Orbital plasma cell myeloma

Retinal Microvascular Changes in Patients with Multiple Myeloma: A Study Based on Optical Coherence Tomography Angiography

PURPOSE

Ocular microvascular networks and variables were analyzed using optical coherence tomography angiography (OCTA) in patients with multiple myeloma (MM) who had no pathological findings in their routine ophthalmologic examinations.

MATERIALS AND METHODS

The study included 31 patients with a diagnosis of MM and 30 healthy controls. The ophthalmologic examination findings and OCTA measurements of the participants were prospectively analyzed. We evaluated the superficial capillary plexus (SCP) vessel density (VD) and deep capillary plexus (DCP) VD in macular region, radial peripapillary capillary (RPC) VD, optic nerve head (ONH) VD and the foveal avascular zone (FAZ) area.

RESULTS

The samples were gender-balanced, and there were no significant differences in age or gender between the MM and control groups. From the OCTA, all the ONH-VD measurements, except for the peripapillary and superotemporal parameters, were found to be significantly lower in MM patients than in the control group; the same was found for the whole image, inferonasal, superonasal, and superotemporal RPC-VD values; for all the SCP-VD values, except for the inferior hemi and temporal; and for all the DCP-VD values. It was also observed that the deep FAZ area was wider in the MM group than in the control group.

CONCLUSIONS

We detected decreased VD in deep and superficial macular retinal areas, papillary, peripapillary regions, suggesting decreased blood flow and possible ischemia in MM patients. Therefore, obtaining information on ischemia by using a noninvasive and easily measurable method such as OCTA, may be beneficial in terms of follow-up and treatment but this needs to be supported by further, larger studies.

Characteristics of orbital multiple myeloma: a case report and literature review

Multiple myeloma is a plasma cell malignancy that destroys skeletal, renal, and neurological function. Orbital involvement is rare, but has been considered an initial presentation for the malignancy. Furthermore, an association between the subtype of multiple myeloma and the likelihood of orbital infiltration has been suggested. We present a case of an orbital mass that was a recurrence of multiple myeloma. A literature search was performed to evaluate the presentation characteristics of orbital multiple myeloma, plasmacytoma and primary (or solitary) extramedullary plasmacytoma. Past reports were analyzed for age, sex, symptoms at presentation, time from symptom onset to presentation, prior diagnosis before presentation for orbital symptoms, radiological characteristics, immunoglobulin subtype, and survival times. Less than half of published cases had orbital multiple myeloma as the primary presentation. Proptosis is the major presenting sign of orbital multiple myeloma, and radiological evaluation shows that the majority of masses originate in the superotemporal quadrant. The dominant immunoglobulin subtype was IgG.

Primary bone tumors of the orbit

Primary tumors of orbital bone constitute 0.6% to 2% of all orbital tumors. Our experience over a 24-year period in the Orbital Clinic at the University of British Columbia yielded 62 (1.9%) cases from a total of 3,340 orbital tumors. Although a heterogeneous group, primary orbital bone tumors may be classified on a clinicopathologic basis into benign fibro-osseous or cartilaginous, reactive, neoplastic and vascular disorders. Presentation is usually a gradual mass effect, with infiltration and acute hemorrhage being features of malignant and reactive lesions respectively. The two most commonly encountered entities were fibrous dysplasia and osteoma, accounting for 22 cases. Although both these conditions rarely present a diagnostic challenge, nonspecific histologic and radiologic appearances can result in poor characterization of several of the rarer lesions. Hence, close cooperation between clinician, radiologist and pathologist is essential for accurate 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.

Multiple myeloma and its ocular manifestations

Multiple myeloma is a malignancy of the cells of the immune system that frequently involves the eye. Cysts of the ciliary body have been reported in 33-50% of myeloma patients, and retinal vascular lesions have been reported in up to 66%. Corneal and orbital involvement is less common. In this review, systemic and immunologic aspects of multiple myeloma are outlined and ocular manifestations are illustrated.

Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy

Multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy are examples of diseases in which there is an uncontrolled proliferation of cells involved in antibody synthesis. Myeloma and macroglobulinemia are considered malignant diseases, whereas monoclonal gammopathy is benign or possibly a pre-myelomatous condition. Following a brief review of the immunoglobulins the various clinical manifestations of these disorders are described. The ophthalmic signs of these disorders can be seen in every ocular structure.

Angiography in myeloma (plasmacytoma). A correlated angiographic and histologic study

Angiography was performed in ten cases of myeloma (plasmacytoma), of which nine were solitary on admission. All lesions were hypervascular bone tumors with extension of neoplastic growth into adjacent soft tissue. Contrast uptake of the tumors occurred regularly and usually was non-homogeneous. In nearly all cases irregular tumor vessels and early venous drainage was evident with arteriovenous shunting in three. Pathologic-anatomic correlation demonstrated 'tumor vessels' to be newly formed vascular spaces lacking the normal constituents of vessel walls. The contrast uptake presumably was caused by passage of contrast into the newly formed, slit-like capillary vascular spaces. Angiography usually permitted separation of myeloma from benign, hypervascular bone lesions. The procedure proved to be of particular value in indicating definite malignancy, since myeloma was considered initially as the probable diagnosis in only one of the series. It was not possible, however, to differentiate myeloma from other malignant tumors by plain radiography or angiography. Irreversible renal failure occurred in one patient after angiography.

Immunofluorescent and immunoperoxidase characteristics of IgDlambda myeloma involving the orbit

A biopsy specimen from a 59-year-old man with unilateral proptosis revealed an orbital plasmacytic tumor. In vitro immunoperoxidase and immunofluorescence studies and direct immunoperoxidase staining of Bouin's fixed, paraffin-embedded tissue sections demonstrated that the tumor consisted of plasma cells with surface and intracellular IgDlambda immunoglobulin. Systemic evaluation demonstrated multiple myeloma. A review of previously published reports combined with the case presented here suggests that IgD myeloma has a predilection for orbital involvement. Thus, while IgD myeloma accounts for only 2% of all myelomas, it may account for a significant percentage of myelomas with orbital involvement. The distinctive clinical course of IgD myeloma, particularly its poor prognosis, warrants consideration of the immunologic and serologic findings in patients with orbital involvement by myeloma. The application of immunofluorescence and immunoperoxidase techniques to the study of orbital lymphoreticular neoplasms should result in a clearer understanding of these neoplasms.

Orbital involvement by plasmacytoma. Report of two cases

Two patients with orbital involvement of plasma cell myeloma are presented. The first patient presented an isolated plasmacytoma in the orbit; the second patient had generalized plasma cell myeloma. In both cases X-rays and computed tomographic scanning gave valuable information and biopsy confirmed the diagnosis.