Orbital Manifestation of Multiple Myeloma: Case Report

Gönül, Engin; İzci, Yusuf; Sefali, Mükerrem; Erdoğan, Erhan; Tımurkaynak, Erdener

doi:10.1055/s-2001-18121

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…Focal plasma cell lesions involving the GWS (plasmacytomas) may occur as isolated lesions (2/12 cases in this review) or within the setting of multiple myeloma (10/12 cases). Ten reported cases, and 1 of our own, of plasmacytoma of the GWS showed purely bone erosion, [35][36][37][38][39][40][41][42][43][44] but another case of ours showed quite marked osteogenesis within the lesion, which had previously been irradiated but then recurred. There was also bone erosion within the lesion (Figure 6).…”

Section: Infectionmentioning

confidence: 70%

“…The list of our own and published lesions appears in Table 2. 2–99 Published cases of 4 of the listed diagnoses were not reviewed because there is a significant literature on these already (sickle cell crisis with sphenoid infarction, tuberculosis of orbital bone, sphenoid bone dysplasia in NF1, and fibrous dysplasia of bone). During the same period as these new cases were collected from our practices, 97 cases (21 males) of spheno-orbital meningioma were encountered by us.…”

Section: Resultsmentioning

confidence: 99%

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Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes

McNab

Jones

Hardy

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma. Methods: We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a “dural tail” on contrast-enhanced MRI. The clinical and imaging features were also briefly summarized for each diagnostic group. Results: The largest diagnostic group was metastasis (67 cases, 47.5%). The most useful imaging features that helped differentiate meningioma from its mimics were the presence of bone erosion and the absence of a “dural tail.” Other features were helpful in a small minority of cases only. Metastatic prostate cancer was the largest single group (21 cases), and 18 (85.7%) of these were osteoblastic and most closely mimicked meningioma. Prostate cancer patients were generally older than males with GWS meningioma. Almost all other (44/46, or 95.7%) metastatic lesions showed evidence of bone erosion. Almost half (30 of 61, 49.2%) of patients with metastasis presented without a known diagnosis of malignancy. Among children 16 years of age and less, Langerhans cell histiocytosis (10 cases), dermoid cyst (5), and Ewing’s sarcoma (5) were the most common diagnoses. Conclusions: A combination of a careful history and both CT and MRI gives information, which can best guide the management of patients with spheno-orbital lesions. Metastatic prostate cancer to the GWS most closely mimics GWS meningioma but can in most cases be differentiated on clinical and imaging features. Older males with hyperostotic lesions of the GWS should be investigated for prostate cancer. Other metastatic lesions and primary tumors of the GWS, as well as benign and structural lesions can readily be differentiated from meningioma on clinical and imaging features.

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Section: Infectionmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes

McNab

Jones

Hardy

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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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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“…We completely removed the gross optic tumor and applied radiotherapy post-surgery using a moderate radiation dose to better control residual microscopic tumor development. In a recent report, Gönül et al [ 16 ] used right orbitozygomatic craniotomy to successfully remove a mass lesion in a 60-year-old subject diagnosed with orbital multiple myeloma.…”

Section: Discussionmentioning

confidence: 99%

Frontal skull craniotomy combined with moderate-dose radiotherapy effectively ameliorate a rare case of non-secretory, multiple myeloma with orbital involvement

Chen

Chi

2009

World J Surg Onc

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BackgroundOrbital infiltration in patients with multiple myeloma is a rare condition, with less than 50 cases reported in the medical literature. Most patients undergo conservative treatment because multiple myeloma is a disseminated systemic disease.Case presentationA 43-year-old male subject with multiple myeloma and long-term survival presented with orbital involvement. The subject lacked the typical features and poor prognostic factors associated with multiple myeloma, such as renal failure, hypercalcemia, and paraprotein in the serum and urine. The orbital computed tomographic scan revealed the tumor encasing the optic nerve, but without prominent bony destruction. Therefore, a frontal skull craniotomy with an epidural entrance to the orbital space was performed, to completely extirpate the orbital mass. The surgical procedure was followed by moderate-dose radiation therapy. After 32 months of follow-up care, the subject is doing well with excellent local control.ConclusionAlthough the effectiveness and applicability of this approach remains to be determined, this case report demonstrates that accurate and early detection combined with local surgical treatment and appropriate radio/chemotherapy, can be applied to effectively extend an orbital multiple myeloma patient's life.

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Orbital Manifestation of Multiple Myeloma: Case Report

Cited by 6 publications

References 12 publications

Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes

Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes

Orbital Involvement in Multiple Myeloma

Frontal skull craniotomy combined with moderate-dose radiotherapy effectively ameliorate a rare case of non-secretory, multiple myeloma with orbital involvement

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