Diplopia and proptosis due to isolated lateral rectus plasmacytoma in a patient with multiple myeloma

Saffra, Norman; Gorgani, Farzan; Panasci, David J.; Kirsch, David

doi:10.1136/bcr-2018-229178

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Literature review identified a total of 111 previously reported cases in 68 articles regarding orbital involvement in patients with systemic MM (Table 2). 4,6-61…”

Section: Resultsmentioning

confidence: 99%

Orbital Involvement in Multiple Myeloma

Shoji

Chen

Topilow

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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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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“…Literature review identified a total of 111 previously reported cases in 68 articles regarding orbital involvement in patients with systemic MM (Table 2). 4,6-61…”

Section: Resultsmentioning

confidence: 99%

Orbital Involvement in Multiple Myeloma

Shoji

Chen

Topilow

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…EOMs are usually affected in combination with adjacent soft tissue or bone. To date, isolated involvement of EOM has been reported in 3 patients [ 7 , 15 , 16 ]. Whether isolated or in combination with other tissues, the hematogenous spread of neoplastic plasma cells could result in extramedullary involvement of EOM [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…EMD affecting EOM is a relatively rare phenomenon. Studies reporting EOM involvement in MM are summarized in Table 1 [7][8][9][10][11][12][13][14]. EOMs are usually affected in combination with adjacent soft tissue or bone.…”

Section: Case Reports In Ophthalmologymentioning

confidence: 99%

Superior Oblique Muscle Extramedullary Plasmacytoma in a Patient with Multiple Myeloma and a Review of Literature

Veisi,

Daneshvar,

Hooshmandi

et al. 2024

Case Rep Ophthalmol

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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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“…They can involve the orbit, conjunctiva [ 7 ], uvea, retina, lacrimal sac [ 8 ], and ciliary body. They present as an orbital mass, epibulbar mass [ 9 ], orbital abcess [ 6 ], chalazion [ 6 ], dacryocystitis [ 6 ], granulomatous uveitis or as an isolated mass in the rectus muscles [ 4 , 10 ]. An increase in the IOP or neovascular glaucoma has also been reported in the iris and ciliary body plasmacytomas [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…They may originate from the bone when involving the orbit [ 2 ] and can mimic other ocular neoplasms such as lymphoma, metastases, chondrosarcoma, or giant cell tumors [ 3 ]. Plasmacytomas of the orbit can present with diplopia, proptosis [ 4 ], and symptoms of orbital cellulitis as well. They may show unspecific imaging characteristics and may not be distinguished from other ocular tumors which would make their diagnosis more difficult [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Huge Lateral Rectus Solitary Plasmacytoma Causing Shunt Extrusion

Hamzeh

Safizadeh

Nozarian

et al. 2021

Case Reports in Ophthalmological Medicine

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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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Diplopia and proptosis due to isolated lateral rectus plasmacytoma in a patient with multiple myeloma

Cited by 7 publications

References 12 publications

Orbital Involvement in Multiple Myeloma

Orbital Involvement in Multiple Myeloma

Superior Oblique Muscle Extramedullary Plasmacytoma in a Patient with Multiple Myeloma and a Review of Literature

Huge Lateral Rectus Solitary Plasmacytoma Causing Shunt Extrusion

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