Primary extramedullary plasmacytoma of the eyelid conjunctiva - A case report and review of the literature

Solitary plasmacytoma of the pancreas: A rare case report

A plasmacytoma is a cancerous growth of abnormal plasma cells that arise within osseous or soft tissue structures. In soft tissue structures, plasmacytomas can present as solitary or multiple masses in the absence of systemic involvement. Solitary plasmacytomas can be subcategorized as extramedullary plasmacytoma (derived from plasma cells located in soft tissues) or osseous plasmacytoma (derived from plasma cells located in the bone marrow). Infrequently, these tumors can arise as extramedullary lesions from the pancreas and present similarly to other tumors, such as pancreatic neuroendocrine tumors (PNETs). In this article, we report the case of a 62-year-old male with a diagnosis of solitary plasmacytoma of the pancreas. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography (CT) scans and positron emission tomography-computed tomography (PET-CT) scans.

Epidemiology and survival of primary extraosseous plasmacytoma: insights from a population-based study with a 20-year follow-up

Primary extraosseous plasmacytoma (PEP) is a rare and localized form of plasmacytoma that is not well understood. This study aimed to investigate the clinical features and prognostic factors associated with PEP. Using the Surveillance, Epidemiology, and End Results (SEER) database, a total of 1044 patients diagnosed with PEP between 2000 and 2019 were identified. The average age was 60.3 ± 15.2 years, with 64.3% being male (male: female = 1.8:1) and 53.8% being over 60-year old. The survival outcome of patients with PEP depends on several factors including age, race, marital status, and treatment options such as chemotherapy, radiotherapy, and surgery, which were also identified as independent predictors of overall survival for PEP. Patients who were younger, Asian or Pacific Islander, American Indian or Native American, and received radiotherapy or surgery had a more favorable prognosis, while those who underwent chemotherapy had poorer outcomes.

Conjunctival Extramedullary Plasmacytoma in Dogs and a Cat: Clinical Characteristics and Histopathological Findings

Simple Summary

Extramedullary plasmacytoma has been occasionally reported to affect the ocular and periocular (orbit, conjunctiva) region. To better describe the clinical and histopathological features of extramedullary plasmacytoma, we reviewed the records of seven cases (six dogs, one cat). In these cases, extramedullary plasmacytoma was found mostly in the conjunctiva of the third eyelid in the form of salmon-colored nodules with clear borders. All tumors were surgically removed with no additional therapy. No signs of recurrence or systemic involvement (multiple myeloma) were observed in the follow up period. We recommend that extramedullary plasmacytoma should be considered in cases of canine and feline conjunctival masses, followed by investigations to rule out multiple myeloma. Our results suggest that conjunctival extramedullary plasmacytoma is unlikely to recur or spread, and that local surgical excision alone or combined with cryotherapy should be curative.

Abstract

Background: Extramedullary plasmacytoma (EMP) is a plasma cell tumor that is very rarely reported in ocular and adnexal tissue and is usually solitary and benign. Methods: This study evaluated seven cases from different ophthalmology referrals submitted for histopathological analysis between 2013 and 2022. Results: EMPs were diagnosed in a 9-year-old domestic short-haired cat and in six dogs (median age, 10 years): three English Cocker Spaniels, a Golden Retriever, a Maltese, and a Pinscher. EMPs affected the third eyelid conjunctiva in five cases (5/7), followed by the superior bulbar (1/7) and palpebral conjunctivae (1/7), respectively, and were presented mostly as well-defined, salmon-colored nodules. Histopathologically, the masses were composed of sheets and packets of round cells morphologically consistent with mature plasma cells with mild anisocytosis and anisokaryosis; mitosis and binucleated giant cells were rarely observed. Follow up for 6/7 cases ranged from 6 months to 2 years. No signs of recurrence or systemic involvement (multiple myeloma) were observed. Conclusions: EMP should be included in the differential diagnoses of canine and feline conjunctival masses. Staging recommendations should include multiple myeloma diagnostic evaluation. Our results suggest that primary conjunctival EMP does not appear to be locally aggressive and has low systemic involvement behavior. The local surgical excision alone or combined with cryotherapy should be curative.

An nusual ocular manifestation of multiple myeloma

A man in his 70s with a history of multiple myeloma presented with a 4-day history of right ptosis and a rapidly enlarging upper eyelid mass. On examination, a large, firm, smooth, pink lesion was found to descend from the conjunctiva of the superior fornix. The patient underwent excision biopsy. Histopathological analysis demonstrated monoclonal plasma cells expressing light-chain kappa, consistent with extramedullary plasmacytoma. Clinical ophthalmic manifestations of multiple myeloma are rare but also diverse. Ocular surface manifestations of multiple myeloma are extremely uncommon. Variable examination findings mean those involving the conjunctiva and may be particularly challenging to diagnose. Secondary ocular extramedullary plasmacytoma, despite its rarity, should be considered in patients with multiple myeloma.

Solitary Extramedullary Plasmacytoma of the Lacrimal Sac With Associated Crystal-Storing Histiocytosis

PURPOSE

To report a rare case of crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma of the lacrimal sac and to review literature on the 2 entities to summarize important diagnostic, management, and prognostic considerations.

METHODS

A case report of the ophthalmologic presentation, pathology workup, and oncologic management is presented. Literature search with focus on lesions occurring in ophthalmic sites and management guidelines from expert panels and working groups.

RESULTS

Crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma arose within the lacrimal sac of a previously healthy middle-aged woman and presented as a painless nodule with epiphora. The biopsy tissue showed sheets of crystal-filled histiocytes, interspersed with monoclonal plasma cells and rarely demonstrated plasma cell phagocytosis. Imaging and laboratory studies confirmed the localized nature.

CONCLUSIONS

Crystal-storing histiocytosis is an uncommon entity in which crystals, most commonly arising from altered immunoglobulins, aggregate within histiocytes and form symptomatic mass lesions. It has been reported in ophthalmic regions in patients with a concurrent lymphoproliferative or plasma cell disorder and can rarely predate a malignancy. The current case is notable because crystal-storing histiocytosis occurs with a localized process, solitary extramedullary plasmacytoma, and presents in an unusual site, the lacrimal sac. Tissue biopsy with multimodal pathological evaluation is necessary to make the diagnosis. Ophthalmologists should recognize that crystal-storing histiocytosis is commonly associated with a hematologic malignancy and, when appropriate, refer the patient for oncologic management. Surveillance may be indicated in cases with no established etiology. Solitary extramedullary plasmacytoma should also be monitored, as a proportion of cases progress to multiple myeloma.

Solitary Conjunctivocorneal Plasmacytoma Arising After Cataract Surgery

PURPOSE

To report a case of solitary plasmacytoma of the conjunctiva with corneal encroachment and to review the literature of all published cases.

METHODS

A 70-year-old man presented with 1-month history of pain and watering in the right eye, 7 months after undergoing cataract surgery in the same eye.

RESULTS

The mass was surgically excised. Pathology and immunohistochemistry were consistent with plasmacytoma. Staging studies found no evidence of systemic disease.

CONCLUSIONS

To our knowledge, this is the first case of plasmacytoma in the literature to involve the cornea. This case was not associated with systemic disease. Surgical excision and brachytherapy remain options for cases without corneal involvement.