Multiple Solitary Plasmacytomas Presenting with Painful Erythematous Swelling of the Upper Eyelid

Yu Jeong Kim; Mijung Chi

doi:10.3341/jkos.2017.58.2.216

Journal List > J Korean Ophthalmol Soc > v.58(2) > 1010706

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Chi: Multiple Solitary Plasmacytomas Presenting with Painful Erythematous Swelling of the Upper Eyelid

Original Article

J Korean Ophthalmol Soc 2017;58(2):216-221.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.216

Multiple Solitary Plasmacytomas Presenting with Painful Erythematous Swelling of the Upper Eyelid

Yu Jeong Kim, M.D., Mijung Chi, M.D., PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

Address reprint requests to Mijung Chi, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: 82-32-460-3751, Fax: 82-32-460-3358 E-mail: cmj@gilhospital.com

Received 20 October 201630 November 2016 Accepted 8 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of multiple solitary plasmacytomas that presented with painful erythematous swelling of the upper eyelid. The patient was diagnosed with extramedullary plasmacytoma, and was later found to have multiple metastases of the bone and soft tissue during follow up.

Case summary

A 55-year-old female patient presented with painful erythematous swelling of the left upper eyelid that persisted for 1 month prior to examination. Under suspicion of lacrimal gland inflammation, anti-inflammatory medication was started but the symptoms worsened. Orbital computed tomography showed that a mass infiltrated the left lacrimal gland. We performed inci-sional biopsy of the mass via eyelid crease incision. Based on histopathological examination, the mass was diagnosed as extra-medullary plasmacytoma and the patient was treated with radiation. After a 10-month follow-up period, multiple metastases on the left parotid gland, thoracic spine, lumbar spine and pelvic bone were observed. Finally, we diagnosed the patient with multi-ple solitary plasmacytomas.

Conclusions

We report the first case of multiple solitary plasmacytomas presenting with upper eyelid painful erythematous swelling. This condition should be considered for patients presenting with eyelid inflammation. In addition, long term follow up should be conducted to detect metastasis or recurrence.

Keywords: Extramedullary plasmacytoma, Multiple solitary plasmacytomas, Orbital mass

References

1. International Myeloma Working Group. Criteria for the classi-fication of monoclonal gammopathies, multiple myeloma and re-lated disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003; 121:749–57.

2. Lee MS, Hur J, Shin SG. Plasmacytoma on the upper cyclid. J Korean Ophthalmol Soc. 1997; 37:156–61.

3. Nam KR, Lee Wj, Kim JS. Case report on primary extramedullary plasmacytoma originating in the lacrimal gland. J Korean Ophthalmol Soc. 1998; 39:771–6.

4. Choi JK, Park JS, Park IK. A case of plasmacytoma in the orbit. J Korean Ophthalmol Soc. 2003; 44:2919–23.

5. Lee SJ, Choi CW, Kim SD. A case of extramedullary plasmacyto-ma in the lacrimal excretory system. J Korean Ophthalmol Soc. 2015; 56:427–31.

6. Kim KH, Oh DE, Kim YD. A case of solitary bone plasmacytoma presenting with erythematous swelling of the upper eyelid. J Korean Ophthalmol Soc. 2007; 48:731–6.

7. Soutar R, Lucraft H, Jackson G. . Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary ex-tramedullary plasmacytoma. Br J Haematol. 2004; 124:717–26.

8. Koçak E, Ballerini G, Zouhair A, Özş ahin M.Radiation therapy for the solitary plasmacytoma. Turk J Hematol. 2010; 27:57–61.

9. Yang B, Wang J, Cai LL. . Treatment of multiple solitary plas-macytomas with cytokine-induced killer cells. Cytotherapy. 2014; 16:278–84.

10. Dattolo P, Allinovi M, Michelassi S, Pizzarelli F. Multiple solitary plasmacytoma with multifocal bone involvement. First clinical case report in a uraemic patient. BMJ Case Rep. 2013; 2013(pii):bcr2013009157.

Figure 1.

Erythematous swelling and induration of left upper eyelid. (A) Frontal view. (B) Worm's eye view.

Figure 2.

Radiologic findings. Preoperative axial (A) and coronal (B) views of the orbit computed tomography show well-enhanced tumor of left lacrimal gland with preserved bony structure and other adnexa. The mass shows iso-signal intensity on T1-weighted (C) and T2-weighted image (D) on orbital magnetic resonance imaging and the mass is well enhanced (E).

Figure 3.

Gross and Pathophysiologic findings of the mass. (A) Gross finding of the specimen. Multiple lobulated round-shaped mass is shown. Histopathologic findings of the mass: (B) Monotonous cells with eccentric nuclei, which are characteristic of mature plasma cell tumors (Hematoxylin and eosin staining [HE] stain, ×400). Tumor cells show CD 135 positive (×200) (C), kappa light chain negative (×200) (D), and cytoplasmic λ– light chain positive (×200) (E).

Figure 4.

Plasmacytoma of left parotid gland. (A) Erythematous swelling of the left infra-auricular area (arrow). (B) Axial view of the head and neck computed tomography shows well-enhanced tumor of left parotid gland (arrow). (C) Gross finding of the specimen.

Figure 5.

Multiple metastases of solitary plas- macytoma. (A) Multiple metastases of solitary plasmacytoma are shown on positron emission tomography-computed tomography (blue arrow: left parotid gland, red arrows: T7, L4, right ilium). (B) Sagittal view of the spine magnetic resonance imaging shows lytic bone lesion of T7 (red arrow).

TOOLS

Similar articles