title: Comparative Confocal and Histopathological Study of Corneal Changes in Multiple Myeloma.
abstract: OBJECTIVE
  Corneal opacities rarely occur in multiple myeloma (MM). Our study correlates the findings of in vivo confocal microscopy (IVCM), a useful diagnostic tool, with histopathological features of corneal opacities appearing in a patient with MM.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 53-year-old man developed corneal opacities in both eyes, more pronounced in the left eye. After IVCM examination, he underwent penetrating keratoplasty in the left eye, and the button was processed for light and electron microscopy and immunohistochemistry. The diagnosis of MM was made, as confirmed by the elevation of IgGk light chains. IVCM demonstrated hyperreflective areas at the epithelial level, hyperreflective keratocytes of dendritic and lamellar morphology in whole stroma, and hyperreflective endothelial cells. Histopathological examination disclosed many vacuoles in the epithelial cell cytoplasm and a homogenous granular material in the Bowman layer. In stroma, keratocytes of different shape and size, with vesicles laden with an abnormal material, were evident. In Descemet membrane, the posterior nonbanded zone had a honeycomb appearance because of the presence of many roundish spaces among wide-spaced collagen fibers. Endothelial cells demonstrated vesicles filled with a material of uneven electron density. Immunohistochemical analysis showed strong positivity for IgGk light chains in keratocytes and among stromal lamellae.
  
  
  CONCLUSIONS
  This is the first study describing a correspondence between IVCM features and histopathological alterations observed in corneal opacities in MM. The results of this study improve the current understanding of the pictures obtained by IVCM studies.
authors.affiliation: *Department of Biomedical Sciences, University of Messina, Messina, Italy; †Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy; ‡Clinical Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; and §Department of Human Pathology, University of Messina, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Micali
authors.forename: Anna M
authors.initials: AM
authors.lastname: Roszkowska
authors.forename: Elisa I
authors.initials: EI
authors.lastname: Postorino
authors.forename: Laura
authors.initials: L
authors.lastname: Rania
authors.forename: Emanuela
authors.initials: E
authors.lastname: Aragona
authors.forename: Edward
authors.initials: E
authors.lastname: Wylegala
authors.forename: Anna
authors.initials: A
authors.lastname: Nowinska
authors.forename: Antonio
authors.initials: A
authors.lastname: Ieni
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Calimeri
authors.forename: Antonina
authors.initials: A
authors.lastname: Pisani
authors.forename: Pasquale
authors.initials: P
authors.lastname: Aragona
authors.forename: Domenico
authors.initials: D
authors.lastname: Puzzolo
mesh_terms: D003318:Corneal Opacity / Q000175:diagnosis*; D005134:Eye Neoplasms / Q000175:diagnosis*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*