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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(03): e144-e155
DOI: 10.1055/s-0044-1790589
Original Report

Immunoglobulin D-Lambda Multiple Myeloma Initially Presenting in the Sphenoid Sinus, Orbital Apex, and Skull Base: A Systematic Review with a Case Report

Yihan Chen 
1   China–Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
,
Jianfeng Liu
1   China–Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
2   Department of Otolaryngology-Head and Neck Surgery, China–Japan Friendship Hospital, Beijing, People's Republic of China
,
Jianhui Zhao
2   Department of Otolaryngology-Head and Neck Surgery, China–Japan Friendship Hospital, Beijing, People's Republic of China
› Author Affiliations Funding National High Level Hospital Clinical Research Funding (2023-NHLHCRF-PY-01).
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Abstract

Objectives Multiple myeloma (MM) with initial manifestations in the sphenoid sinus, orbital apex, and skull base is exceedingly rare. A systematic review was conducted to investigate the epidemiology and advancements.

Methods Relevant cases were identified by searching CNKI, WanFang Data, CQVIP databases, PubMed, Embase, and Web of Science. Additionally, we present a case of IgD-λ (immunoglobulin D-lambda) MM with initial symptoms of dizziness, unilateral pain, blindness, and ophthalmoplegia, leading to a 4-month overall survival. Strictly based on PRISMA standards, we included and summarized existing cases and reflected our case.

Results Our systematic review includes 34 case reports, revealing 67.6% of patients initially presented with diplopia and 44.1% underwent endoscopic procedures, notably with only two cases of IgD-λ subtype. In our case, we performed an endoscopic wide trans-ethmoidal sphenoidotomy and biopsy of the skull base and orbital apex lesion. Postoperative pathology confirmed a highly active plasmacytoma, clinically diagnosed as IgD-λ MM with a TP53 deletion mutation and multiple extramedullary metastases. A range of diagnostic tools was employed, including hemoglobin, immunoglobulin, urinary protein analysis, positron emission tomography-computed tomography (CT), bone marrow cytology, and gene detection.

Conclusion The subtle clinical manifestations of IgD-λ MM in the paranasal sinuses and skull base hinder early diagnosis. There is a paucity of literature describing MM initially presenting in these locations. CT/magnetic resonance scans are necessary to identify characteristic bone destruction. An endoscopic approach is popular for tissue biopsy. Bone marrow biopsy with a smear, serum or urine protein electrophoresis, and immunofixation electrophoresis are crucial upon the appearance of target organ damage.

Keywords

case report - extramedullary metastasis - multiple myeloma - sphenoid sinus - skull base

Trial Registration

Chen, Y., Liu, J. (September 12, 2023). Immunoglobulin D-Lambda Multiple Myeloma Initially Positioning in Orbital Apex and Skull Base: a Case Report and Scoping Reviews. Retrieved from: https://osf.io/wzafy// DOI: 10.17605/OSF.IO/WZAFY.


Author Contributions

J.L. was responsible for conceptualization, funding acquisition, project administration, supervision, and writing (review and editing). Y.C. handled data curation, formal analysis, investigation, methodology, resources, software, validation, visualization, and writing (original draft) and J.H. contributed to investigation, resources, and visualization.


Ethical Statements

The case study has gained institutional approval and informed consents.


Supplementary Material



Publication History

Received: 29 June 2024

Accepted: 13 August 2024

Article published online:
16 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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