PMC10450026_01
(A) Orbital tumor presentation. Orbital mass in the left eye presenting subconjunctival extension and no evidence of adherence to the globe or eyelids. (B) Surgical biopsy of the left orbital mass. Macroscopic view of the excised red colored mass measuring 16 mm x 14 mm x 12 mm with an elastic consistency.
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We present a 51-year-old woman who consulted the ophthalmology emergency department with proptosis on the left eye, oedema, and superior palpebral induration of one week duration ( Figure 1A ). A surgical biopsy of the lesion was performed through superior-temporal conjunctival incision ( Figure 1B ).
Histopathological features of plasma cell neoplasm with pleomorphic features. (A-C) Histopathological features showing a dense subepithelial infiltrate (A) of a medium-sized cells with diffuse distribution. (B) At higher magnification, (C) the tumor cells show plasma cell differentiation with Dutcher bodies but a higher level of pleomorphism than expected for a mature plasma cell proliferation. (D) Positive staining for CD138 and negative staining for CD20 (E) with partial positivity for cyclin D1 (F). Staining for kappa (G) and lambda (H) shows lambda light-chain restriction. In addition, staining for KI67 (I) shows a proliferation index of around 70%, higher than expected for a mature plasma cell proliferation.
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All findings were consistent with a diagnosis of plasmacytoma, suggestive of extramedullary progression ( Figure 2 ).
Axial MRI and PET-CT. Red arrow: Right orbital mass in the superior-temporal quadrant. Green arrow: Right orbital mass with increased FDG uptake. Blue arrow: Surgical bed after left orbital biopsy with high FDG uptake, possibly related to postsurgical inflammation.
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Body PET-CT scan and orbital MRI were performed after the pathology results to exclude other tumor lesions, evidencing an orbital mass in the right orbit without any other signs of activity in other organs ( Figure 3 ).