An unusual ocular manifestation of multiple myeloma

Abstract

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.

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

“…In humans, conjunctival plasmacytomas are extremely rare [ 9 ] and mostly originate from the extension of orbital lesions. Most human orbital plasmacytomas are diagnosed in patients with a history of MM or in asymptomatic cases of MM where the diagnosis is not yet established [ 10 ].…”

“…A single case of conjunctival/third eyelid gland primary EMP has previously been reported in a dog [ 6 ]. Additionally, presumed intraocular [ 8 ] and orbital [ 9 ] primary EMPs have been described in a cat and a dog, respectively. In both of these species, cutaneous and gastrointestinal EMPs are more common and occur mainly in middle aged to older animals with no apparent sex predisposition [ 17 ], but with a higher occurrence in some dog breeds: American and English Cocker Spaniels, Airedale, Kerry Blue and Scottish Terriers [ 2 , 18 ].…”