Abstract
Only two cases of cranial nerve involvment in IgD myeloma have been reported in Japan. Pleural involvement with fluid accumulation has been found in four cases of myeloma.
A rare autopsy case of a 61-year-old male with IgD myeloma who presented Foix syndrome and fluid accumulation with myeloma cells in pleural cavity was described.
The initial symptom of this patient was the right chest tumor, which was resected and was histologically diagnosed as plasmacytoma. A month after, he had headache and diplopia and admitted to our hospital. The physical and laboratory examinations revealed Foix syndrome and the tumor on the left chest was suspected to be caused by myeloma. Later, accumulation of the pleural fluid with numerous myeloma cells and increase of IgD immunoglobulin were observed.
Many acidophilic inclusions were seen in the myeloma cells. They were ultrastructurally fibrillar and did not react with anti-IgD immunoglobulin.
The patient was treated with oral administration of Melphalan and Prednisolone and local irradiation with Lineac. A transient and partial recovery of the symptoms followed. He died of the tumor dissemination seven months after the onset.
An autopsy revealed the tumors in the parasinus, especially sphenoid sinus, lymph nodes, esophagus, stomach, larynx, trachea, liver and testis. Histological findings of the kidneys were compatible with those of the myeloma kidney.
