Orbital aspergillosis. Report of a case diagnosed by fine needle aspiration biopsy

Presentation is made of a case of orbital aspergillosis, a rare condition that may clinically mimic nonspecific orbital inflammatory disease. It can be a subacute or chronic disease that develops in otherwise healthy individuals. Fine needle aspiration biopsy, which has been useful in the diagnosis of a variety of orbital diseases, provided the initial diagnosis in this case.

Episcleral and orbital pseudorheumatoid nodules

Pseudorheumatoid nodules are subcutaneous necrobiotic granulomas that are histopathologically similar or identical to those seen with rheumatoid arthritis, granuloma annulare, necrobiosis lipoidica diabeticorum, and systemic lupus erythematosus. Although these nodules are most common in children, they are also seen in adults and are usually located on the extremities and scalp. Eyelid and eyebrow involvement is seen infrequently. We histopathologically verified episcleral and orbital pseudorheumatoid nodules in an adult with eyelid and eyebrow nodules. Pseudorheumatoid nodules must be included in the differential diagnosis of subconjunctival mass lesions that may concomitantly involve the orbit, episclera, and periocular region.

Orbital manifestations of Erdheim-Chester disease

The ophthalmological changes in two patients with Erdheim-Chester disease are described. These consist of exophthalmos, ophthalmoplegia, xanthelasma, optic disc swelling, blindness due to optic atrophy, retinal striae, and bilateral enhancing orbital masses on CT scan. The clinical and histopathologic findings of Erdheim-Chester disease are reviewed and the manifestations in two patients with orbital change are presented. This is believed to be the first report describing the ophthalmological manifestations of Erdheim-Chester disease. Our observations support the view that Erdheim-Chester disease is unrelated to the histiocytosis X group.

Ocular and orbital involvement in leukemia

Leukemia may involve almost any ocular tissue, by direct infiltration, by hemorrhage, and by ischemic changes. Both acute and chronic leukemia can cause ocular signs, either initially or later in the disease process; the clinical features and pathologic correlations of this involvement are reviewed. Also, various chemotherapeutic agents used to treat leukemia may cause ocular toxicity. Recently, bone marrow transplants have been performed more frequently in an attempt to prolong patient survival; if graft-versus-host disease results, one symptom is dry eyes from alacrima. Superimposed infection due to immunosuppression can occur from the disease itself or from treatment. Recognition by the ophthalmologist of the various ocular signs is important in assessing the course and prognosis of leukemia.

Apparent monoclonal origin of lymphocytes and plasma cells infiltrating ocular adnexal amyloid deposits: report of 2 cases

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Isolated, bilateral orbital mass lesions during childhood

A 9-year-old female developed bilateral orbital masses over four months without associated orbital inflammation or systemic disease. Orbital biopsy documented an unusual presentation of childhood pseudotumor. Nine days following surgery orbital inflammatory signs appeared suddenly and involved both the unoperated and biopsied orbits equally. These orbital lesions resolved completely after three months of systemic corticosteroid therapy. The sudden and progressive development of palpable bilateral orbital mass lesions rarely occurs in children without readily identifiable systemic disease. The 9-year-old girl described herein acquired bilateral orbital space-occupying lesions without evidence of ocular, orbital, or systemic abnormalities.

'Cholesteatoma' of the orbit

'Cholesteatoma' of the orbit is a variant of pseudotumor histologically characterized by masses of cholesterol crystals. We propose the term "epidermoid or true cholesteatoma" for lesions containing epithelial elements and refer to those nonepithelium-containing pseudotumors as "cholesterol granulomas." Important clinical features distinguish between epidermoid cholesteatomas and cholesterol granulomas of the orbit and justify a separation of these two pathologic entities.

Pseudo-tumours, a clinical concept

Space-filling lesions in the orbit can be divided into 3 large groups: 1. Acute and subacute inflammatory processes (bacterial, fungal, parasitic, foreign body). 2. Benign and malignant tumours, true new growths. 3. Pseudo-tumours. The conditions in group 3 are also space-filling lesions, but have the characteristics of a chronic, infiltrating, inflammatory process. In 11% of 340 consecutive patients in the Orbital Centre in Amsterdam this diagnosis was made. The group is far from uniform: the dominant cell type varies from one case to another. Usually lymphocytic cells are dominant; if these are arranged in follicles the lesion is called a pseudo-lymphoma. This condition can gradually leave the province of the pseudo-tumours and begin to show the characteristics of a malignant or non-Hodgkin lymphoma. Sometimes the inflammatory character of the lymphoid infiltration is dominant, as in myositis, sclerotenonitis and infiltrative Graves' ophthalmopathy; these conditions are clearly related to immunological processes. Attempts to classify all pseudo-tumours on a pathological basis have remained rather vague.

CLINICAL PICTURE

rapid development (2-6 months); pain and oedema are present, but these are not the principal symptoms; secondary features are: disorders of motility, visual loss and other symptoms. Bilaterality usually indicates the presence of a systemic disease.

Orbital granuloma in Hodgkin's disease

A 44-year-old white man with nodular sclerosis type Hodgkin's disease proven by lymph node biopsy developed a diffuse subconjunctival anterior orbital mass that proved to be a noninfectious granuloma. An isolated granuloma in the orbit of a patient with Hodgkin's disease is unusual.

Orbital tuberculosis

A 37-year-old man had epistaxis, headache, intermittent swelling of the periorbital region, proptosis, epiphora, and chronic sinusitis. X-ray films showed marked erosion of the midline facial bones, total opacification of both maxillary sinuses, and clouding of the sphenoid and left ethmoid sinuses. He also had a cutaneous-maxillary sinus fistula and a purulent discharge. A histopathologic examination disclosed areas of acute and chronic inflammation with occasional noncaseating granulomas. Biopsy specimens and postoperative sputum cultures grew Mycobacterium tuberculosis, although the patient had no obvious signs of systemic disease. Because tuberculosis of the orbit is rare in developed countries, it is often overlooked in the diagnosis of granulomatous inflammation of the orbit. This can lead to exacerbation of the disease by corticosteroid treatment.

Orbital mucopyoceles. Two cases and a review

Two patients with superior orbital masses that were initially diagnosed as orbital cellulitis with abscess formation had orbital mucopyoceles, from which Enterobacteriaceae was cultured. Both patients had frontal sinus involvement and one had massive destruction with posterior extension abutting the frontal lobes. The radiology, computerized tomography, surgical procedures, and histopathologic findings pertaining to each case and the disease entity are reviewed. Antibiotic usage is discussed.

Eosinophilic granuloma of the soft tissue in the orbit

A 61-year-old Japanese man was treated for eosinophilic granuloma of the soft tissue in the orbit. The clinical characteristics were typical for eosinophilic granuloma of the soft tissue: 8% eosinophils, very soft tumor masses in both orbits, multifocal lesions including the salivary glands, good response to steroid hormone, and hypergammaglobulinemia. The ocular signs were exophthalmos and lid swelling. Light microscopy showed many lymphoid follicles with many eosinophils, also in other parts of the body. The previously reported cases of orbital lesion are reviewed. Patients with orbital eosinophilic granuloma of the soft tissue are apt to be 30-50 years of age, older than patients without ocular lesions.