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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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Wiffen J, Kalantary A, Ardakani NM, Turner A. Adult onset xanthogranuloma of the eyelid. Am J Ophthalmol Case Rep 2022; 29:101775. [PMID: 36544751 PMCID: PMC9762145 DOI: 10.1016/j.ajoc.2022.101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To report a rare case of an eyelid lesion in an adult, with histological features of juvenile xanthogranuloma (JXG). Observations Juvenile xanthogranuloma primarily affects the skin of infants and young children. It infrequently can involve the structures of the eye and orbit and rarely occurs in individuals beyond the second decade of life. We present a case of adult onset xanthogranuloma (AXG) involving the eyelid of a 29-year-old female. This lesion required management with multiple treatment modalities. Conclusions This is a rare example of an eyelid xanthogranuloma in an adult. As such, JXG-like lesions should be included as a differential diagnosis for lesions of the eye and orbit in adults. Surgical management may be required if there is no response to intralesional steroids.
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Affiliation(s)
- James Wiffen
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Corresponding author. Lions Outback Vision, 2 Verdun Street, Nedlands, Western Australia, 6009, Australia.
| | - Amy Kalantary
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia,College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Angus Turner
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
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Al-Owaid AA, Al-Dossari S, Maktabi A, Edward D, Sesma G. Bilateral Spontaneous Hyphema in Juvenile Xanthogranuloma: A Case Report. Case Rep Ophthalmol 2021; 11:668-675. [PMID: 33568985 PMCID: PMC7841722 DOI: 10.1159/000510905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is an idiopathic granulomatous inflammatory condition that usually affects children. Intraocular involvement, especially bilateral, is rare in JXG. Most patients with ocular lesions are typically infants and usually present with hyphema, iridocyclitis, and secondary glaucoma. We report a case of a 3-month-old baby girl who presented to our emergency department with bilateral hyphema that started 3 weeks ago. She was medically free with no history of any recent trauma or preceding febrile illness. General physical examination showed a quiet baby with multiple hyperpigmented macules over the inner thigh and right upper arm, with one pinkish nodule over the occiput. She also had high intraocular pressures. A detailed ophthalmic assessment was done under general anesthesia. The nodular lesion was excised and sent for histopathological evaluation, which confirmed the diagnosis of JXG. Treatment of JXG cases present a challenge to ophthalmologist due to rebleeding and refractory glaucoma. Our case was admitted multiple times for rebleeding and refractory glaucoma and was treated with full antiglaucoma drops, steroid drops and peribulbar injection of steroid.
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Affiliation(s)
- Abdullah A Al-Owaid
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Fahd University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | | | - Azza Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Deepak Edward
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Gorka Sesma
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Unlu B, Ayhan Z, Lebe B, Men S, Durak I, Saatci AO. Unilateral Adult Xanthogranulomatous Infiltration of the Conjunctiva, Limbus and Sclera Leading to a Combined Ophthalmic Artery and Central Retinal Vein Occlusion. Open Ophthalmol J 2018; 11:362-367. [PMID: 29299083 PMCID: PMC5725586 DOI: 10.2174/1874364101711010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/28/2017] [Accepted: 11/10/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the features of a female patient with a biopsy-proven xanthogranulomatous infiltration of the conjunctiva, limbus and sclera who had an exudative retinal detachment, combined ophthalmic artery and central retinal vein occlusion unilaterally. Method A-53-year old otherwise healthy woman presenting with a painful visual loss in her right eye underwent an ophthalmic examination, meticulous systemic work-up and histopathologic assessment. Results Ophthalmic examination revealed multiple subconjunctival masses, upper limbal infiltrations, trace cells in the anterior chamber, pale looking posterior fundus, 360 degree scattered retinal hemorrhages and marked exudative retinal detachment in her right eye. Left eye was completely normal.A biopsy taken from one of the subconjunctival masses demonstrated a diffuse infiltration of the histiocytes and this was interpreted as a xanthogranulomatous infiltration with the help of immunohistochemical staining techniques. Conclusion Present case is the only reported adult case with xanthogranulomatous-like infiltration of the eyeball featuring both anterior and posterior segment involvement without any concomitant major systemic disturbances.
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Affiliation(s)
- Burak Unlu
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Banu Lebe
- Department of Pathology, Dokuz Eylul University, İzmir, Turkey
| | - Suleyman Men
- Department of Radiology, Dokuz Eylul University, İzmir, Turkey
| | - Ismet Durak
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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Alkatan HM, Al-Rajhi AA. Corneal xanthogranuloma in association with multiple endocrine neoplasia 1: A clinicopathologic case report and review of the literature. Saudi J Ophthalmol 2016; 30:49-52. [PMID: 26949359 PMCID: PMC4759509 DOI: 10.1016/j.sjopt.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
Juvenile xanthogranuloma (JXG) is a benign inflammatory condition of uncertain pathogenesis. It is characterized by skin and ocular involvement – typically in the iris – in children. It has been reported in older age groups and has been also observed to involve other ocular structures such as the cornea and conjunctiva. In this case report, we are presenting an extensive right eye corneal lesion in a 43-year old male which showed the typical histopathological feature of JXG and in association with multiple endocrine neoplasia (type 1). Similar cases in the English-language literature have been also reviewed.
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Affiliation(s)
- Hind M Alkatan
- Pathology & laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali A Al-Rajhi
- Alfaisal University, Riyadh, Saudi Arabia; Al-Magrabi Hospital, Riyadh, Saudi Arabia
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The epidemiology, clinical characteristics, histopathology and management of juvenile- and adult-onset corneoscleral limbus xanthogranuloma. Graefes Arch Clin Exp Ophthalmol 2016; 254:413-20. [PMID: 26794218 DOI: 10.1007/s00417-015-3261-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Adult-onset xanthogranuloma (AOX) of the corneoscleral limbus is a rare inflammatory condition of unknown aetiology. Similar to limbal juvenile xanthogranuloma (JXG), it presents as a growing mass at the corneoscleral junction. Limbal AOX and JXG can lead to sight-threatening complications if not managed in a timely manner. This systematic review summarises the main clinical and histopathological features of limbal AOX/JXG and discusses the management of this uncommon disease. METHODS We performed a literature search in the MEDLINE database for all historical entries, using the search terms "limbus", "limbal" and "xanthogranuloma", and retrieved all articles reporting on limbal xanthogranuloma. After refining the search to articles relevant to limbal AOX, we were able to identify ten adult cases of limbal AOX and compare those with all reported cases of limbal JXG. RESULTS Clinically, AOX usually presents as an isolated smooth, yellowish, dome-shaped nodule at the corneoscleral junction, similar to an ocular presentation of JXG, with which it also shares similar histopathological features. CONCLUSION Limbal JXG and AOX may represent the same disease entity. Diagnosis relies on the clinical presentation, pathology and immunohistochemical profile. Spontaneous regression is unlikely, and thus prompt surgical intervention should be considered to prevent sight-threatening complications. Xanthogranuloma should be included in the differential diagnosis of corneoscleral limbal masses in patients of all age groups.
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Kim MS, Kim SA, Sa HS. Old-age-onset subconjunctival juvenile xanthogranuloma without limbal involvement. BMC Ophthalmol 2014; 14:24. [PMID: 24602225 PMCID: PMC3946074 DOI: 10.1186/1471-2415-14-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is a benign idiopathic cutaneous granulomatous tumor occurring primarily in infants less than 1 year old, and less commonly found in older children and adults. To date, however, there have been no reports of patients aged >50 years with cornealscleral JXG without limbal involvement. We describe here a 58-year-old woman with subconjunctival JXG without limbal involvement. CASE PRESENTATION A 58-year-old female was referred for evaluation of a subconjunctival mass in her left eye, found incidentally 2 weeks earlier. Examination revealed a protruding yellow-orange subconjunctival mass just below the 6-o'clock limbus of her left eye, measuring 6.0 × 4.5 mm, but not extending into the cornea. The overlying conjunctival epithelium was intact, and a feeding vessel was observed between the mass and the episclera. The subconjunctival lesion was excised under local anesthesia, by dissecting the mass from the overlying conjunctiva and underlying sclera. The conjunctiva was reattached to the sclera without creating a bare area. Hematoxylin and eosin-stained sections showed that the mass was a mixed inflammatory lesion containing dense infiltrations of epithelioid histiocytes with foamy cytoplasm, lymphocytes, and plasma cells, as well as multinucleated Touton giant cells with the characteristic circumferential ring of nuclei. Immunohistochemical staining showed that the lesion was positive for the macrophage marker CD68 and negative for the Langerhans cell markers S-100 protein and CD1a, indicating that the lesion was a xanthogranuloma. The patient has been followed up for 12-months without recurrence. CONCLUSIONS JXG can occur as a solitary subconjunctival mass even in older adults, and immunohistochemistry is useful in differential diagnosis. Simple excision with careful dissection may be effective for subconjunctival JXG.
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Affiliation(s)
| | | | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Pungnap-2-dong, Songpa-gu, 138-736 Seoul, Korea.
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[Juvenile xanthogranuloma of the corneoscleral limbus]. J Fr Ophtalmol 2009; 32:436.e1-6. [PMID: 19515457 DOI: 10.1016/j.jfo.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/12/2009] [Indexed: 11/23/2022]
Abstract
An 18-year-old patient presented with a solitary limbal tumor on his left eye that had appeared and increased in size for 3 weeks. This mass did not display any extension into the anterior chamber on gonioscopy. Excisional biopsy by lamellar sclerokeratectomy was carried out and the lesion was sent for histologic examination. The pathologic diagnosis showed the characteristic picture of juvenile xanthogranuloma with numerous Touton giant cells. There was no recurrence after a 9-month follow-up. The diagnosis of isolated ocular juvenile xanthogranuloma may be difficult and histologic examination of ocular lesions is often necessary. When juvenile xanthogranuloma affects the uvea, treatment is medical. When it appears as a limbal mass, treatment is surgical. Juvenile xanthogranuloma should always be considered a differential diagnosis of a limbal mass, especially in children.
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Hirata M, Nozaki M, Ozeki H, Hirata F, Ogura Y. A Case of Adult Limbal Xanthogranuloma. Jpn J Ophthalmol 2007; 51:302-4. [PMID: 17660993 DOI: 10.1007/s10384-007-0449-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 03/19/2007] [Indexed: 11/28/2022]
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Abstract
PURPOSE To report an 11-year-old Chinese girl with juvenile xanthogranuloma of the limbus, occurring in isolation without dermatologic involvement, and to discuss the clinical and histologic features, pathogenesis, and treatment of juvenile xanthogranuloma. METHODS Case report and review of medical literature. RESULTS A total excision and biopsy of the limbal lesion with lamellar graft was performed. Histologic examination showed a xanthogranuloma. At 12-month follow-up, there was no recurrence of tumor. CONCLUSION The diagnosis of juvenile xanthogranuloma may be straightforward in cases that have concomitant cutaneous manifestations. However, in isolated ocular forms, histopathological examination is necessary. Unlike the more common iris lesions that are preferably treated nonsurgically, limbal lesions require surgical excision.
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Affiliation(s)
- Zena Lim-I-Linn
- Cornea Service, Singapore National Eye Centre, Singapore 168751
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Wang JJ, Edward DP, Tu E. Xanthogranuloma of the corneoscleral limbus in an adult. CANADIAN JOURNAL OF OPHTHALMOLOGY 2001; 36:275-7. [PMID: 11548145 DOI: 10.1016/s0008-4182(01)80022-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J J Wang
- Department of Ophthalmology, University of Illinois at Chicago, USA
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Chang MW. Update on juvenile xanthogranuloma: unusual cutaneous and systemic variants. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:195-205. [PMID: 10468039 DOI: 10.1016/s1085-5629(99)80017-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a well-recognized benign disorder of infancy and early childhood characterized by yellowish cutaneous nodules that spontaneously regress over months to years. In the vast majority of children, JXG is limited to the skin and requires no treatment. Over the past two decades, unusual cutaneous and systemic forms of JXG have been increasingly reported. JXGs have been discovered, usually unexpectedly, in every organ system of the body. Correct diagnosis is crucial to prevent unnecessary invasive diagnostic and therapeutic procedures. Unusual clinical and histological variants of JXG often require immunohistochemical studies and/or electron microscopy to establish the diagnosis. Nonlipidized, giant, intramuscular, subcutaneous, and clustered JXG are but some of the variants that are discussed in this article. The immunohistochemistry of JXG, current nosology, and hypotheses regarding the origins of JXG are also reviewed.
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Affiliation(s)
- M W Chang
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY 10016, USA
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Abstract
Juvenile xanthogranuloma (JXG) is a benign, self-healing disorder characterized by solitary or multiple yellow-red nodules on the skin and, occasionally, in other organs. It is predominantly a disease of infancy or early childhood, although adults may also be affected. Histologically, JXG represents an accumulation of histiocytes lacking Birbeck granules (non-Langerhans cells), which can be differentiated from Langerhans cells by specific staining techniques. Affected persons have normal lipid metabolism. JXG is therefore classified as a normolipemic non-Langerhans cell histiocytosis. The patient's general health is not impaired and, in the absence of associated conditions, the prognosis is excellent. Diagnosis is readily made in typical cases, but may be more difficult in unusual variants.
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