|Year : 1993 | Volume
| Issue : 1 | Page : 34-36
Plasmacytoma of orbit
PK Agrawal, Shubhi Mittal, Puneet Gupta, Kapil Agrawal, Jitendra Agrawal, Padma K Agrawal
Departments of Ophthalmology and Pathology K.G. Medical College, Lucknow, India
P K Agrawal
Dept. of Pathology, K.G. Medical College, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal P K, Mittal S, Gupta P, Agrawal K, Agrawal J, Agrawal PK. Plasmacytoma of orbit. Indian J Ophthalmol 1993;41:34-6
Plasmacytoma is a descriptive term applied to tumours consisting essentially of plasma cells. Ocular involvement by plasmacytoma has been described in conjunctiva, lacrimal sac, lids, caruncle and orbit. The incidence of this tumour in the orbit remains very low as even in some of the large series of orbital tumours, plasmacytoma has not been mentioned. Because of the paucity of reports concerning orbital involvement by this type of tumour, the following two case reports are presented.
| Case report|| |
Case I: A 60 year old female was admitted in Ophthalmology department with a progressive proptosis of right side of 1 month duration [Figure - 1].
There was no associated history of trauma or any systemic illness. On examination, there was axial proptosis of 8mm with displacement 2mm inferiorly and 2mm medially. Orbital tonometry was raised with restricted movements in all gazes. The visual acuity was counting fingers in both the eyes due to lenticular opacity. CT scan was not done because of inaccessability.
On superolateral orbitotomy a firm to hard mass with necrosis was removed and sent for histopathological examination. Histopathological examination showed an infiltrative lesion. Normal structure of lacrimal gland was totally destroyed. Plasma cells with lymphocytes were seen embedded in eosinophilic cytoplasm. Plasma cells exhibited pleomorphism and immaturity.
Case II: A 70 year old male was admitted to Ophthalmology department with the complaint of progressive proptosis of right side of 15 days duration. There was no history of trauma or any systemic illness although proptosis was associated with diminution of vision in the same eye [Figure - 2].
On examination, a mass was felt on the superolateral aspect of right orbit, the posterior limit of which was not reachable. There was axial proptosis of 9mm (Hertel's exophthalmometer) with 4mm and 2mm downwards and medial displacement respectively. Orbital tonometry was raised with restricted movements in all gazes but more restricted in upward gaze. Vision in right eye was reduced to FC 3 mts. Fundus of both eyes were normal.
CT scan of orbit revealed a mass in superolateral aspect of right orbit in relation to lacrimal gland with intracranial extension and infiltration in bones without any evidence of brain tissue involvement [Figure - 3][Figure - 4].
On surgical exposure through orbitotomy, one haemorrhagic necrosed mass with adjoining lacrimal gland and tissues, with intracranial extension was removed and sent for histopathological examination.
Histopathological examination of the section revealed an infiltrative lesion consisting of plasma cells and lymphocytes with eosinophilic cytoplasm. The cells were anaplastic and exhibited pleomorphism. The normal structure of lacrimal gland could not be made out [Figure - 5][Figure - 6].
In an attempt to determine the frequency of orbital involvement by plasmacytomas, several large series of orbital tumours were reveiwed. [Table - 1] lists five such series in which specific reference was made to orbital plasmacytomas. Out of total almost 2,500 orbital tumours, only seven were believed to be plasmacytomas. In the present study of 712 cases of orbital tumours, only 2 cases were diagnosed as plasmacytoma of orbit.
The Diagnosis of plasmacytoma is based largely upon histologic study of the tumour tissue. The clinical picture of a slowly progressive unilateral proptosis associated with subjective diplopia and bony erosive changes on X-Ray and CT scan, as demonstrated in these cases, fits into the neoplastic category or orbital tumours as defined by Beneducts. This tumour is highly malignant as even after surgical excision both the patients died due to intracranial extension.
Surgical removal of the tumour is the treatment of choice. Regression of plasmacytoma, with extensive involvement of vital orbital tissues and bony erosive changes, with radiotherapy has been described. However, a subtotal removal combined with extensive radiotherapy may produce good therapeutic and clinical results.
| References|| |
Herold J, Rodman and Font RL. Orbital involvement in multiple myeloma, review of literature and report of three cases. Arch Ophthalmol. 90: 87,1972.
Edwin Clarke. Plasma cell myeloma of the orbit. Br J Ophthalmol. 37:545,1953.
Vernon KS Jim. Plasmacytoma of the orbit. Am J Ophthalmol. 39: 43, 1955.
Henderson JW. Orbital tumours: WB Saunders Company, 1973.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
[Table - 1]