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Yang J, Liang Q, Han L, Wang Y, Guo Y. Primary intraorbital inflammatory lumpy lesion: A rare case report. Medicine (Baltimore) 2024; 103:e37869. [PMID: 38640264 PMCID: PMC11029932 DOI: 10.1097/md.0000000000037869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery. PATIENT CONCERNS This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case. DIAGNOSES Orbital EAF. INTERVENTIONS Surgical radical resection and postoperative glucocorticoid therapy. OUTCOMES After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief. LESSONS EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.
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Affiliation(s)
- Jinxin Yang
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
| | - Qianlei Liang
- Department of Neurosurgery, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Liang Han
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wang
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yongchuan Guo
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
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Lin LY, Stone JH, Liou VD, Stagner AM, Lee NG. Eosinophilic Angiocentric Fibrosis of the Orbit: A Clinicopathologic Review of 6 Novel Cases With Review of the Literature. Am J Ophthalmol 2023; 256:9-19. [PMID: 37495006 DOI: 10.1016/j.ajo.2023.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To describe 6 cases and review the current state of knowledge of eosinophilic angiocentric fibrosis (EAF) involving the orbit. DESIGN Retrospective clinicopathologic case series and review of the current literature METHODS: Clinical records and histopathologic data of orbit-involving EAF were gathered between 2004 and 2022 from a single academic institution. The patients' presenting clinical symptoms and signs, laboratory data, radiographic studies, and management documentation were collected. RESULTS Retrospective review identified 6 novel cases, totaling 31 cases of EAF involving the orbit described as of this writing. Fourteen patients were male, and the average age of presentation was 49.8 years (range 25-78 years). Eighteen patients had concurrent sinonasal involvement, whereas 13 had primary orbital involvement. The median duration of symptoms prior to evaluation was 24 months, with nasal symptoms, proptosis, periorbital swelling, and pain being the most common presenting symptoms. The majority of patients underwent surgical debulking, as well as treatment with glucocorticoids and steroid-sparing agents, such as rituximab, with varied results. CONCLUSION EAF involving the orbit is uncommon. The histopathologic findings include a perivascular, eosinophil-rich infiltrate and a pauci-inflammatory storiform type of fibrosis concentrated around small vessels. Orbital involvement usually results from local extension from adjacent sinuses, but primary orbital involvement has been described. Surgical debulking and immunosuppressive agents such as rituximab have been shown to stabilize disease.
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Affiliation(s)
- Lisa Y Lin
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.)
| | - John H Stone
- Department of Rheumatology, Massachusetts General Hospital (J.H.S.)
| | - Victor D Liou
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.)
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School (A.M.S.), Boston, Massachusetts, USA
| | - N Grace Lee
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.).
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Liu R, Li J, Ren T, Zhang H, Ma J. A rare lumpy inflammatory lesion of the orbit: a unique case report. Diagn Pathol 2023; 18:30. [PMID: 36823652 PMCID: PMC9948480 DOI: 10.1186/s13000-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory lesion, especially in orbit. EAF is believed to be related to IgG4-related disease (IgG4-RD), but the clinical manifestations of systemic involvement are relatively rare and easy to be confused with tumors or other inflammatory diseases. Histopathological examination is the most important way of its diagnosis and differentiation. CASE PRESENTATION We presented a 55-year-old female patient presented with recurrent swelling of the right lower eyelid for more than 2 months. The pathological diagnosis was EAF. Positive immunostaining for IgG, CD34, κ, and λ, while negative immunostaining for IgG4. CONCLUSIONS Complete surgical resection is the preferred treatment, histopathological examination is the main diagnostic standard.
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Affiliation(s)
- Rui Liu
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Jing Li
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Tingting Ren
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Hong Zhang
- grid.24696.3f0000 0004 0369 153XPathology Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Jianmin Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Javadirad E, Roozbahani NE, Sadafi S. Eosinophilic angiocentric fibrosis of the sinonasal tract: a case report and review of the literature. J Int Med Res 2022; 50:3000605221126039. [PMID: 36172997 PMCID: PMC9528026 DOI: 10.1177/03000605221126039] [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] [Indexed: 11/16/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare chronic benign disorder of unknown etiology and is characterized by submucosal thickening and fibrosis in the upper respiratory tract. In this report, we describe a case of EAF in the nasal cavity of a woman who underwent elective surgery for division of adhesions and has had no recurrence during 2 years of postoperative follow-up. A review of the literature on the clinical manifestations of EAF, sites of lesions, management, and outcomes identified 48 articles that included 72 cases. A summary of these reports is presented, including our present case. The most common anatomic site involved was the nose (77.8%), the most common manifestation was nasal obstruction (66.7%), and the most common treatment modality was surgical resection (83.3%). After surgery, 36% of patients remained free of EAF. The most common pharmacologic agent used was a corticosteroid (38.9%).
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Affiliation(s)
- Etrat Javadirad
- Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Eskandari Roozbahani
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepehr Sadafi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Gallogly JA, Faraji F, Jumaily MH, Schneider JS, Brunworth JD. Diagnostic dilemmas of mechanical restriction of the medial rectus: A case report. ALLERGY & RHINOLOGY 2018; 9:2152656718764231. [PMID: 29977655 PMCID: PMC6028159 DOI: 10.1177/2152656718764231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Due to the proximity of the maxillary sinus and ethmoid sinuses to the orbit, inflammatory processes that originate in the sinonasal region have the potential to extend into the orbit. Objective We presented a case of ptosis and restrictive strabismus of the medial rectus muscle. Methods A case report with a literature review of possible diagnoses. Results Biopsy, imaging, and laboratory evaluation by otolaryngology, ophthalmology, and rheumatology services were unable to identify the cause of the fibrosis after 22 months of follow-up. A response to oral steroids indicated an inflammatory process. Conclusion Unilateral mechanical restriction of the medial rectus muscle is a rare complication of nasal disease. Inflammatory processes and iatrogenic injury are known to cause fibrosis of surrounding tissue. We presented a unique case of medial rectus fibrosis that did not meet the diagnostic criteria of recognized etiologies.
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Affiliation(s)
- James A Gallogly
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.,No funding sources supported research.,The authors have no conflicts of interest to declare pertaining to this article
| | - Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.,No funding sources supported research.,The authors have no conflicts of interest to declare pertaining to this article
| | - Mejd H Jumaily
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.,No funding sources supported research.,The authors have no conflicts of interest to declare pertaining to this article
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.,No funding sources supported research.,The authors have no conflicts of interest to declare pertaining to this article
| | - Joseph D Brunworth
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.,No funding sources supported research.,The authors have no conflicts of interest to declare pertaining to this article
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Right ethmoid eosinophilic angiocentric fibrosis with orbital extension. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:351-354. [PMID: 28359733 DOI: 10.1016/j.anorl.2017.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Eosinophilic angiocentric fibrosis (EAF) is a slowly progressive, benign disease involving the mucosa of the upper airways or, more rarely, the orbit. It belongs to the spectrum of IgG4-related disease. CASE REPORT The authors report the case of a 61-year-old man who presented with orbital involvement (visual loss, pain, proptosis, and eyelid oedema), headache and nasal obstruction. Imaging revealed a right ethmoido-orbital mass infiltrating the periorbital fat and enveloping the optic nerve. Histological examination concluded on a diagnosis of EAF in the presence of perivascular infiltration by inflammatory cells, predominantly eosinophils, and zones of "onion skin" fibrosis. Immunohistochemistry attributed these lesions to IgG4-related disease. Initial treatment with corticosteroids followed by dapsone failed to control the disease and resulted in severe steroid dependence. Surgical ethmoidectomy with resection of the lamina papyracea was performed to allow displacement of the eyeball into the nasal cavity in the event of another episode. DISCUSSION The combination of surgery and rituximab achieved lasting pain relief with no recurrence of exophthalmos.
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Heft Neal ME, Rowan NR, Willson TJ, Wang EW, Lee SE. A Case Report and Systematic Review of Eosinophilic Angiocentric Fibrosis of the Paranasal Sinuses. Ann Otol Rhinol Laryngol 2017; 126:415-423. [PMID: 28397561 DOI: 10.1177/0003489417696510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a paucity of literature discussing prognostic factors or comparing outcomes in eosinophilic angiocentric fibrosis (EAF). This review aims to analyze tumor and patient characteristics as possible prognostic markers and compare surgical approaches. METHODS Systematic literature review and case report analyzing available cases of EAF located within the paranasal sinuses. RESULTS The literature search yielded 39 articles meeting criteria for a total of 59 cases (including 1 from our institution). Median patient age was 46 years. The most common presenting symptoms were nasal obstruction (69%, n = 41) and change in external nasal appearance (39%, n = 32). The majority of cases (85%) were treated with surgical resection alone or in combination with medication. Of surgical patients, 62% underwent a complete resection with a recurrence rate of 20%. Median follow-up duration was 2 years. Endoscopic approach showed a significant positive correlation with complete resection ( P = .045). Patient sex ( P = .6), tumor location (range, P = .32-.98), lateral rhinotomy ( P = .26), septoplasty ( P = .84), and external rhinoplasty ( P = .28) were not significantly correlated with total resection. Insufficient sample size precluded calculation of predictors of recurrence following surgery. CONCLUSION This review suggests that an endoscopic approach to EAF tumor is a viable option, frequently yielding complete resection.
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Affiliation(s)
- Molly E Heft Neal
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,2 University of Michigan Department of Otolaryngology, Ann Arbor, Michigan, USA
| | - Nicholas R Rowan
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Thomas J Willson
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Stella E Lee
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
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