J Korean Ophthalmol Soc.  2017 Feb;58(2):216-221. 10.3341/jkos.2017.58.2.216.

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

• Kim YJ
• Chi M

• KMID: 2369472
• DOI: http://doi.org/10.3341/jkos.2017.58.2.216

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 incisional biopsy of the mass via eyelid crease incision. Based on histopathological examination, the mass was diagnosed as extramedullary 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 multiple 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.

Keyword

Extramedullary plasmacytoma; Multiple solitary plasmacytomas; Orbital mass

MeSH Terms

Biopsy
Eyelids*
Female
Follow-Up Studies
Humans
Inflammation
Lacrimal Apparatus
Middle Aged
Neoplasm Metastasis
Orbit
Parotid Gland
Pelvic Bones
Plasmacytoma*
Recurrence
Spine

Figure

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  Figure 1. Erythematous swelling and induration of left upper eyelid. (A) Frontal view. (B) Worm's eye view.

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  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).

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  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).

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  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.

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  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).

Reference

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