title: Immunoglobulin D multiple myeloma involving the sella manifesting as oculomotor palsy: case report.
abstract: OBJECTIVE
  Immunoglobulin D multiple myeloma (IgD MM) is an uncommon type of MM characterized by an aggressive clinical behavior and a short survival time. We report a rare case in which oculomotor palsy caused by a sellar lesion was the initial manifestation of IgD MM; systemic treatments were beneficial in this case.
  
  
  METHODS
  A 61-year-old man presented with diplopia, left-sided ptosis, and retro-orbital pain. An examination revealed left cranial nerve (CN) III and IV palsies. CT scanning demonstrated a mass in the sellar and parasellar regions and partial destruction of the left side of the dorsum sellae. MRI revealed that the mass extended into the left cavernous sinus with minimal suprasellar extension. An endocrinologic evaluation did not reveal any abnormality. At the time of admission, the patient had no symptoms of MM.
  
  
  METHODS
  A transsphenoidal resection was performed. Histopathologic examination revealed a tumor consisting of plasma cells. Appropriate laboratory studies, a bone scan, and a bone marrow biopsy led to a diagnosis of IgD lambda-type MM. High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation was therapeutically beneficial. The patient's symptoms were gradually relieved.
  
  
  CONCLUSIONS
  This case demonstrates that an unusual sellar tumor might be the first manifestation of IgD MM. Careful observation can suggest a possible non-pituitary etiology for a tumor, leading to appropriate diagnostic and therapeutic procedures.
authors.affiliation: Department of Neurosurgery, Japanese Red Cross Society Wakayama Medical Center, and Department of Neurological Surgery, Wakayama Medical University, Kimiidera, Wakayama, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Fukai
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nohgawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uematsu
authors.forename: Toru
authors.initials: T
authors.lastname: Itakura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kamei
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D001797:Blood Protein Electrophoresis; D001853:Bone Marrow / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology; D003131:Combined Modality Therapy; D036101:Cord Blood Stem Cell Transplantation; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000473:pathology; D004172:Diplopia / Q000209:etiology; D006801:Humans; D007072:Immunoglobulin D; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D054219:Neoplasms, Plasma Cell / Q000601:surgery; D019635:Neurosurgical Procedures; D009886:Ophthalmoplegia / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012658:Sella Turcica / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D007072:Immunoglobulin D