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Garg N, Diwaker P, Gaur JH, Shastri M, Sharma S. Conjunctival Amyloidosis: A Report of Two Cases with Review of Literature - 2000-2020. J Microsc Ultrastruct 2022; 10:214-218. [PMID: 36687329 PMCID: PMC9846930 DOI: 10.4103/jmau.jmau_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 01/25/2023] Open
Abstract
Amyloidosis is a complex multisystem disorder characterized by deposition of an aberrant protein in tissues and results in disruption of the normal organ function. Localized amyloidosis is a rare disorder. It commonly affects the head-and-neck region, and only 4% of these lesions are encountered in the orbital region. Hence, conjunctival amyloidosis is a very rare entity. It is thought to be a manifestation of local immunologic disorders. Amyloidosis of conjunctiva is more often localized with no other systemic features. Here, we present two cases of unilateral conjunctival amyloidosis, one with extensive calcification. Conjunctival amyloidosis must be considered in the differential diagnosis of conjunctival neoplasms. Histopathological examination and apple-green birefringence on polarized microscopy with Congo red stain remain the gold standard for diagnosing this entity.
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Affiliation(s)
- Neha Garg
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Preeti Diwaker
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India,Address for correspondence: Dr. Preeti Diwaker, Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India. E-mail:
| | - Jyotsana Harit Gaur
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Malvika Shastri
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Hirt B, Worma MB, Rastelli GJC, Kormann RB. Amiloidose de conjuntivas palpebrais inferiores: um relato de caso. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kono S, Lee PAL, Kakizaki H, Takahashi Y. Amyloidosis in the Palpebral Conjunctiva Mimicking Lymphoproliferative Lesion. Case Rep Ophthalmol 2021; 12:73-76. [PMID: 33613254 PMCID: PMC7879327 DOI: 10.1159/000510392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/22/2020] [Indexed: 11/20/2022] Open
Abstract
A 47-year-old Japanese woman presented with a 1-year history of foreign body sensation in the right eye. Upon examination, a linear soft tissue lesion in the lower conjunctival fornix was noted. The mass resembled a conjunctival lymphoproliferative lesion but was pinkish-yellow rather than salmon pink in color. Histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. The conjunctival lesion did not recur at 3 months postoperatively. Since conjunctival amyloidosis mimics conjunctival lymphoproliferative lesions, it is important to keep conjunctival amyloidosis as a differential diagnosis in the diagnosis of a pinkish conjunctival lesion.
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Affiliation(s)
- Shinjiro Kono
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
| | - Patricia Ann L Lee
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan
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Venkateswaran N, Mercado C, Wall SC, Galor A, Wang J, Karp CL. High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 16:81-95. [DOI: 10.1080/17469899.2021.1851598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Mercado
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Grupo de Investigacion Escuela Barraquer, Escuela Superior de Oftalmologia del Instituto Barraquer de America, Bogota, Colombia
| | - Sarah C. Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
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Konjunktivale Malignome. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Conjunctival malignancies are rare. However, some of these tumors are among the most aggressive malignancies in ophthalmology and require radical forms of therapy that may lead to blindness or loss of the ipsilateral eye and tumor-associated death. The most relevant primary conjunctival malignancies for oncologists are squamous cell carcinoma, malignant melanoma and malignant lymphoma. Surgical therapy is the primary treatment for squamous cell carcinoma and malignant melanoma. An adjuvant therapy in the form of topical chemotherapy or radiation is necessary in most cases. The isolated malignant lymphoma of the conjunctiva is biopsied excisionally if possible. However, if an incisional biopsy was unavoidable, additional irradiation should be performed; malignant lymphoma generally responds very well to relatively low irradiation doses with a good prognosis quad vitam. More aggressive forms, such as diffuse large cell B‑cell lymphoma or mantle cell lymphoma, must also be treated systemically at an early stage.
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Affiliation(s)
- Claudia Auw-Hädrich
- Klinik für Augenheilkunde Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Thomas Reinhard
- Klinik für Augenheilkunde Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Venkateswaran N, Mercado C, Tran AQ, Garcia A, Diaz PFM, Dubovy SR, Galor A, Karp CL. The use of high resolution anterior segment optical coherence tomography for the characterization of conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia. EYE AND VISION 2019; 6:17. [PMID: 31236423 PMCID: PMC6580598 DOI: 10.1186/s40662-019-0143-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
Background Conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia (BRLH) are conditions that often have a similar appearance on the ocular surface. The use of high resolution anterior segment optical coherence tomography (HR-OCT) enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions. In this study, we characterize the morphological differences seen in conjunctival lymphoma, conjunctival amyloidosis and BRLH on HR-OCT imaging. Methods A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma, conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute. Patients were excluded if HR-OCT imaging was not performed on initial presentation. Results Thirty-four total eyes of 27 patients were identified. Twenty eyes had conjunctival lymphoma (16 patients), 8 eyes had conjunctival amyloidosis (6 patients) and 6 eyes had BRLH (5 patients). All conditions appeared clinically as pink, red or yellow subepithelial lesions but had different features on HR-OCT. In lymphoma, HR-OCT images typically showed homogenous, dark subepithelial lesions with smooth borders, containing monomorphic dot-like infiltrates. HR-OCT images of amyloidosis typically showed heterogeneous, dark lesions with irregular borders, often containing hyperreflective linear infiltrates. HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue, at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective, subepithelial tissue. Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions. Conclusions Distinctive features on HR-OCT of conjunctival lymphoma, conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination. Future studies can further validate this technology’s use with more subtle and challenging lesions.
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Affiliation(s)
- Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Carolina Mercado
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Ann Q Tran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Armando Garcia
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Pedro Francisco Monsalve Diaz
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Sander R Dubovy
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA.,2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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Hsiao PJ, Chang YC, Tsao YH, Wu KL, Kao YH, Chan JS, Wang CH, Lin YY, Chuu CP, Lin YS. Ptosis and macroglossia in a woman with systemic light-chain amyloidosis. Clin Chim Acta 2019; 494:112-115. [PMID: 30905590 DOI: 10.1016/j.cca.2019.03.1624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Amyloidosis is a rare and variable disease, characterized by extracellular deposits of amyloid protein in different tissues and organs. Patients may present with a range of symptoms, depending on the extent of involvement. Rapid, accurate diagnosis is still challenging in clinical practice. CASE REPORT A 72-y-old woman presented with a 1-y history of droopy upper left eyelid, resulting in decreased visual acuity, and progressive tongue swelling, resulting in dysarthria, dysphagia, and sleep apnea. Physical examination revealed puffy eyes, moderate swelling up to 1 cm of the upper left eyelid, swollen submental region, and protrusion of the tongue, causing an inability to close the mouth. An abnormal serum free light chain ratio implied the presence of monoclonal gammopathies, and Congo red staining revealed amyloid deposits in specimens from both the tongue and left eyelid. Therefore, a diagnosis of systemic light-chain (AL) amyloidosis was confirmed. The patient then received oral melphalan therapy and surgical intervention for macroglossia. Clinical symptoms including dysarthria, dysphagia, and sleep apnea were under control at 6-month follow-up. CONCLUSIONS We report an uncommon case presenting initially with both ptosis and macroglossia, for which a final diagnosis of systemic AL amyloidosis was made. Detailed history and laboratory investigation must be implemented on suspicion of amyloidosis, because early recognition of amyloid-associated diseases and appropriate treatment can improve clinical outcomes.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan; Department of Life Sciences, National Central University, Taoyuan City, Taiwan.
| | - Ya-Chieh Chang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Yuan-Heng Tsao
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Otolaryngology-Head and Neck Surgery, Taoyuan Armed Forces General Hospital, Taiwan
| | - Kun-Lin Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Taoyuan City, Taiwan
| | - Jenq-Shyong Chan
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Chih-Hung Wang
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Yue Lin
- Department of Life Sciences, National Central University, Taoyuan City, Taiwan; Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan City, Taiwan
| | - Chih-Pin Chuu
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County, Taiwan; Graduate Program for Aging, China Medical University, Taichung City, Taiwan
| | - Yaoh-Shiang Lin
- Division of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Prager AJ, Habib LA, Gambogi T, Busam KJ, Marr BP. Long-Term Follow-Up of 4 Patients with Conjunctival Amyloidosis. Ocul Oncol Pathol 2018; 4:313-317. [PMID: 30320104 PMCID: PMC6167687 DOI: 10.1159/000485918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/18/2017] [Indexed: 11/19/2022] Open
Abstract
Conjunctival amyloidosis is a rare cause of ocular inflammation, mass, and hemorrhage that can be difficult to diagnose and treat. In this case series, we describe 4 patients with a histopathological diagnosis of conjunctival amyloidosis treated at a single institution. All patients underwent surgical excision and biopsy. On histopathological examination, 3 patients had local deposition of either kappa or lambda monoclonal immunoglobulin light chains, favoring localized amyloid light-chain amyloidosis. Systemic workup to exclude rheumatologic disorders (e.g., anti-neutrophil cytoplasmic antibody and rheumatoid factors) and hematological disorders (e.g., imaging, biopsies, and serum protein electrophoresis/urine protein electrophoresis) was negative except for a positive abdominal fat biopsy in 1 patient. Patients were followed for an average of 6.1 years (range 4 months to 15 years) with stable ocular disease.
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Affiliation(s)
- Alisa J. Prager
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Larissa A. Habib
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Talita Gambogi
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian P. Marr
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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10
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Blandford AD, Yordi S, Kapoor S, Yeaney G, Cotta CV, Valent J, Perry JD, Singh AD. Ocular Adnexal Amyloidosis: A Mass Spectrometric Analysis. Am J Ophthalmol 2018; 193:28-32. [PMID: 29890159 DOI: 10.1016/j.ajo.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Ocular adnexal amyloidosis (OAA) may represent localized manifestation of an underlying systemic process. Accurate identification of the amyloid fibrils can guide the systemic evaluation and treatment. The aim of this study was to characterize subtypes of OAA using immunohistochemistry and mass spectrometric analysis and to correlate with ocular involvement and systemic association. DESIGN Retrospective case series. METHODS Review of patients with OAA subtyped by immunohistochemistry and mass spectrometric analysis at the Cleveland Clinic from June 1995 to June 2017. RESULTS While immunohistochemistry identified AL amyloid protein in 67% (4/6) of specimens tested, mass spectrometry identified AL amyloid protein in all specimens (10/10). AL lambda was identified in 5 (50%) samples, kappa in 3 (30%), and both kappa and lambda light chains in 2 (20%). The 5 cases of conjunctival amyloidosis were either AL lambda only (3 cases) or both lambda and kappa (2 cases). There were 3 cases that had associated systemic involvement. Two of these had eyelid skin involvement and AL kappa amyloidosis and the other patient had uveal involvement and AL lambda amyloidosis. CONCLUSIONS Primary amyloidosis-AL is the most common form diagnosed by mass spectrometric analysis in patients with OAA. Immunohistochemistry is ineffective in the characterization of the amyloid deposits in a significant number of cases. Evaluation to exclude systemic involvement or associated underlying lymphoproliferative disorder is warranted.
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Affiliation(s)
| | - Sari Yordi
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Saloni Kapoor
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gabrielle Yeaney
- Department of Anatomic Pathology, R. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Claudiu V Cotta
- Department of Laboratory Medicine, R. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason Valent
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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11
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Martel A, Oberic A, Moulin A, Tieulie N, Hamedani M. [Clinical, radiological, pathological features, treatment and follow-up of periocular and/or orbital amyloidosis: Report of 6 cases and literature review]. J Fr Ophtalmol 2018; 41:492-506. [PMID: 29954616 DOI: 10.1016/j.jfo.2017.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/22/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess demographic, clinical, radiological, pathological features, treatment and follow-up of periocular or/and orbital amyloidosis. PATIENTS AND METHODS We conducted an observational retrospective monocentric study from January 2004 to April 2017 in patients diagnosed with histologically proven periocular or/and orbital amyloidosis. RESULTS Six patients were included (2 females, 4 males). Mean age was 76.8 years (range 66-88 years). Mean time between first ophthalmological symptoms and diagnosis was 27 months (range 11-36 months). The main symptoms were subconjunctival infiltration (6 patients; 100%), periocular pain or discomfort (4 patients; 66.6%) and subconjunctival hemorrhage (1 patient; 16.6%). Clinical findings included ptosis (4 patients; 66.6%), keratitis (3 patients; 50%) leading to corneal perforation in one patient, and proptosis (3 patients; 50%). One-half of the patients showed bilateral involvement. AL amyloidosis was identified on immunohistochemistry in 5 patients (83.3%). One case of B cell marginal zone orbital lymphoma was diagnosed. Systemic work-up was negative for all patients. Treatment consisted of simple monitoring (1 patient; 16.6%), surgical debulking (3 patients; 50%), ptosis surgery (1 patient; 16.6%), eyelid or eyelash malposition surgery (2 patients; 33.3%) and orbital radiation beam therapy (2 patients; 33.3%). Mean follow-up was 14.6 months (range 6-36 months), and no progression nor recurrence were noted. CONCLUSION Periocular or/and orbital amyloidosis is rarely encountered. Diagnosis is based on pathological examination, and immunohistochemistry analysis should always be performed to guide systemic work-up. Orbital lymphoma and multiple myeloma should be ruled out if AL amyloidosis is diagnosed. Progression is slow, and surgery is the mainstay of treatment in symptomatic patients. Long-term multidisciplinary follow-up is advocated.
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Affiliation(s)
- A Martel
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse; Service d'ophtalmologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France.
| | - A Oberic
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
| | - A Moulin
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
| | - N Tieulie
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - M Hamedani
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
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Byers JT, Qing X, Lo C, French SW, Ji P. Unilateral localized conjunctival amyloidosis in a patient with a history of contralateral orbit/eyelid lymphoma. Exp Mol Pathol 2018; 104:151-154. [DOI: 10.1016/j.yexmp.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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13
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A Case of Conjunctival Amyloidosis with Repeated Subconjunctival Hemorrhage. Case Rep Ophthalmol Med 2017; 2017:5423027. [PMID: 28326212 PMCID: PMC5343237 DOI: 10.1155/2017/5423027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022] Open
Abstract
Conjunctival amyloidosis is a very rare disease, and its presence may be a sign of systemic amyloidosis. We present our ocular and systemic findings in a patient with conjunctival amyloidosis. A 43-year-old man had repeated subconjunctival hemorrhages (SCHs) for two years and was referred to the Chiba University Hospital. He had comprehensive ophthalmological and systemic examinations to determine the cause of the SCHs. His visual acuities were 1.2 OU, and the intraocular pressures were 13-14 mmHg OU. Magnetic resonance imaging was normal. Initially, the SCH was the only abnormality. After 3 months, the SCH had partially cleared, and a pink mass was detected in the superior area of the subconjunctiva. Partial biopsy and histopathological examinations showed a greenish birefringence and dichroism under polarized light illumination. The birefringence was located in amyloid fibers. Immunofixation electrophoresis detected λ-light chain abnormality in the ocular biopsy specimen but systemic examinations did not find any lesions. Multiple myeloma was ruled out, and the patient is being followed closely to detect any early signs of systemic amyloidosis. Because repeated SCHs might be initial signs of systemic amyloidosis, patients with conjunctival amyloidosis should be comprehensively examined for systemic amyloidosis because of its poor life prognosis.
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A Rare Case of Amyloidosis of the Eyelid and Conjunctiva. Case Rep Ophthalmol Med 2016; 2016:2915196. [PMID: 27752377 PMCID: PMC5056286 DOI: 10.1155/2016/2915196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/06/2016] [Indexed: 11/17/2022] Open
Abstract
Amyloidosis of the eyelid is uncommon and is typically associated with systemic associations. In contrast, amyloidosis of the conjunctiva is often localised with no other associations. We present a rare case of a 92-year-old gentleman with both cutaneous lid lesions and conjunctival amyloid with no systemic involvement. Biopsy demonstrated the hallmarks of amyloid and treatment has remained conservative. He remains at the department to be monitored for secondary glaucoma.
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15
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Ocular adnexal and orbital amyloidosis: a case series and literature review. Int Ophthalmol 2015; 36:281-98. [PMID: 26466598 DOI: 10.1007/s10792-015-0138-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
The purpose of the study was to describe the main clinical and epidemiologic characteristics, treatment options, and outcome in a large series of patients with periocular and orbital amyloidosis. This is a retrospective, descriptive, observational study of a case series of 14 patients with periocular and orbital amyloidosis and is a review of previously published cases with this diagnosis between September 2004 and January 2015. In this study, we analyzed our 14 patients in conjunction with 69 well-documented cases of orbital and/or periocular amyloidosis previously reported, with a total of 83. Of these, 54 were female (65.1 %), 28 male (33.7 %), and one with unspecified gender. The mean age at diagnosis was 54.9 years (range, 18-87). The localization of the amyloidosis was classified as superficial, deep and combined, with involvement of 53 (63.9 %), 26 (31.3 %), and four cases (4.8 %) in each group, respectively. The main findings in superficial amyloidosis were mass or tissue infiltration (84.9 %) and ptosis (30.2 %) and, in the cases with deep involvement, mass (65.4 %), proptosis (57.7 %), limited ocular movements (34.6 %), ocular displacement (30.8 %), and ptosis (26.9 %). The cases with combined involvement presented with signs and symptoms of the two groups. Regarding the outcome, 43 patients were reported stable after the diagnosis and 21 had recurrence or required new surgical procedures. Periocular and orbital amyloidosis is a rare disease that can present with a variety of symptoms and signs depending on the localization and extension of involvement. Its prompt recognition is important in order to investigate systemic disease, which will affect the prognosis of each case.
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