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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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Okuyama S, Yazu H, Ito Y, Minato H, Fujishima H. Eosinophilic Angiocentric Fibrosis in Bilateral Upper Eyelid Conjunctivas: A First Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924042. [PMID: 32366815 PMCID: PMC7227441 DOI: 10.12659/ajcr.924042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patient: Female, 55-year-old Final Diagnosis: Eosinophilic angiocentric fibrosis Symptoms: Lid swelling Medication: Topical eye drops Clinical Procedure: Resection of conjunctivas Specialty: Ophthalmology
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Affiliation(s)
- Sho Okuyama
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan.,Keio Allergy Center, Keio University Hospital, Tokyo, Japan
| | - Yumi Ito
- Division of Diagnostic Pathology, Tsurumi University Dental Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Fujishima
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan.,Keio Allergy Center, Keio University Hospital, Tokyo, Japan
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Ahn J, Flanagan M. Eosinophilic Angiocentric Fibrosis: A Review and Update of Its Association With Immunoglobulin G4-Related Disease. Arch Pathol Lab Med 2018; 142:1560-1563. [PMID: 30289267 DOI: 10.5858/arpa.2017-0223-rs] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eosinophilic angiocentric fibrosis is a rare indolent lesion of the head and neck region that has characteristic histologic findings of onionskin fibrosis and prominent eosinophils. Its pathogenesis has been poorly understood and has been most commonly attributed to hypersensitivity or previous trauma. Recently, the lesion has been included in the spectrum of immunoglobulin G4 (IgG4)-related disease. However, few of the existing cases of eosinophilic angiocentric fibrosis have been evaluated for IgG4+ and IgG+ plasma cells. Therefore, we provide an update on the clinical and histologic features of eosinophilic angiocentric fibrosis to increase awareness of the entity and encourage its further characterization as an IgG4-related disease.
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Affiliation(s)
- Janice Ahn
- From the Department of Pathology, West Virginia University, Morgantown
| | - Melina Flanagan
- From the Department of Pathology, West Virginia University, Morgantown
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Legare N, Frosh S, Vasquez JB, Ho ST. Eosinophilic angiocentric fibrosis : a sino-orbital masquerader. BMJ Case Rep 2018; 2018:bcr-2017-223675. [PMID: 30093462 DOI: 10.1136/bcr-2017-223675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 58-year-old Caucasian male presented with left periorbital oedema extending to the nasal area for 1 year along with nasal discharge for 1 month. Lab work was significant for positive cytoplasmic antineutrophil cytoplasmic antibodies. CT scan showed solid mass along the nasal soft tissue with bony nasal destruction. A CT scan of the thorax was performed to rule out granulomatosis with polyangiitis and showed multiple pulmonary nodules. Biopsies of the nasal mass and lung nodule were performed which showed fragments of fibrosis with spindle cell proliferation consistent with eosinophilic angiocentric fibrosis (EAF). EAF is a very rare disease, recently described as a subtype of immunoglobulin G4-related disease. A few rare cases of EAF involving the structures of the orbit have been reported in the literature.
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Affiliation(s)
- Nicole Legare
- University of Central Florida, College of Medicine, Orlando, Florida, USA
| | - Seema Frosh
- Rheumatology, Orlando VA Medical Center, Orlando, Florida, USA
| | | | - Son T Ho
- Ophthalmology, Orlando VA Medical Center, Orlando, Florida, USA
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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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Eosinophilic Angiocentric Fibrosis as a Stenosing Lesion in the Subglottis. Case Rep Otolaryngol 2017; 2017:2381786. [PMID: 28251006 PMCID: PMC5303848 DOI: 10.1155/2017/2381786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/13/2016] [Indexed: 11/18/2022] Open
Abstract
Subglottic Eosinophilic Angiocentric Fibrosis (EAF) is an extremely rare disease of an elusive aetiology. It is chronically progressive benign condition that causes narrowing of the subglottic region leading to dysphonia and airway compromise. The diagnosis is historical and imaging is nonspecific. We report a case xc of 56-year-old lady referred to our institution with globus sensation, hoarseness, and mild stridor. Incidental subglottic mass was found at time of diagnostic microlaryngoscopy and biopsy confirmed subglottic EAF. All laboratory investigations were unremarkable. Lesion was removed with laryngeal microdebrider and three courses of intravenous dexamethasone were administered. Patient's postoperative period was uneventful and had remained disease free for 1 year. To date, no consensus has been reached on the optimal treatment of subglottic EAF. We recommend regular follow-up to detect early recurrence.
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Jin CJ, Perez-Ordonez B, Witterick I. Eosinophilic angiocentric fibrosis of the sinonasal tract. BJR Case Rep 2016; 2:20150419. [PMID: 30363608 PMCID: PMC6180858 DOI: 10.1259/bjrcr.20150419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/09/2016] [Accepted: 01/26/2016] [Indexed: 11/05/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is an exceedingly rare and potentially disfiguring and obstructing benign lesion involving the upper airways. We report two cases of EAF originating from the nasal cavity in a 31-year-old female and a 58-year-old male exhibiting nasal obstructive symptoms, with imaging features and histopathology characteristic of EAF. Surgical excision was performed on one patient with a disfiguring nasal mass at a tertiary referral rhinology practice within a university centre. Summarized are the relevant clinical issues to increase awareness of this disease. The slow progression and rarity of the disease has previously resulted in diagnostic difficulty. We review the limited current literature surrounding the clinical features and treatment options for this progressive and potentially morbid condition. These cases reinforce that, while rare, inflammatory and fibrosing lesions in general should still be considered as part of the differential diagnosis in patients presenting with obstructive lesions in the sinonasal tract.
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Affiliation(s)
- Chunzi Jenny Jin
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Queen's University, Kingston, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, University Health Network, University of Toronto, Toronto, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
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11
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Nasal Eosinophilic Angiocentric Fibrosis with Orbital Extension. Head Neck Pathol 2015; 9:426-9. [PMID: 25601283 PMCID: PMC4542801 DOI: 10.1007/s12105-014-0605-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is an extremely rare, chronic, benign, idiopathic disorder that mostly affects the upper respiratory tract, particularly the nasal cavity, and features progressive submucosal perivascular fibrosis. To the best of our knowledge, only seven cases of EAF with orbital involvement have been reported. We report a case of sinonasal EAF with orbital extension that presented with left nasolacrimal duct obstruction. A 35-year-old man presented with left epiphora, proptosis, anterolateral globe displacement and nasal obstruction. Endoscopic sinus examination showed a firm, gritty, creamy, yellow, fibrous, adherent mass of maxillary sinus. Diagnosis was established with histopathological examination of excisional biopsy of the lesion. Although EAF is very rare, it should be considered in the differential diagnosis of lesions of upper airway tract, particularly the nasal cavity. Biopsy is necessary for diagnosis and treatment planning. Resecting of the involved tissues completely is essential for prevention of recurrence.
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12
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Fang CH, Mady LJ, Mirani NM, Baredes S, Eloy JA. Sinonasal eosinophilic angiocentric fibrosis: a systematic review. Int Forum Allergy Rhinol 2014; 4:745-52. [PMID: 25065665 DOI: 10.1002/alr.21347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis (EAF) is a benign rare lesion of the upper respiratory mucosa. EAF most commonly presents with an obstructive nasal mass. Due to the rarity of EAF, case reports and case studies have predominated the literature. This systematic review discusses the demographics, clinical presentation, associated findings, management, and outcomes of this uncommon entity. METHODS The PubMed database was searched for all articles describing patients diagnosed with sinonasal EAF. Additional cases were examined from the bibliographies of selected articles. Demographics, clinical presentation, associated findings, radiography, management, and outcome were analyzed. RESULTS Fifty-two cases were included from 34 articles, including 1 case from our institution. The most common presenting symptom was nasal obstruction (78.8%). Fourteen patients (26.9%) had a previous history of nasal surgery or trauma. Surgical resection alone was the most commonly used primary treatment approach (50.0%), resulting in the greatest proportion of disease-free patients (55.6%) over a median follow-up period of 36 months. A combination of surgery and corticosteroids was the second-most-common treatment modality, used in 28.8% of cases. Of the 40 cases reporting patient outcomes, 100% of patients were alive at follow-up independent of treatment modality. CONCLUSION To date, this review contains the largest number of patients with sinonasal EAF. Aggressive surgical resection alone constitutes the most common treatment modality and may be most effective at eradicating disease.
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Affiliation(s)
- Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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Karligkiotis A, Volpi L, Ferreli F, Cerati M, Kagkelari E, Meloni F, Castelnuovo P. Primary orbital eosinophilic angiocentric fibrosis with intranasal extension. Head Neck 2013; 36:E8-E11. [PMID: 23733241 DOI: 10.1002/hed.23396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/12/2013] [Accepted: 05/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis is a chronic, idiopathic disorder that usually involves the upper respiratory tract and features progressive submucosal perivascular fibrosis of unknown etiology. To our knowledge, only 5 cases of eosinophilic angiocentric fibrosis with primary orbital involvement have been reported. METHODS AND RESULTS We report the case of a 46-year-old man with right proptosis and lateral globe displacement caused by a primary eosinophilic angiocentric fibrosis extending from the orbit into the anterior ethmoid. The nasal extension of the lesion helped in establishing the correct diagnosis. CONCLUSION Physicians involved in the treatment of orbital pathologies should be familiar with this entity, because it may manifest as an intraorbital mass growing primarily or secondly into the orbit. The clinical manifestations of eosinophilic angiocentric fibrosis with orbital involvement often mimic other more common ophthalmological diseases. Biopsies are necessary for diagnosis and treatment planning, although cures are usually of palliative effect.
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Eosinophilic angiocentric fibrosis of the nasal septum. Case Rep Otolaryngol 2013; 2013:267285. [PMID: 23634315 PMCID: PMC3619668 DOI: 10.1155/2013/267285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Eosinophilic angiocentric fibrosis (EAF) is a rare benign condition of unknown aetiology that causes stenosis of the upper respiratory tract. It is most commonly found at the nasal septum and sinus mucosa causing mucosal thickening and nasal obstructive symptoms. The diagnosis is mainly based on characteristic histologic findings. Case Report. A 27-year-old young woman presented with a slow growing mass at her anterior nasal septum for over eight years. She complained of persistent nasal obstruction, epistaxis, sometimes diffused facial pain, and chronic headache. 3 years ago, the tumor was partially resected for ventilation and a nasal septum perforation was left. Imaging findings indicated soft-tissue thickening of the anterior part of septum and adjacent lateral nasal walls. Pathological examination showed numerous inflammatory cells infiltrates containing eosinophils, fibroinflammatory lesion with a whorled appearance fibrosis which typically surrounded vessels. A diagnosis of eosinophilic angiocentric fibrosis was made. All laboratory tests were unremarkable. Skin prick test was positive. The tumor-like lesion was totally resected. Conclusions. EAF is a rare benign and progressive disorder causing destruction. Combined with radiological imaging of EAF historical findings contribute to the diagnosis. It is important to prevent tumor from recurrence by total resection of the lesion.
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Fibrose angiocentrique à éosinophiles : une manifestation de la maladie systémique liée au IgG4 ? Ann Pathol 2012; 32:271-5. [DOI: 10.1016/j.annpat.2012.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 06/07/2012] [Accepted: 06/21/2012] [Indexed: 12/24/2022]
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Yang BT, Wang YZ, Wang XY, Wang ZC. Nasal cavity eosinophilic angiocentric fibrosis: CT and MR imaging findings. AJNR Am J Neuroradiol 2011; 32:2149-53. [PMID: 21998106 DOI: 10.3174/ajnr.a2786] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE EAF consists of exceedingly rare lesions and presently lacks specific imaging reports. The purpose of this study was to determine the CT and MR imaging features of nasal cavity EAF. MATERIALS AND METHODS We retrospectively reviewed 6 patients with histology-proven EAF in the nasal cavity. All 6 patients underwent CT and 3 patients also underwent MR imaging. The following imaging features were reviewed: 1) location, 2) shape, 3) margin, 4) CT attenuation, and 5) MR imaging signal intensity. In addition, the accompanying changes and the TIC of the DCE MR imaging were analyzed. RESULTS All occurrences of EAF were located at the anterior nasal cavity, arising from the nasal septum in 4 patients, with irregular shape, and the lateral nasal wall in 2, with oval configuration. The mean size was 29.8 mm (range 12-52 mm). On nonenhanced CT, EAF lesions appeared isoattenuated relative to gray matter. On the T1-weighted image, the lesions were isointense in 3 (100%) patients. On the T2-weighted image, the lesions were isointense in 1 (33.3%) patient and hypointense in 2 (66.7%) patients. Occurrences of EAF revealed moderate inhomogeneous contrast enhancement. Three patients underwent DCE MR imaging and the TICs exhibited a rapidly enhancing and slow washout pattern. One patient had bilateral lacrimal gland enlargement, which displayed low signal intensity on the T2-weighted image. CONCLUSIONS A familiarity with imaging findings, including lesion location, isoattenuation and bony changes, and hypointensity on T2-weighted images may help to accurately diagnose this rare entity.
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Affiliation(s)
- B T Yang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Sinonasal eosinophilic angiocentric fibrosis: a report of four cases and review of literature. Head Neck Pathol 2008; 2:309-15. [PMID: 20614301 PMCID: PMC2807588 DOI: 10.1007/s12105-008-0077-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition of unknown etiology involving the sinonasal tract and the upper respiratory airways, and rarely, larynx, and orbit. We report four cases of EAF identified, in three women and one man, aged 31, 57, 27, and 51 years, respectively. The patients complained of sinonasal obstructive symptoms of long duration, nasal masses, epiphora, and/or proptosis. Histologically, all cases demonstrated a dense fibrotic stroma with a perivascular "onion-skin" whorling pattern, and a dense inflammatory infiltrate consisting of lymphocytes, plasma cells, eosinophils, and some neutrophils. In addition, one patient demonstrated modest acute neutrophilic inflammation with focal endothelial proliferation. No patient exhibited clinical or histological evidence of Wegener's granulomatosis, granuloma faciale, Kimura's disease, and malignant lymphomas. Surgical excision was performed in all cases, and to date, medical therapy has been of limited help. The clinical and histopathological features and differential diagnoses of this underreported EAF condition are discussed.
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