Oyemade Kafayat A, Stafford Scott L, Gertz Morie A, Patel Sanjay V, Baratz Keith H, Dalvin Lauren A
Alix School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
Department of Radiation Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
Am J Ophthalmol Case Rep. 2022 Apr 10;26:101533. doi: 10.1016/j.ajoc.2022.101533. eCollection 2022 Jun.
Describe a case of intraocular plasmacytoma in a patient with multiple myeloma successfully treated with photon irradiation.
A 61-year-old man with a history of relapsing/refractory multiple myeloma and left frontal bone plasmacytoma treated with monthly belantamab mafodotin salvage chemotherapy developed bilateral treatment-related corneal keratopathy. An iris mass was incidentally noted in the right eye during a follow-up examination. The mass was amelanotic with diffuse intrinsic vasculature involving the pupillary margin from 1:30 to 10:30. Fundus examination showed an irregularly shaped amelanotic superotemporal scleral lesion in the right eye and two smaller amelanotic scleral lesions in the left eye. Given known systemic multiple myeloma and history of left frontal bone plasmacytoma, a presumed diagnosis of iris and scleral plasmacytoma was made. Due to rapid progression of the iris plasmacytoma despite systemic chemotherapy, the patient was treated with 20 Gy photon irradiation to the anterior and posterior segments of both eyes. One month after photon irradiation, there was complete regression of the iris plasmacytoma, and the scleral lesions in both eyes also appeared to be regressing despite systemic progression of multiple myeloma.
Intraocular plasmacytoma is rare and can occur in isolation but typically occurs as a manifestation of systemic multiple myeloma. Intraocular plasmacytoma can be successfully treated with photon irradiation in patients with multiple myeloma who progress on systemic chemotherapy.
描述一例患有多发性骨髓瘤的患者发生眼内浆细胞瘤，并成功接受光子照射治疗的病例。
一名61岁男性，有复发性/难治性多发性骨髓瘤病史，曾接受每月一次的贝兰他单抗马福多汀挽救化疗，治疗左额骨浆细胞瘤，现出现双侧与治疗相关的角膜病变。在一次随访检查中，偶然发现右眼有一个虹膜肿物。该肿物无色素，有弥漫性内在血管，累及瞳孔边缘1:30至10:30的范围。眼底检查显示右眼有一个形状不规则的无色素性颞上巩膜病变，左眼有两个较小的无色素性巩膜病变。鉴于已知有系统性多发性骨髓瘤及左额骨浆细胞瘤病史，推测诊断为虹膜和巩膜浆细胞瘤。尽管进行了全身化疗，但虹膜浆细胞瘤仍迅速进展，遂对患者双眼的前段和后段进行20 Gy的光子照射治疗。光子照射治疗1个月后，虹膜浆细胞瘤完全消退，尽管多发性骨髓瘤有全身性进展，但双眼的巩膜病变似乎也在消退。
眼内浆细胞瘤罕见，可单独发生，但通常是系统性多发性骨髓瘤的一种表现。对于在全身化疗中病情进展的多发性骨髓瘤患者，眼内浆细胞瘤可通过光子照射成功治疗。
