Sphenoid sinus localization of multiple myeloma revealing evolution from benign gammopathy

Bachmeyer, Claude; Lévy, Vincent; Carteret, Martine; Laccourreye, O.; Danel, Claire; Tourneau, A. Le; Zittoun, R; Grateau, Gilles

doi:10.1002/(sici)1097-0347(199707)19:4<347::aid-hed14>3.0.co;2-6

Cited by 8 publications

(1 citation statement)

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“…The anatomic localization accounts in large part for the difficulty of diagnosing a pathologic process when it is confined to the sphenoid and for the wide diversity of presenting findings when the mass extends out of the sphenoid or arises in adjacent structures. [6] Unlike other paranasal sinus lesions that usually present with nasal obstruction, epistaxis, and nasal discharge, headache and II, III, IV, VI cranial nerve palsies are the most frequent symptoms of isolated sphenoid sinus diseases. However, these symptoms are usually vague and nonspecific, until the tumor grows and expands to the sinus wall.…”

Section: Discussionmentioning

confidence: 99%

An unusual presentation of multiple myeloma with unilateral sudden vision loss

Lee

Chen

et al. 2017

Medicine

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Rationale:Plasma cell neoplasms are categorized by neoplastic proliferation of a single clone of plasma cells which produce a monoclonal immunoglobulin. Plasma cell neoplasms can present as a solitary plasmacytoma or as multiple myeloma. Both of them can progress to multiple myeloma. Once a diagnosis of plasmacytoma has been made, thorough examinations should be carried out for identifying the disease entity.Patient concerns and diagnoses:Herein, we describe an extraordinary rare case of multiple myeloma with initial presentation of a left sphenoid neoplasm resulting in left-sided headache and rapid deterioration of visual acuity. Histo-pathologic analysis revealed a plasma cell neoplasm with positive immunostaining for cluster of differentiation (CD)138, CD79a, and kappa light chain of immunoglobulin. A bone marrow aspiration was then performed, and the diagnosis of multiple myeloma was then confirmed.Interventions and outcomes:After investigative workup, our patient received chemotherapy, localized radiotherapy, and autologous stem cell transplantation. Her visual acuity recovered to the baseline and she sustained a partial response without subjective discomfort.Lessons:Extramedullary plasmacytoma is an interesting but infrequent presentation of multiple myeloma. Moreover, involvement of the sphenoid sinus in multiple myeloma resulting in extrinsic optic nerve compression is extremely rare. Clinicians should consider plasmacytoma as a diagnostic possibility when presented with cases of solitary sphenoid neoplasm and rapid progression of clinical course.

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Section: Discussionmentioning

confidence: 99%