Frontal skull craniotomy combined with moderate-dose radiotherapy effectively ameliorate a rare case of non-secretory, multiple myeloma with orbital involvement

Abstract

Background: Orbital infiltration in patients with multiple myeloma is a rare condition, with less than 50 cases reported in the medical literature. Most patients undergo conservative treatment because multiple myeloma is a disseminated systemic disease.

Case presentation: A 43-year-old male subject with multiple myeloma and long-term survival presented with orbital involvement. The subject lacked the typical features and poor prognostic factors associated with multiple myeloma, such as renal failure, hypercalcemia, and paraprotein in the serum and urine. The orbital computed tomographic scan revealed the tumor encasing the optic nerve, but without prominent bony destruction. Therefore, a frontal skull craniotomy with an epidural entrance to the orbital space was performed, to completely extirpate the orbital mass. The surgical procedure was followed by moderate-dose radiation therapy. After 32 months of follow-up care, the subject is doing well with excellent local control.

Conclusion: Although the effectiveness and applicability of this approach remains to be determined, this case report demonstrates that accurate and early detection combined with local surgical treatment and appropriate radio/chemotherapy, can be applied to effectively extend an orbital multiple myeloma patient's life.

Figure 1

Light microscopy image of formalin-fixed tissue demonstrating mature and atypical plasma cells with eccentric hyperchromatic nuclei.

Figure 2

Axial view of the orbital computerized tomographic scan showing the tumor encasing the optic nerve. Prominent bony destruction could not be observed.

Figure 3

Coronal view of the orbital computerized tomographic scan showing left intra-orbital mass lesion, occupying the upper-outer quadrant and compressing the superior rectus muscle.