Stacey Andrew W, Lavric Alenka, Thaung Caroline, Siddiq Samreen, Sagoo Mandeep S
*Moorfields Eye Hospital, London, United Kingdom;†St. Bartholomew's Hospital, London, United Kingdom;‡Department of Ophthalmology, University of Washington, Seattle, WA;§University College London Institute of Ophthalmology, London, United Kingdom; and¶Department of Haematology, North Bristol NHS Trust, Bristol, United Kingdom.
Cornea. 2017 Jul;36(7):875-877. doi: 10.1097/ICO.0000000000001222.
To report a case of solitary iris plasmacytoma successfully treated with ruthenium plaque radiotherapy.
A 44-year-old white woman presented with pain in the right eye and raised intraocular pressure. Her medical history included breast cancer treated 11 years earlier with lumpectomy, lymph node clearance, chemotherapy, and radiotherapy. On examination, the right iris had a tan-colored mass with crystalline deposits visible on the mass surface and on the corneal endothelium. The fundus and left eye were normal. An anterior segment ultrasound scan showed a mass with mixed internal echogenicity and internal blood flow.
An iris biopsy showed an infiltrate of plasma cells. Immunohistochemistry for kappa and lambda light chains demonstrated lambda light chain restriction. Systemic hematologic investigations including complete blood count, serum paraproteins, bone marrow biopsy, and full-body magnetic resonance image were normal. The monoclonal plasma cell infiltrate was consistent with a solitary iris plasmacytoma. The mass was treated with ruthenium plaque radiotherapy. After 4 years of follow-up, the mass remained regressed, and no systemic myeloma has developed.
Iris plasmacytoma is rare and should prompt systemic evaluation to rule out multiple myeloma. Solitary iris plasmacytoma can be successfully treated with plaque radiotherapy.
报告一例采用钌板放射治疗成功治愈的孤立性虹膜浆细胞瘤病例。
一名44岁白人女性因右眼疼痛和眼压升高就诊。她的病史包括11年前接受保乳手术、淋巴结清扫、化疗和放疗的乳腺癌。检查发现，右眼虹膜有一个棕褐色肿块，肿块表面和角膜内皮可见结晶沉积物。眼底和左眼正常。前段超声扫描显示肿块内部回声不均匀且有内部血流。
虹膜活检显示浆细胞浸润。κ和λ轻链的免疫组织化学显示λ轻链受限。包括全血细胞计数、血清副蛋白、骨髓活检和全身磁共振成像在内的全身血液学检查均正常。单克隆浆细胞浸润与孤立性虹膜浆细胞瘤一致。该肿块采用钌板放射治疗。经过4年的随访，肿块持续消退，未发生系统性骨髓瘤。
虹膜浆细胞瘤罕见，应进行全身评估以排除多发性骨髓瘤。孤立性虹膜浆细胞瘤可通过斑块放射治疗成功治愈。
