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Mandić JJ, Bakula M, Šklebar LK, Jakovčević A, Mandić K, Petrović Jurčević J, Padjen I. Histiocytosis and adult-onset orbital xanthogranuloma in 2023: a review of the literature and mini case series. Int Ophthalmol 2024; 44:301. [PMID: 38951425 DOI: 10.1007/s10792-024-03181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Within the large umbrella of histiocytosis are a few similar yet heterogenous entities involving the orbit and periocular tissues with or without systemic infiltration, termed adult onset xanthogranuloma or orbital xanthogranuloma. Due to rarity of these conditions, different classifications in use, diverse clinical presentations and still unknown etiology, the aim of this paper was to provide an up-to-date literature review of the actual understanding of histiocytosis and its subgroups involving the orbit and periocular area, diagnostic strategies and therapeutic modalities. METHODS We present a review of literature and small case series comprising four patients diagnosed and treated in the period from 2001 until 2023 in our hospital. Clinical files of 4 patients with adult-onset xanthogranulomatous disease of the orbit and ocular adnexa (AOXGD) were reviewed retrospectively. Clinical, laboratory, radiological, histopathological, and immunohistochemical findings were reexamined. RESULTS Reviewing medical records of our patients with AOXGD, we found significant overlap between histiocytosis and different immune disorders. A broad workup should be considered in these patients as they can harbour severe immune disfunctions and hematologic disorders. Preferred treatment modality depends on a histopathologic type of AOXGD, clinical presentation and systemic involvement and should be conducted multidisciplinary. CONCLUSION The diagnosis is often delayed because of its rarity and diverse clinical findings. Development of molecular genetic tests, detection of BRAF V600E mutation and different types of kinase mutations, mutations in transcriptional regulatory genes as well as tyrosine kinase receptors have shed a new light on the etiopathogenesis and potential targeted treatment of histiocytosis.
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Affiliation(s)
- Jelena Juri Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia.
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia.
| | - Maja Bakula
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Lorena Karla Šklebar
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Antonia Jakovčević
- Department of Pathology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Krešimir Mandić
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | | | - Ivan Padjen
- School of Medicine, University of Zagreb, Šalata 3B, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Referral Centre for Systemic Lupus Erythematosus and Related Disorders, Department of Internal Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
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Rajabi MT, Abdol Homayuni MR, Samiee R, Mobader Sani S, Aghajani AH, Rafizadeh SM, Amanollahi M, Pezeshgi S, Hosseini SS, Rajabi MB, Sadeghi R. Orbital histiocytosis; From A to Z. Int Ophthalmol 2024; 44:236. [PMID: 38902584 DOI: 10.1007/s10792-024-03179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Histiocytosis is one of the most challenging diseases in medical practice. Because of the broad spectrum of clinical manifestations, systemic involvements, unknown etiology, and complex management, different types of histiocytosis are still a big question mark for us. Orbital histiocytosis is characterized by the abnormal proliferation of histiocytes in orbital tissues. It could affect the orbit, eyelid, conjunctiva, and uveal tract. Orbital histiocytosis can cause limited eye movement, proptosis, decreased visual acuity, and epiphora. In this study, we review the novel findings regarding the pathophysiology, diagnosis, and treatment of different types of histiocytosis, focusing on their orbital manifestations. METHOD This review was performed based on a search of the PubMed, Scopus, and Embase databases or relevant published papers regarding orbital histiocytosis on October 9th, 2023. No time restriction was proposed, and articles were excluded if they were not referenced in English. RESULTS 391 articles were screened, most of them being case reports. The pathophysiology of histiocytosis is still unclear. However, different mutations are found to be prevalent in most of the patients. The diagnostic path can be different based on various factors such as age, lesion site, type of histiocytosis, and the stage of the disease. Some modalities, such as corticosteroids and surgery, are used widely for treatment. On the other hand, based on some specific etiological factors for each type, alternative treatments have been proposed. CONCLUSION Significant progress has been made in the detection of somatic molecular changes. Many case studies describe various disease patterns influencing the biological perspectives on different types of histiocytosis. It is necessary to continue investigating and clustering data from a broad range of patients with histiocytosis in children and adults to define the best ways to diagnose and treat these patients.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Reza Abdol Homayuni
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Samiee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Mobader Sani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- NCweb Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Aghajani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mobina Amanollahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Pezeshgi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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3
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De Santana AR, Castro de Oliveira Figueirôa MDL, Souza Pedreira AL, Behrens Pinto GL, Santiago MB. Adult ocular adnexal xanthogranulomatous disease associated with immunoglobulin G4-related disease: an unusual association. Reumatismo 2024; 76. [PMID: 38523581 DOI: 10.4081/reumatismo.2024.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/05/2023] [Indexed: 03/26/2024] Open
Abstract
Adult-onset xanthogranuloma (AOX) and immunoglobulin G4-related disease (IgG4-RD) are uncommon fibrosing conditions that may exhibit localized ocular manifestations and occasionally systemic symptoms. These conditions exhibit overlapping clinical and histological features, suggesting a potential correlation between them, although their exact relationship remains unclear. This paper presents the case of a black male patient exhibiting typical histological indications of both AOX and IgG4-RD. The patient responded positively to corticosteroid treatment.
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Affiliation(s)
| | | | | | - G L Behrens Pinto
- Professor Edgard Santos University Hospital Complex, Federal University of Bahia.
| | - M B Santiago
- Bahiana School of Medicine and Public Health, Salvador; Professor Edgard Santos University Hospital Complex, Federal University of Bahia; Specialized Rheumatology Services, Bahia.
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Alkatan HM, Fatani DR, Maktabi AMY, Alzahem TA. Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions. BMC Ophthalmol 2024; 24:124. [PMID: 38504269 PMCID: PMC10949701 DOI: 10.1186/s12886-024-03388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The "C group" of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). METHODS This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). RESULTS Twenty patients were diagnosed as "Group C" disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans' histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). CONCLUSION Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.
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Affiliation(s)
- Hind Manaa Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box 266, Riyadh, 11362, Saudi Arabia.
- Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Dalal R Fatani
- Oculoplasty and Orbit Surgery, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Tariq A Alzahem
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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5
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Lai KKH, Wong ACC, Ng JKM, Choi PCL, Cheuk W, Yip WWK, Tham CCY, Chong KKL. Immunoglobulin G4-related orbital xanthogranulomatous disease: A case series and literature review. J Fr Ophtalmol 2024; 47:103914. [PMID: 37648548 DOI: 10.1016/j.jfo.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Affiliation(s)
- K K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - A C C Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - J K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - P C L Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - W Cheuk
- Department of Anatomical and Cellular Pathology, Queen Elizabeth Hospital, Hong Kong
| | - W W K Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - C C Y Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - K K L Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Eye Hospital, Hong Kong.
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Rajabi MT, Amoli FA, Koochakzadeh L, Rafizadeh SM, Rajabi MB, Hosseini SS, Aghajani AH, Pezeshgi S, Aghdam MA, Farrokhpour H, Abla O, Sadeghi R. Orbital histiocytosis and fibrohistiocytosis: the clinicopathological characteristics of 117 patients, over a decade of experience. Int Ophthalmol 2023; 43:4997-5009. [PMID: 37840073 DOI: 10.1007/s10792-023-02903-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To describe the clinicopathological features of a large cohort of patients with orbital histiocytoses and fibrohistiocytosis, such as Langerhans cell histiocytosis (LCH) and non-LCH disorders, and correlate patients' clinical characteristics with their pathological diagnosis. METHODS In this retrospective study, medical records of patients presenting to Farabi Eye Hospital, a tertiary eye care center in Tehran, Iran, from 2010 until 2022, were reviewed. Patients' demographics, chief complaint, location and laterality of the tumor, best-corrected visual acuity, presence of bone erosion on imaging, and their pathological diagnosis were retrieved. Excisional biopsy was performed and evaluated through light microscopy and immunohistochemistry study for their respective markers, including CD1a, CD68, CD207, and S100. RESULTS A total of 117 patients with 11 pathological subtypes of histiocytoses and fibrohistiocyosis were identified, with 56.4% male and 43.6% female patients. The mean age at presentation was 23.4 years (range 1.5 months-73 years). Swelling and palpable mass were the most common chief complaints. LCH was the most common pathology (32.5%), followed by juvenile xanthogranuloma (26.5%) and adult xanthogranuloma (21.4%). Age, lesion location, and bone erosion had a statistically significant difference among the various diagnosed subtypes. CONCLUSIONS Histiocytoses and fibrohistiocytosis are diverse and rare disorders potentially involving multiple organ systems. Ophthalmic manifestations of these diseases are even more uncommon. We reviewed their orbital presentation along with their respective histopathological findings. Our results also suggested that an orbital CT scan can be of diagnostic value to discriminate LCH from other histiocytic pathologies.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Fahimeh Asadi Amoli
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Leili Koochakzadeh
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammad Bagher Rajabi
- Eye Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir Hossein Aghajani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Saharnaz Pezeshgi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Abdolahzadeh Aghdam
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Hossein Farrokhpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
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7
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Detiger SE, Hötte GJ, Verdijk RM, de Keizer ROB, van Hagen PM, van Laar JAM, Paridaens D. Adult orbital xanthogranuloma: long-term follow-up of treated cases. Eye (Lond) 2023; 37:2475-2481. [PMID: 36526862 PMCID: PMC10397269 DOI: 10.1038/s41433-022-02357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/04/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adult orbital xanthogranulomatous disease (AOXGD) is a group of rare disorders. Four subtypes are identified: adult-onset xanthogranuloma (AOX), adult-onset asthma and periocular xanthogranuloma (AAPOX), necrobiotic xanthogranuloma (NBX), and Erdheim-Chester disease (ECD). Therapy options vary and little is known about the long-term effect of the treatment. In this study, we will describe the clinical behaviour, effect of treatment, and long-term outcome in a consecutive series of patients with AOXGD. METHODS This is a descriptive, retrospective study with a long follow-up term of 21 patients with histologically proven AOXGD, treated between 1989 and 2021 in the Rotterdam Eye Hospital and Erasmus MC University Medical Center. RESULTS Twenty-one patients with histologically proven AOXGD were included. The follow-up ranged from 2-260 months (median of 67 months). Six of the nine patients with AOX were treated with surgery alone, with recurrence in two. Three received systemic therapy, with recurrence in one. All four patients with AAPOX received systemic treatment, the disease recurred in two. Two patients with NBX were treated with surgery alone, with recurrence in one. Four required additional therapy with recurrence in two. Both patients with ECD required systemic therapy. CONCLUSIONS Recognition of AOXGD is important, in particular, because of the potential severe systemic locations in the different subtypes. Surgical excision might be a sufficient therapy for patients with AOX. Patients with AAPOX, NBX, and ECD warrant systemic therapy. Currently, there is no conclusive evidence for a superior treatment strategy, but further studies are necessary to investigate treatment options.
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Affiliation(s)
- S E Detiger
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
| | - G J Hötte
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
| | - R M Verdijk
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Department of Pathology, Section of Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R O B de Keizer
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P M van Hagen
- Departments of Internal Medicine and Immunology, section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J A M van Laar
- Departments of Internal Medicine and Immunology, section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Paridaens
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Ramirez Marquez E, Ayala Rodríguez SC, De Jesús Rodríguez E, Montes JR, Noy Malave MA, Oliver AL. Xanthogranuloma of the Eyelid: A Case Report. Cureus 2023; 15:e42477. [PMID: 37637556 PMCID: PMC10451097 DOI: 10.7759/cureus.42477] [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] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.
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Affiliation(s)
| | - Sofía C Ayala Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Edgar De Jesús Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Jose Raul Montes
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Armando L Oliver
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
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9
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Papa BM, Prince HM, McNab AA, McKelvie P. IgG4-related ophthalmic disease in association with adult-onset asthma and periocular xanthogranuloma: a case report. Orbit 2023; 42:98-103. [PMID: 34493168 DOI: 10.1080/01676830.2021.1973512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 54-year-old male presented with a three-year history of bilateral upper eyelid and peri-orbital swelling and adult-onset asthma. Histopathology of a left orbital biopsy showed lymphoid follicles with foamy macrophages and Touton giant cells. Clinical, histological and radiological features were consistent with adult-onset asthma and periocular xanthogranuloma. Treatment with rituximab led to a complete clinical and radiological remission. Nine years later, his condition relapsed with a biopsy of the left orbit and lacrimal gland demonstrating features of IgG4-related disease and adult-onset asthma and periocular xanthogranuloma. Immunohistochemistry showed increased numbers of IgG4+ plasma cells (290 per high power field) and an elevated IgG4+/IgG+ plasma cell ratio of 480%. Involvement by both disorders in the orbit and ocular adnexa of a single patient has not previously been reported in the literature, to the best of our knowledge, and suggests a possible aetiologic or pathophysiologic association.
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Affiliation(s)
- Brigitte M Papa
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - H Miles Prince
- Epworth Healthcare, Richmond, Australia.,University of Melbourne, Melbourne, Australia
| | - Alan A McNab
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Penny McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Australia
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10
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Cozzani E, Muracchioli A, Orcioni GF, Parodi A. Symmetrical Periorbital Yellow Plaques in a Patient with Haematological Dyscrasia: A Quiz. Acta Derm Venereol 2021; 101:adv00612. [PMID: 34708246 PMCID: PMC9472095 DOI: 10.2340/actadv.v101.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Andrea Muracchioli
- Di.S.SAL Section of Dermatology, University of Genoa, Section of Dermatology, University of Genoa DiSSal, IRCCS Policlinic Hospital San Martino-IST, IT-16132 Genoa, Italy.
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11
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Rech KL, He R. Challenges in the Histopathologic Diagnosis of Histiocytic Neoplasms. J Natl Compr Canc Netw 2021; 19:1305-1311. [PMID: 34781270 DOI: 10.6004/jnccn.2021.7098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
Histiocytic neoplasms, including Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), present a diagnostic challenge due to nonspecific fibroinflammatory infiltrates and a diverse clinical presentation. The pathologist can play a key role in classification of these disorders through multidisciplinary collaboration and correlation of pathologic features with clinical and radiologic findings. The histopathologic differential diagnosis is broad, requiring knowledge of the possible diagnoses at each specific anatomic site, and a careful assessment to exclude other inflammatory and neoplastic disorders. An immunohistochemistry panel including CD163, CD1a, langerin, S100, Factor XIIIa, OCT2, and BRAF V600E can provide definitive diagnosis in LCH and RDD, whereas ECD requires classic clinical features as well as confirmation of an activating MAPK pathway mutation by genetic studies.
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Affiliation(s)
- Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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12
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Shapira Y, Juniat V, Smith C, Selva D. Adult-Onset Xanthogranuloma With Frontal Nerve and Intracranial Involvement. Ophthalmic Plast Reconstr Surg 2021; 37:e167-e170. [PMID: 33710041 DOI: 10.1097/iop.0000000000001964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adult-onset xanthogranuloma (AOX) typically affects the preseptal and anterior orbital regions. The authors report a 49-year-old man with a 6-month history of unilateral AOX, demonstrating diffuse extraconal and intraconal orbital involvement, including the lacrimal gland and extraocular muscles. There was frontal nerve enlargement, intracranial and pterygopalatine fossa involvement. Investigations excluded IgG4 disease and Erdheim-Chester disease. This case illustrates that AOX may be added to the causes of orbital nerve enlargement and may demonstrate intracranial extension.
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Affiliation(s)
- Yinon Shapira
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | | | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Choroidal mass as the first presentation of Erdheim-Chester disease. Am J Ophthalmol Case Rep 2019; 16:100539. [PMID: 31463417 PMCID: PMC6706652 DOI: 10.1016/j.ajoc.2019.100539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose To describe a choroidal mass that proved to be histiocytic choroidal infiltration in Erdheim-Chester disease. Observations A 54-years-old Caucasian male presented to our Retina Clinic with a suspect of choroidal melanoma in the left eye. Dilated fundus exam of the left eye showed a yellow-grey lesion along the inferior arcade, with sub-retinal fluid clinically visible. Enhanced depth imaging-OCT (EDI-OCT) showed a dome-shaped choroidal lesion with hyperreflective exudation present between the inner retina and the retinal pigment epithelium (RPE). On fundus autofluorescence the lesion appeared to have a diffuse speckled hyper-autofluorescent pattern secondary to the exudative subretinal material. On ultrasound, the lesion appeared hyper-echoic and dome-shaped, with a baseline thickness of 6.13 mm. Indocyanine green angiography (ICGA) was performed and showed hypocyanescence of the lesion from the early phases that persisted through the whole exam. Chest CT with contrast showed an abnormal, non-calcific, eccentric thickening of segments of the aorta (“coated aorta”) and PET an abnormally strong labeling of the distal ends of the long bones. An additional proximal tibial biopsy was performed to confirm the diagnosis on histology of Erdheim-Chester disease and the patient was started on oral prednisone. The choroidal mass progressively shrunk and the subretinal exudative material on top partially reabsorbed. Conclusions and importance Intraocular involvement in Erdheim-Chester disease is extremely rare but as a result of recent better awareness the number of new diagnosis is increasing. Erdheim-Chester disease should be considered in the differential of every choroidal mass.
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Maeng MM, Godfrey KJ, Jalaj S, Kazim M. Adult xanthogranulomatous disease of the orbit: case report of spontaneous regression and review of treatment modalities. Orbit 2019; 39:31-37. [PMID: 31021176 DOI: 10.1080/01676830.2019.1590421] [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] [Indexed: 10/27/2022]
Abstract
Adult xanthogranulomatous disease of the orbit is a rare and incompletely understood entity. It can be limited to the orbit or be associated with systemic disease. While routine systemic surveillance is the standard of care for patients with orbital xanthogranulomatous disease, there is no universally accepted protocol for managing periorbital and orbital involvement. The authors report a case of adult orbital xanthogranuloma, without systemic disease, who, after 10 years of observation, demonstrated sustained radiographic regression of the lesions. To the authors' knowledge, this represents one of the first reports of spontaneous regression of untreated orbital xanthogranuloma, and supports observation of lesions that do not compromise ocular function. We present our case in the context of a major review of various treatment strategies described in the literature, including surgical resection, radiotherapy, plasmapheresis, corticosteroids, multiple immunomodulatory medications.
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Affiliation(s)
- Michelle M Maeng
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Kyle J Godfrey
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Sanjai Jalaj
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael Kazim
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
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15
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Ding X, Cao Y, Xing Y, Ge S, Lin M, Li J. TIMP-1 Mediates Inflammatory and Immune Response to IL-6 in Adult Orbital Xanthogranulomatous Disease. Ocul Immunol Inflamm 2019; 28:288-297. [PMID: 30973282 DOI: 10.1080/09273948.2019.1581227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore the pathogenesis that TIMP-1 mediated in adult orbital xanthogranulomatous disease (AOXGD), a rare type of non-Langerhans histiocytosis that damages the appearance and quality of life of patientsMethods: We reviewed 22 patients diagnosed with AOXGD based on clinical manifestations and histological analysis, and then investigated the expression of TIMP-1 and IL-6 with q-PCR and IHC in AOXGD tissues and the possible mechanism involved in the induction of TIMP-1 by IL-6.Results: IL-6 and TIMP-1 were significantly increased in AOXGD tissues. IL-6 promoted TIMP-1 production by M1 macrophages by stimulating the phosphorylation of JAK2 and STAT3. Moreover, IL-17 and IFN-γ, the classical markers of Th1 and Th17 cells, were increased in AOXGD.Conclusion: These data implied that the IL6~JAK2/STAT3-TIMP-1 signalling pathway is activated in AOXGD and that adaptive Th1 and Th17 responses are involved in the development of AOXGD.
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Affiliation(s)
- Xia Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuan Cao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Xing
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ming Lin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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16
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Navarro-Hernández E, Hernández-Pons A, Montolío-Marzo S, Pérez-López M. Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling. ACTA ACUST UNITED AC 2019; 94:248-251. [PMID: 30712950 DOI: 10.1016/j.oftal.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/02/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas.
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Affiliation(s)
- E Navarro-Hernández
- Servicio de Oftalmología, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - A Hernández-Pons
- Servicio de Oftalmología, Hospital Universitario Dr. Peset, Valencia, España
| | - S Montolío-Marzo
- Servicio de Oftalmología, Unidad de Órbita, Párpados y Vía Lagrimal, FISABIO Oftalmología Médica, Valencia, España.
| | - M Pérez-López
- Servicio de Oftalmología, Unidad de Órbita, Párpados y Vía Lagrimal, FISABIO Oftalmología Médica, Valencia, España
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17
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Hellman JB, Kim E, Lin LK. Recurrent Bilateral Periorbital Swelling. JAMA Ophthalmol 2018; 136:1406-1407. [PMID: 30242331 DOI: 10.1001/jamaophthalmol.2018.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Esther Kim
- University of California, Davis, Eye Center, Sacramento
| | - Lily Koo Lin
- University of California, Davis, Eye Center, Sacramento
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18
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Rodrigues F, Georgin Lavialle S, Bachmeyer C. Underlying Mechanisms of Adult-Onset Asthma and Periocular Xanthogranuloma: Comment on the Article by Gallo et al. Arthritis Care Res (Hoboken) 2018; 70:959-960. [PMID: 28692771 DOI: 10.1002/acr.23316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Claude Bachmeyer
- Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
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19
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Rituximab Monotherapy Is Effective in Treating Orbital Necrobiotic Xanthogranuloma. Ophthalmic Plast Reconstr Surg 2018; 34:e24-e27. [DOI: 10.1097/iop.0000000000000988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Lakdawala N, Ferenczi K, Grant-Kels JM. Granulomatous diseases: Kids are not just little people. Clin Dermatol 2017; 35:555-565. [PMID: 29191347 DOI: 10.1016/j.clindermatol.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous diseases represent a heterogeneous group of conditions characterized by histiocytic inflammation that affect patients of any age. These diseases differ widely in their pathogenesis and include infectious and noninfectious conditions. This review focuses on noninfectious granulomatous conditions, with particular emphasis on age-related differences in the onset, epidemiology, clinical manifestations, prognosis, and age-specific management of specific granulomatous disorders. Knowledge of age-specific aspects of granulomatous conditions in adults and children improves both the extent of the diagnostic workup and the management of these patients.
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Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwuakee, WI.
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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21
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Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Baykal C, Polat Ekinci A, Yazganoglu KD, Buyukbabani N. The clinical spectrum of xanthomatous lesions of the eyelids. Int J Dermatol 2017; 56:981-992. [PMID: 28500693 DOI: 10.1111/ijd.13637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 03/10/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
Yellowish papules, nodules, or plaques, namely "xanthomatous" lesions, may be seen on the eyelids in the course of various disorders. The prototype is "xanthelasma palpebrarum" (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non-Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult-onset xanthogranuloma, adult-onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease, Rosai-Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.
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Affiliation(s)
- Can Baykal
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Algun Polat Ekinci
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kurtulus D Yazganoglu
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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23
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Gonzales JA, Haemel A, Gross AJ, Acharya NR. Management of Uveitis and Scleritis in Necrobiotic Xanthogranuloma. J Ocul Pharmacol Ther 2017; 33:325-333. [PMID: 28394239 DOI: 10.1089/jop.2016.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Necrobiotic xanthogranuloma (NXG) is a chronic, progressive non-Langerhans histiocytic granulomatous disease. While case reports describing periorbital involvement of NXG are frequent, only a few case reports describing ocular involvement, such as scleritis and uveitis, exist. Herein, we present a case presenting initially as bilateral anterior and posterior scleritis, as well as a chronic bilateral granulomatous panuveitis, and discuss the immunosuppressant options that should be considered for this disease with protean manifestations.
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Affiliation(s)
- John A Gonzales
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
| | - Anna Haemel
- 3 Department of Dermatology, University of California , San Francisco, San Francisco, California
| | - Andrew J Gross
- 4 Department of Rheumatology, University of California , San Francisco, San Francisco, California
| | - Nisha R Acharya
- 1 F.I. Proctor Foundation, University of California , San Francisco, San Francisco, California.,2 Department of Ophthalmology, University of California , San Francisco, San Francisco, California
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24
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Comparative Study of Clinical, Pathological, Radiological, and Genetic Features of Patients With Adult Ocular Adnexal Xanthogranulomatous Disease, Erdheim-Chester Disease, and IgG4-Related Disease of the Orbit/Ocular Adnexa. Ophthalmic Plast Reconstr Surg 2017; 33:112-119. [PMID: 26882062 DOI: 10.1097/iop.0000000000000661] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare and contrast the clinical, radiologic, pathologic, and genetic features of patients with ocular adnexal IgG4-related disease (IgG4-RD) and patients with adult ocular adnexal xanthogranulomatous disease (XG). METHODS This retrospective review study identified patients with histological evidence of either disease from records of the pathology department of our hospital from 1996 to 2014. Clinical, imaging, and a variety of histopathologic features were collected for 23 patients with IgG4-RD and 13 patients with XG. Next generation sequencing with a 50-gene cancer screening panel was performed on biopsy tissues from 10 patients in each group. RESULTS Statistical differences between the 2 groups include eyelid (67%; p = 0.0002) and anterior orbital (75%; p = 0.0352) predilection for XG except for Erdheim-Chester disease subgroup which was more posterior and diffuse. Eyelid involvement was rare (4%) for IgG4-RD. Involvement of orbital nerves was seen in 30% of IgG4-RD and 0% in XG (p = 0.0695). Five patients with IgG4-RD developed malignancy (4 lymphoma, 1 leiomyosarcoma), but none of XG patients. Discriminating pathological features were the presence of any IgG4+ plasma cells (p = 0.0121) and the ratio of IgG4+/IgG+ plasma cells (p =0.0294) for IgG4-RD. Five of 12 (42%) patients with XG had sufficient numbers of IgG4+ plasma cells/high power field to fulfill published diagnostic criteria for IgG4-RD, and 5 (42%) had a ratio of IgG4+/IgG+ plasma cells over 40%, but the numbers overall were less than seen in the IgG4-RD patients. The only genetic difference between the 2 groups was that BRAF V600E mutation was found in 1 of the 2 Erdheim-Chester disease patients, which form a subgroup of XG. CONCLUSIONS IgG4-RD and XG share clinical, imaging, and histopathological features including IgG4+ plasma cells. Significant differences were the eyelid involvement in XG, orbital nerve involvement, and an elevated IgG4+/IgG+ ratio in IgG4-RD and the only genetic abnormality found was BRAF V600E mutation in the Erdheim-Chester disease subgroup of XG.
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25
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Ortiz Salvador JM, Subiabre Ferrer D, Pérez Ferriols A. Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:400-406. [PMID: 28262109 DOI: 10.1016/j.ad.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/10/2016] [Accepted: 12/02/2016] [Indexed: 01/18/2023] Open
Abstract
Adult xanthogranulomatous disease of the orbit refers to a heterogeneous group of clinical syndromes with differing degrees of systemic involvement and distinct prognoses. The different syndromes all present clinically with progressively enlarging, yellowish lesions of the orbit. Histologically, the lesions are characterized by an inflammatory infiltrate of foam cells and Touton-type multinucleated giant cells. The xanthomatized histiocytes are CD68+, S100-, and CD1a-. There are 4 clinical forms of xanthogranulomatous disease of the orbit: adult xanthogranulomatous disease of the orbit, adult onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, and Erdheim-Chester disease. The treatment of local lesions are treated with systemic corticosteroids and other immunosuppressors. Vemurafenib, tocilizumab, and sirolimus have shown promising results in systemic disease.
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Affiliation(s)
- J M Ortiz Salvador
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - D Subiabre Ferrer
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - A Pérez Ferriols
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
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26
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Edwards LR, Kidd LL, Gru AA, Wilson BB. Image Gallery: Necrobiotic xanthogranuloma in association with chronic myelomonocytic leukaemia. Br J Dermatol 2017; 176:e16. [PMID: 28244100 DOI: 10.1111/bjd.15285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L R Edwards
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA, 22908, U.S.A
| | - L L Kidd
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA, 22908, U.S.A
| | - A A Gru
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA, 22908, U.S.A
| | - B B Wilson
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA, 22908, U.S.A
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28
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Bhutani M, Shahid Z, Schnebelen A, Alapat D, Usmani SZ. Cutaneous manifestations of multiple myeloma and other plasma cell proliferative disorders. Semin Oncol 2016; 43:395-400. [DOI: 10.1053/j.seminoncol.2016.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Orbital inflammation: Corticosteroids first. Surv Ophthalmol 2016; 61:670-3. [PMID: 26973286 DOI: 10.1016/j.survophthal.2016.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
Orbital inflammation is common, and may affect all ages and both genders. By combining a thorough history and physical examination, targeted ancillary laboratory testing and imaging, a presumptive diagnosis can often be made. Nearly all orbital inflammatory pathology can be empirically treated with corticosteroids, thus obviating the need for histopathologic diagnosis prior to initiation of therapy. In addition, corticosteroids may be effective in treating concurrent systemic disease. Unless orbital inflammation responds atypically or incompletely, patients can be spared biopsy.
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30
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