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Page 4 of 7 Valković et al. J Cancer Metastasis Treat 2022;8:16 https://dx.doi.org/10.20517/2394-4722.2021.208

Figure 1. CT of the thorax presents a large tumor (14.5 cm × 9.4 cm) of the posterior mediastinum infiltrating Th6-Th12 vertebrae and
prolapsing into the spinal canal. CT: Computed tomography.

Figure 2. Mediastinal (A-C) and maxillary sinus (D-F) plasmacytomas stained immunohistochemically to visualize microvessel density
(MVD) and expression of osteopontin (OPN). On hematoxylin-eosin staining, the poorly differentiated plasma cells can be seen in both
extramedullary plasmacytomas (A,D), while immunostaining confirmed high grade of MVD (B,E) and high expression of OPN in plasma
cells.

Figure 3. Brain MRI showed a 62 mm × 37 mm large tumor that infiltrated the right orbit, eroded the skull base, protruded into the
middle cranial fossa suppressing the brain, and infiltrating the sphenoid and maxillary sinus. MRI: Magnetic resonance imaging.

disease progressed. The patient developed anemia, kidney damage, enlargement of the viscerocranial tumor
mass with progression into the right orbit, and bone disease progression. The second line of treatment with
the KRd regimen was started and initially had a good clinical response (regression of anemia, renal failure,
and orbital tumor mass), but after the sixth cycle of therapy, tumor mass of the right orbit showed clinical
and radiological progression causing protrusion of the right eye. This time, radiotherapy was clearly
warranted, so the patient received a total dose of 30 Gy/10 fractions with a significant reduction of the
tumor mass. After approximately 30 months from diagnosis, a third line of therapy with PVd