Multiple myeloma recurrence with optic nerve infiltration diagnosed by vitrectomy, immunohistochemistry, and in situ hybridization.
OBJECTIVE
We present a case of multiple myeloma recurrence diagnosed by optic nerve infiltration.


METHODS
Interventional case report with clinical, surgical, immunohistochemical, and fluorescence in situ hybridization correlation.


RESULTS
A 51-year-old woman with a history of bilateral invasive ductal breast carcinoma and multiple myeloma, both in remission on maintenance bortezomib, was referred for sudden, painless loss of vision OS. Examination demonstrated anterior vitritis with severe optic disc elevation, with yellow-white thickening, peripapillary hemorrhages, and a retinal detachment inferiorly. Diagnostic vitrectomy showed CD138-positive and BRST2-negative cells. Fluorescence in situ hybridization was positive for del(13q) and p53 deletion and negative for CCND1/IGH.


CONCLUSIONS
This is the first report of optic nerve infiltration of multiple myeloma as evidence of recurrence while on maintenance chemotherapy. We demonstrate that diagnostic vitrectomy and immunohistochemistry of vitreous fluid is feasible for the diagnosis of recurrent multiple myeloma.
1 Department of Ophthalmology, Stanford University, Palo Alto, California - USA.
Alex K
AK
Nugent
Yannis M
YM
Paulus
Annie
A
Chan
Jonathan W
JW
Kim
Erich J
EJ
Schwartz
Darius M
DM
Moshfeghi
D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology*; D002872:Chromosome Deletion; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D017254:Leukemic Infiltration / Q000378:metabolism / Q000473:pathology*; D060046:Maintenance Chemotherapy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D009378:Neoplasms, Multiple Primary; D009898:Optic Disk / Q000473:pathology; D019574:Optic Nerve Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D011719:Pyrazines / Q000627:therapeutic use; D012163:Retinal Detachment / Q000601:surgery; D014821:Vitrectomy
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib