based on histopathologic and immunologic studies of the biopsy. Biochemistry and bone marrow examination further confirmed the myeloma as IgDK type. The clinical, radiological, and pathological findings are presented. The patient was treated with radiotherapy with satisfactory results.