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| CASE REPORT |
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| Year : 1984 | Volume
: 32
| Issue : 3 | Page : 181-183 |
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Primary extramedullary solitary plasmacytoma of conjunctiva - a case report
MCR Vyas, SP Vyas, RK Chaudhary
Department of Pathology, Ophthalmology & Radiology. & Radiotherapy, Sardar-Patel Medical College. Bikarner, India
Correspondence Address:
MCR Vyas
Department of Pathology, Sardar Patel Medical College, Bikaner
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 6519736 
How to cite this article:
Vyas M, Vyas S P, Chaudhary R K. Primary extramedullary solitary plasmacytoma of conjunctiva - a case report. Indian J Ophthalmol 1984;32:181-3 |
The primary ocular (conjunctiva) plasmo cytomas are rare.[1],[2],[3] In view of this rarity, a case of solitary primary extramedullary plasmacytoma involving conjunctiva is reported.
| Case report | |  |
KR. a 22 years old female was first admitted in Government Hospital, Ratangarh (Rajasthan) with the complaints of a progressively increasing painless swelling in the left lower fornix of the eye and slightly incomplete closure of eye of one year duration. There was no history of any ocular infection, trauma or foreign-body in affected eye in past approximately six months.
On examination there was a grayish pink soft smooth non lobulated, nonreducible and nonfixed painless swelling of approximately 2X0.75X0.5' cms size occupying the lower for nix of the left eye, the upper bulge of the smooth swelling was just visible with open eye. There was no congestion of palpebral and bulbar conjunctiva. The upper eye lid and the right eye were normal and free of tumour.
Cornea was normal without any vascularization or opacity. Fundus examination was normal. The examination of ear, nose and throat revealed no abnormality. There was no palpable cervical or axillary lymphadenopathy.
A clinical diagnosis of a benign tumour and conjunctival amyloidosis was made and a local excision was done.
Gross specimen was a tan soft apparently encapsulated mass of 2X 1X0.5 cms size. Histology of the tumour mass showed a thin fibrous capsule. It was-cellular with virtually no connective tissue stroma. the cells resembled
The patients haemoglobin level was 12.8 gm%, the ESR 25 mm in the first hour. A bone marrow aspirate showed normal cellularity with no myeloma cells and normal number of plasma cells, a complete skeletal survey failed to show bony masses or osteolytic deposits. No albuminuria or Bence Jones proteinuria was demonstrated, the latter being excluded by serum and urine (concentrated) electrophoresis. The serum total protein was 6.3 gms/100 ml. There were no hone tenderness and her body weight unchanged.
Patient received a course of radiotherapy (2500 rads in 10 sittings) and was asked to report for checkup once in a month. In 10 months under follow up no recurrence has occurred.
| Discussion | | |
Plasma cell tumours have been divided by Wills[6] into three types viz., plasma cell myelomatosis, solitary plasmacytoma of bone and primary plasmocytoma of soft tissue.
Histological diagnosis of solitary plasmocytoma at sites like conjunctiva warrants a critical appraisal of the lesion and the diagnosis is made when only monomorphic neoplastic plasma cells seen in sheets groups and clusters without any admixture of the inflammatory cells and other features of inflammatory granuloma.
More et a1[7] and Soja et alb makes the point that the mere presence of large number of plasma cells should not lead to the diagnosis of plasma cell neoplasms but indicates that granuloma may become large enough to be mistaken for the neoplasm. In such cases an infiltrate consisting predominantly of plasma cells found with an admixture of lymphocytes or polymorphs occasionally macrophages and even fibroblasts. Vascular proliferation is common and mitotic figures may also be seen. Our present case rigidly fulfilled the histological criteria for plasmo cytoma and was completely free from inflammatory pathology. It also provided a supplementary evidence of paramyloid like material in the wall of medium sized vessels.
The presence of generalized disease was adequately excluded by urine examination for Bence Jones proteins, serum protein estimation, skeletal survey, bone marrow studies and serum protein electrophores-is which excluded generalized disease.
The age at presentation range from 8 years plasma cells with hyperchromatic often acentric nuclei and eosinophilic cytoplasm [Figure - 1][Figure - 2]. There was a moderate degree of nuclear pleomorphism, cells with two nuclei were present. Methyl green pyronin staining showed pyroninophilia of the cytoplasm. Capsular and vascular invasion by tumour cell was not seen. In the tumour substance a few medium sized blood vessels were seen with thickened wall partially replaced by a homogenous eosinophilic hyaline like material. This material was not present elsewhere in tumour. (Amyloid stains provided inconsistent staining -characters). to 52 years, the peak incidence being 5th and 6th decade Wiltshaw.[5] Extramedullary plasmocytoma vary considerable in size ranging from 1 cm to several cms in diameters, these are normally well defined firm and spherical may be polypoidal.
Treatment of extramedullary plasmocytoma may be surgery, radiotherapy on chemotherapy, radiotherapy is sometimes given after surgical excision. The behaviour of extra medullary plasmacytoma is unpredictable. They may follow a benign course with apparent cure after treatment[2],[5]. They may recur spread to regional lymph nodes or disseminate involving bone in 40% of cases.[5] Role of radiotherapy for solitary plasmacytoma at various locations has been stressed by Tood[11].
Generally however, more pleomorphic tumours behave more aggressively. Our present case without conspicuous cellular pleomorphism, mitotic activity and capsular or vascular invasion and also absence of lymphadenopathy has been free of tumour after ten months of surgical removal and radiotherapy. With this we believed that the benign course followed by our patient so far should be maintained.
Atypical amyloid (paramyloid) with atypical histochemical properties may be observed as a consequence of a primary disorder of plasma cell proliferation in situations as blood vessels, skin muscle and gastrointestinal tract[10] present case also showed paramyloid deposits in vessel walls.
| References | | |
| 1. | Ashley. D.J.B.: Even's histological appearances of tumour, 1978. 3rd Edn. P. 217, Churchill Livingatons England.  |
| 2. | Dolin, S. and Dever, J.P. 1956. amer. J. Pathol., 32:83. Am.J. Pathol. 32:83, 1956. |
| 3. | Innes, J. and Newall, J. 1961. Lancet, 1, 239, 1968. |
| 4. | Hellwig, G.A., 1943, Arch. Pathol. 36:95. |
| 5. | Wiltshaw; E. 1971. Brit Med. 12:327. |
| 6. | Willis. R.A., 1967, Pathology of tumours, 4th Edn., Page 795. Buttetworth, London, P. 795. |
| 7. | More, J.RS., Dawson, D.W., Ralston, A.J. and Craig, I. 1968. J. Clin. Pathol. 21. 661. |
| 8. | Soja. J. Sailo, K Suzhki. N. and Sakai, T. 1970 25,618. |
| 9. | WEBB. H.E., Harrison, E.G.; Mason, J.K. and RE Mine. W.G. 1962-16:1142. |
| 10. | Osserman. E.F.: 1959. New Eng. J. Med. 261;952, 1006. |
| 11. | Tood, I.D.H. 1965, Clin. Radiol. 16:395. |
[Figure - 1], [Figure - 2]
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