1
|
Dhodapkar RM, Spadaro JZ, Heng JS, Sinard JH, Lee YH, Habib LA, Pointdujour-Lim R. NK/T-cell Lymphoma With Orbital Involvement: A Case Report and Systematic Review of the Literature. Ophthalmic Plast Reconstr Surg 2023; 39:316-327. [PMID: 36692957 DOI: 10.1097/iop.0000000000002317] [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: 01/25/2023]
Abstract
PURPOSE To present the clinical course of a patient with recurrent NK/T-cell lymphoma (NKTL) involving the orbit and to review the literature on patients with NKTL involving the orbit. METHODS The PubMed database was searched for all cases of NKTL involving orbital, intraocular, or adnexal ocular structures. RESULTS Ninety-six patients were included in the final analysis. The mean age of diagnosis was 48.1 ± 16.8 years. The patients were 53/96 (55.2%) male and 43/96 (44.8%) female. Tumor location varied and included the orbit in 80/96 (83.3%), nasosinus in 56/96 (58.3%), uvea in 11/96 (11.5%), lacrimal gland in 9/96 (9.4%), lacrimal drainage system in 11/96 (11.5%), and conjunctiva in 7/96 (7.3%) cases. Management included surgical debulking in 29/96 (30.2%) cases, radiotherapy in 52/96 (54.2%) cases, and chemotherapy in 82/96 (85.4%) cases. Median survival was 6 months (95% CI: 5-9). Chemotherapy (hazard ratio = 0.80, 95% CI: 0.67-0.95, p = 0.013), radiotherapy (hazard ratio = 0.75, 95% CI: 0.64-0.87, p < 0.001), and orbital involvement being a recurrence of disease (hazard ratio = 0.79, 95% CI: 0.67-0.95, p = 0.009) were associated with improved survival. Advanced Ann Arbor stage (III-IV) at diagnosis (hazard ratio = 1.22, 95% CI: 1.08-1.38, p = 0.001), vision loss (hazard ratio = 1.18, 95% CI: 1.04-1.34, p = 0.009), proptosis (hazard ratio = 1.15, 95% CI: 1.01-1.30, p = 0.035) and periorbital swelling (hazard ratio = 1.15, 95% CI: 1.00-1.33, p = 0.048) were associated with poor survival. CONCLUSIONS NK/T-cell lymphoma involving the orbit, globe, or ocular adnexa heralds a poor prognosis where early diagnosis and therapy are critical. The use of radiotherapy and chemotherapy is associated with improved survival.
Collapse
Affiliation(s)
- Rahul M Dhodapkar
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - John H Sinard
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Larissa A Habib
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, U.S.A
| |
Collapse
|
2
|
Li DM, Lun LD. Rhino-Orbital-Cerebral Mycosis and Extranodal Natural Killer or/and T-Cell Lymphoma, Nasal Type. Front Med (Lausanne) 2022; 9:851208. [PMID: 35783622 PMCID: PMC9248758 DOI: 10.3389/fmed.2022.851208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma, nasal type is a syndrome of middle face destruction with an association to Epstein-Barr virus. Fungi have been recovered from the diseased tissue now and then but were often seen as a lymphoma-associated secondary infection. However, there are ENKTL-NT cases with the recoveries of fungi and complete recovery with antifungal therapy, which are quite similar to rhino-orbital-cerebral mycosis (ROCM) that often confuses the physicians. Methods We searched Medline for English-language manuscripts limited to “human” and “case reports,” “letters,” “reviews,” and “clinical conferences” from 1966 to 2022. We used MeSH terms “lymphoma, extranodal nk-t-cell” [MeSH Terms] or “lethal midline granuloma” [MeSH Terms], in combination with MeSH terms “microbiology” [subheading] or “microbiology” [all fields] or “fungi” [all fields] or “fungi” [MeSH Terms] for ENKTL-NT with infections. We used MeSH terms “Mycoses” in combination with “Nose” [Mesh] OR “Orbital Diseases” [Mesh] for rhino-orbital-cerebral fungal infections. Results We appraised 149 included articles and extracted references related to ENKTL-NT and/or ROCM. Themes and subcategories were subsequently derived. Our findings revealed that ROCM and ENKTL-NT are characterized by progressive and destructive ulcers in the midline face or rhino-orbital structures. ROCM is mainly caused by fungi in the order of Mucorales, and ENKTL-NT is usually associated with Epstein-Barr virus and sometimes fungi. Radiologically, both are characterized by non-specific features of sinusitis, soft tissue infection, and necrosis. Pathologically, ROCM and ENKTL-NT share the same characteristics of inflammation, necrosis, and granuloma. ROCM is characterized by the detection of fungi in tissue, while ENKTL-NT is typically positive for NK/T-cell markers and cytotoxic granule-associated proteins, proliferation, and vascular damage of angioinvasion, which could be incited by Mucor irregularis and Rhizopus arrhizus in patients and mice. Conclusion ENKTL-NT and ROCM share many similarities in clinical presentations, radiology, and histopathology, and might have the same etiology. This may explain why the two diseases are tangled together in the reported cases, and suggests the role that the fungi may play in the development of these ENKTL-NT/ROCM diseases. The reason why ENKTL-NT and ROCM are sometimes confused is that the main pathogens of ROCM, Mucor irregularis and Rhizopus arrhizus, are the fungal causative agents of ENKTL-NT.
Collapse
Affiliation(s)
- Dong Ming Li
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing, China
- *Correspondence: Dong Ming Li, ,
| | - Li De Lun
- Division of Nephrology and Rheumatism, Air Force General Hospital PLA, Beijing, China
| |
Collapse
|
3
|
Kim HJ, Kim LM, Rotenberg BW. Nasal Lymphoma Presenting With Contralateral Proptosis and Vision Changes: A Case Report and Literature Review. Cureus 2020; 12:e11287. [PMID: 33274161 PMCID: PMC7707916 DOI: 10.7759/cureus.11287] [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: 11/10/2022] Open
Abstract
Non-Hodgkin lymphoma (NHL) is a hematological malignancy that can sometimes originate from the nasal cavities and paranasal sinuses. Patients who present with these tumors typically report sinonasal symptoms. However, a diagnostic challenge can arise when a patient’s primary complaints include unique complex symptoms limited to the contralateral side of the tumor. This report describes the case of an 83-year-old man who presented to our center with a left-sided mass and right-sided proptosis with vision loss. After a nasal biopsy was taken, the patient was referred to the ophthalmology department to diagnose the cause of his ocular symptoms, which were not believed to be related to the mass. When biopsy results later returned as diffuse large B-cell lymphoma (DLBCL), an emergent repeat biopsy following lymphoma protocol was performed to confirm the diagnosis. A CT scan of the head and orbits showed generalized enlargement of the right optic nerve and extraocular muscles, and a positron emission tomography (PET) scan showed increased 18F-fluorodeoxyglucose (FDG) uptake in the right ethmoid sinus and orbit. The left-sided mass and right-sided symptoms resolved simultaneously with chemotherapy. This is the first documented case of a sinonasal mass causing ocular symptoms exclusively on the contralateral side. The presented diagnostic challenge highlights the importance of thorough investigations.
Collapse
Affiliation(s)
- Hugh J Kim
- Otolaryngology, Western University, London, CAN
| | - Laura M Kim
- Otolaryngology, Western University, London, CAN
| | | |
Collapse
|
4
|
Ben Salah R, Kammoun S, Frikha F, Bouattour Y, Chabchoub I, Feki J, Bahloul Z. Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. Eur J Ophthalmol 2019; 31:NP131-NP135. [PMID: 31476885 DOI: 10.1177/1120672119873275] [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: 11/15/2022]
Abstract
Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.
Collapse
Affiliation(s)
- Raida Ben Salah
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Sonda Kammoun
- Department of Ophthalmology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Yosra Bouattour
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Jamel Feki
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| |
Collapse
|
5
|
Yang Y, Li Z, Zhiyang C, Liang H. Extranodal natural killer/T-cell lymphoma nasal type with central nervous system involvement mimicked tuberculous meningitis: A case report. Medicine (Baltimore) 2019; 98:e16747. [PMID: 31441847 PMCID: PMC6716710 DOI: 10.1097/md.0000000000016747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Neurologic deficits are rare in patients with extranodal natural killer/T-cell lymphoma (NKTL), nasal type. We present a case that was initially suspected as tuberculous meningitis, but later diagnosed as central nervous system metastasis of NKTL, nasal type, which has never been published previously. PATIENT CONCERNS A 55-year-old Chinese man presented with persistent headache and fever. The initial head computed tomography and magnetic resonance imaging (MRI) scan was normal. Low glucose, elevated protein, and pleocytosis of cerebral spinal fluid led to a diagnosis of tuberculous meningitis. The patient did not respond to anti-tuberculosis treatment, and his symptoms aggravated. MRI showed abnormal lesions in the right hemisphere and a lesion in the maxillary sinus region. DIAGNOSIS Endoscopic biopsy of the maxillary lesion showed features consistent with NKTL. Positron emission tomography revealed a hypermetabolic mass involving the right maxillary sinus and brain. INTERVENTIONS The patient received chemotherapy. OUTCOMES The patient died 30 days after chemotherapy. LESSONS Lymphoma of the nasal cavity and paranasal sinuses is extremely rare and may be easily misdiagnosed. Nasal NKTL metastasis should be considered when a patient presents with symptoms of leptomeningeal involvement.
Collapse
Affiliation(s)
- Yina Yang
- Department of Neurology, Ninghai First Hosptial, Zhejiang
| | - Zhouling Li
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chen Zhiyang
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Liang
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
6
|
Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
Collapse
Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Isolated Third Cranial Nerve Palsy Leading to the Diagnosis of Disseminated Burkitt Lymphoma: A Case Report and Literature Review. Neurologist 2018; 22:182-185. [PMID: 28859023 DOI: 10.1097/nrl.0000000000000130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dysfunction of the third cranial nerve can result from lesions anywhere along its course between the midbrain and the orbit. Lymphoma is a rare cause of isolated oculomotor nerve palsy (OMP), with only 19 cases reported in the literature. We describe a case of an isolated OMP leading to the diagnosis of disseminated Burkitt lymphoma (BL). CASE REPORT A 37-year-old man presented with acute onset diplopia and right ptosis and was found to have a right pupillary sparing OMP. The diagnostic workout was unremarkable, including contrast-enhanced brain and orbital magnetic resonance imaging, MR angiography, exhaustive laboratory tests, and cerebrospinal fluid analysis. After a course of high-dose intravenous steroid therapy, the patient recovered almost completely. Three weeks after the discharge, he developed lumbar radicular pain and lower limbs weakness followed by the relapse of the right OMP. A second lumbar puncture revealed the presence of "small monomorphic lymphocytes," consistent with leptomeningeal lymphomatosis. A whole-body positron emission tomography scan disclosed a mediastinal mass, whose histopathologic "starry sky" appearance was pathognomonic for BL. CONCLUSIONS Reviewing the literature, we were able to find only 3 cases of OMP as the presenting manifestation of BL, all occurring in patients with predisposing HIV infection.Our case of isolated OMP highlights some "red flags" for a lymphomatous etiology, including young age, a progressive course, a response to high-dose steroid therapy, and relapse upon steroid discontinuation; these cases require a comprehensive evaluation, including repeated cytological cerebrospinal fluid analysis and sensitive imaging techniques to detect a possible primary lesion.
Collapse
|
8
|
Orbital and central nervous system extension of nasal natural killer/T-cell lymphoma. Ophthalmic Plast Reconstr Surg 2014; 30:20-3. [PMID: 24398482 DOI: 10.1097/iop.0b013e3182a7500e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To describe a case series of nasal natural killer (NK)/T-cell lymphoma (NKTL) with orbital and central nervous system extension. METHODS This is a retrospective study. The medical records of 9 patients with a diagnosis of NKTL were reviewed. All patients had a positive biopsy for CD3, CD56, T-cell-restricted intracellular antigen-1, and granzyme expression and CT imaging of nose, sinuses, orbits, and brain. Five patients were also examined with MRI. RESULTS Orbital extension occurred in 6 patients. All had extraocular muscle enlargement and 5 showed signs of perineural spread. CONCLUSIONS NKTL is a polymorphous disease. Extraocular muscle involvement and perineural spread are overlooked features that explain dissemination of the tumor to both the orbit and the central nervous system.
Collapse
|
9
|
Termote K, Dierickx D, Verhoef G, Jorissen M, Tousseyn T, Mombaerts I. Series of extranodal natural killer/T-cell lymphoma, nasal type, with periorbital involvement. Orbit 2014; 33:245-51. [PMID: 24831171 DOI: 10.3109/01676830.2014.902478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical presentation, diagnosis and treatment of periorbital extranodal natural killer/T-cell lymphoma, nasal type. METHODS Case series of three patients with periorbital involvement of extranodal natural killer/T-cell lymphoma, nasal type, of whom clinical data, orbital imaging and immunohistochemical analysis were collected. For the purpose of this study, all histopathological and immunohistochemical slides were re-examined. RESULTS All patients presented with painless eyelid swelling and a history of sinonasal disease, of whom one with bilateral panuveitis, not responding to systemic antibiotics. Extraocular muscle involvement was present in 2 cases upon presentation and in 1 case later on. Initial paranasal and orbital biopsies were negative in 2 patients, with only the second orbital biopsy leading to the diagnosis. Natural killer/T-cell and cytotoxic markers were present in all cases, as well as Epstein-Barr virus encoded RNA in situ hybridization. The patients died respectively 5, 9 and 35 months from diagnosis despite treatment with chemotherapy and radiotherapy. CONCLUSION Extranodal natural killer/T-cell lymphoma, nasal type, should be suspected in a painless periorbital cellulitis with chronic sinusitis, not responding to conventional therapy. A high index of suspicion is necessary in biopsies showing angiodestruction and necrosis. Epstein-Barr virus encoded RNA in situ hybridization and expert hematopathologist consultation is necessary to decrease the delay in diagnosis.
Collapse
|
10
|
Yang YJ, Li YX, Liu YB, Yang M, Liu K. CD30 + extranodal natural killer/T-cell lymphoma mimicking phlegmonous myositis: A case report. Oncol Lett 2014; 7:1419-1421. [PMID: 24765148 PMCID: PMC3997696 DOI: 10.3892/ol.2014.1924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/04/2014] [Indexed: 02/05/2023] Open
Abstract
The current study presents a case of a 23-year-old male with CD30+ nasal-type extranodal natural killer/T-cell lymphoma (NKTL), with unusual clinical features mimicking phlegmonous myositis. The patient initially presented with swelling and tenderness of the left lower limb, particularly around the left ankle. One month later, pharyngalgia and fever developed and the patient was treated with antibiotics for the phlegmonous inflammation, however, the symptoms were not relieved. A muscle biopsy was performed on the lesion and revealed diffuse infiltration of atypical lymphoid cells with irregular nuclei. Immunohistochemistry showed staining for CD3ɛ(-), CD20(-), CD45(+), CD30(+) and CD56(+) presented with positive staining for certain tumor cells, granzyme B(+), activin receptor-like kinase 1(-), Ki-67(+) and Epstein-Barr virus-encoded small RNA(+), which indicated nasal-type extranodal NKTL. The present case emphasized that extranodal NKTL may be a rare cause of phlegmonous inflammation and fever of undetermined origin.
Collapse
Affiliation(s)
- Yan-Jia Yang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ya-Xin Li
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan-Bin Liu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Mei Yang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Kai Liu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
11
|
Türker B, Uz B, Işık M, Bektaş O, Demiroğlu H, Sayınalp N, Uner A, Ozcebe Oİ. Nasal Natural Killer/T-cell Lymphoma with Skin, Eye, and Peroneal Nerve Involvement. Turk J Haematol 2012; 29:413-9. [PMID: 24385732 PMCID: PMC3781633 DOI: 10.5505/tjh.2012.03360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 10/06/2011] [Indexed: 11/15/2022] Open
Abstract
Nasal-type natural killer (NK)/T-cell lymphoma (NKTL) is a rare disease strongly associated with Epstein-Barr virus and is often localized to the upper aerodigestive tract at presentation. Extranodal NKTL may involve any extranodal site and disease beyond the nasal cavity is highly aggressive, with short survival time and poor response to therapy. Herein we present a 57-year-old male that had been treated with systemic chemotherapy and cranial radiotherapy for nasaltype NKTL in the palate with skin, right eye, and right peroneal nerve involvement. He was given salvage chemotherapy consisting of 3 cycles of ICE and his response to the therapy was satisfactory, except for persistent right drop foot. About 6 weeks later, the patient presented with bilateral total loss of vision and proptosis; therefore, DHAP chemotherapy was started. Unfortunately, after 1 cycle of the second salvage chemotherapy, he died due to severe fungal infection of the hard palate. Despite the fact that involvement of any extranodal site is possible, concurrent involvement of many systems in NKTL patients is unusual. Nasal-type NKTL has a poor prognosis, despite local radiotherapy and systemic chemotherapy. Physicians should be aware of this rare disorder than can only be diagnosed after extensive immunohistochemical studies. Conflict of interest:None declared.
Collapse
Affiliation(s)
- Burcu Türker
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Burak Uz
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Metin Işık
- Hacettepe University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey
| | - Ozlen Bektaş
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Nilgün Sayınalp
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Aysegül Uner
- Hacettepe University, Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Osman İlhami Ozcebe
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| |
Collapse
|
12
|
Li DM, Lun LD. Mucor irregularis infection and lethal midline granuloma: a case report and review of published literature. Mycopathologia 2012; 174:429-39. [PMID: 22744721 DOI: 10.1007/s11046-012-9559-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/28/2012] [Indexed: 12/16/2022]
Abstract
Mucor irregularis (Rhizomucor variabilis) infection and lethal midline granuloma (LMG) are characterized by progressive swelling, ulceration, and destruction of the central face that is usually fatal. Pathological features are inflammation, necrosis, and granulation. LMG has been called by various names, and in recent years, it has been known as NK/T cell lymphoma. However, diagnosis still relies on the progressive necrosis course rather than malignancy in histology. The disease has long challenged physicians, particularly when it worsens with radiotherapy or chemotherapy but sometimes achieves total remission without anti-malignancy therapies. We describe a 35-year-old man who had typical clinical-pathological symptoms of LMG, which turned out to be primary M. irregularis infection; that was diagnosed by positive tissue culture and fungal elements in histology. The patient was successfully treated with antifungal therapy (liposomal amphotericin B, total 4,600 mg and amphotericin B total 277 mg, over a duration of 70 days). We hereby review current knowledge about the epidemiology, clinical manifestations, radiographic characteristics, and pathologic features of LMG with those of M. irregularis infection and their associations. We conclude that primary M. irregulars infection can mimic the clinico-pathological symptoms of LMG and the condition responds favorably to aggressive antifungal therapy.
Collapse
Affiliation(s)
- Dong Ming Li
- Department of Dermatology, Research Center for Medical Mycology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
| | | |
Collapse
|
13
|
Sato H, Hashimoto T, Yoneda S, Hirabayashi K, Oguchi K, Higuchi K. Lymphoma as a cause of isolated oculomotor nerve palsy. J Clin Neurosci 2011; 18:1256-8. [DOI: 10.1016/j.jocn.2010.12.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 12/16/2010] [Accepted: 12/19/2010] [Indexed: 11/25/2022]
|
14
|
Bourre B, Collongues N, Bouyon M, Aupy J, Blanc F, Speeg C, de Seze J. [A case of bilateral horizontal gaze ophthalmoplegia: The 1+1 syndrome]. Rev Neurol (Paris) 2010; 166:1028-31. [PMID: 20728911 DOI: 10.1016/j.neurol.2010.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/07/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Oculomotor deficiencies in multiple sclerosis (MS) are frequently characterized by internuclear ophthalmpoplegia or isolated abduction or adduction palsies. Complete unilateral conjugate gaze paralysis and the "one and a half" syndrome are rare. Complete bilateral horizontal gaze paralysis has been exceptionally reported. OBSERVATION Here, we describe an unusual oculomotor paralysis as a suspected first event of MS. A 24-year-old woman with an uneventful medical history presented for sudden onset of binocular diplopia. On examination, abduction and adduction saccades were impossible, whereas vertical eye saccades and convergence were normal. Oculocephalic reflex failed to improve horizontal eye movement. No nystagmus and no other sign of brainstem dysfunction were observed. Visual acuity was 4/10 in the right eye and 6/10 in the left eye. A sign of Marcus Gunn was noted in the right eye. Blood samples and cerebrospinal fluid were normal, no oligoclonal bands were detected. Visual evoked potentials were significantly impaired in both eyes and argued for bilateral optic neuritis. Brain MRI scans showed white matter T2-hypersignal abnormalities, which fulfill Barkhof criteria for MS. A small symmetric lesion was noted in the posterior part of the medial pontine tegmentum. As a first episode of MS was suspected, treatment with methylprednisolone 1000 mg/d for 3 days was started, and was followed by complete recovery of eye movements and visual acuity after 3 weeks. DISCUSSION To our knowledge, only two cases of complete horizontal bilateral ophthalmoplegia have been reported in the literature. Both were associated with peripheral facial nerve palsy as a first event in MS. In our case report, we describe for the first time a complete bilateral horizontal ophthalmoplegia with no other brainstem dysfunction. By analogy with the "one and a half" syndrome, such complete horizontal gaze paralysis could be named a "one and one" syndrome and seems to be specifically related to a first event of MS.
Collapse
Affiliation(s)
- B Bourre
- Département de neurologie, hôpital universitaire de Rouen, 1, rue de Germont, 76031 Rouen, France
| | | | | | | | | | | | | |
Collapse
|
15
|
Current world literature. Curr Opin Ophthalmol 2008; 19:435-43. [PMID: 18772678 DOI: 10.1097/icu.0b013e32830d5da2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|