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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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Carpenter T, Ye C, Wolff A, Capitle E. Another link between adult orbital xanthogranulomatous disease and IgG4-related disease. Ann Allergy Asthma Immunol 2024; 133:114-115. [PMID: 38648974 DOI: 10.1016/j.anai.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Taya Carpenter
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Catherine Ye
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Alan Wolff
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Eugene Capitle
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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Chalard F, Nguyen T, Morel B, Leiber LM, Roux CJ, Petit P, Soto Ares G, Donadieu J, Ducou le Pointe H. Juvenile Xanthogranuloma of the Head and Neck: Imaging Findings in 11 Cases. J Pediatr Hematol Oncol 2024:00043426-990000000-00428. [PMID: 38832444 DOI: 10.1097/mph.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Juvenile Xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis, occurring mainly in infancy. With an extracutaneous lesion, its diagnosis is difficult, because of a wide clinical spectrum. Here we demonstrate and characterize imaging features of 11 patients with JXG of the head and neck in various locations. MATERIAL AND METHODS We recorded clinical data and reviewed all imaging studies of 11 patients with JXG of the head and neck. Ultrasonography (US) alone was performed in 1 patient; MRI alone in 6 patients; US and MRI in 1 patient; and US, CT, and MRI in 3 patients. We evaluated the following characteristics in all studies: location and number of lesions, echogenicity and vascularization on US, density on CT, signal intensity on T1- and T2-weighted images, ADC and enhancement on MRI, and tumor boundaries and bone involvement. RESULTS Lesions were well-defined in 9 cases, and bone erosion was present in 2. On US, lesions were hypoechoic or hyperechoic and with or without vascularization. On CT, lesions were hyper-dense, with no calcification. On MRI, lesions were mildly hyper-intense or iso-intense on T1-weighted images in 8 of 9 patients, hypo-intense on T2-weighted images in 7 of 10, low ADC in 7 of 9, and enhancement in 7 of 7. CONCLUSIONS The diagnosis of extra cutaneous JXG may be proposed, with the following suggestive criteria: age < 1 year, well-defined lesion, mild hyper-intensity on T1-weighted images, hypo-intensity on T2-weighted images, low ADC, enhancement, and possible adjacent bone involvement.
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Affiliation(s)
| | - Toan Nguyen
- Radiologie pédiatrique, hôpital Armand Trousseau, Paris
| | - Baptiste Morel
- Radiologie pédiatrique, hôpital Gatien de Clocheville, Tours
| | | | | | - Philippe Petit
- Radiologie pédiatrique, hôpital de la Timone Enfants, Marseille
| | | | - Jean Donadieu
- Onco-hématologie pédiatrique, hôpital Armand Trousseau, Paris, France
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Lee MHH, Smith EJ, Hardy TG, Graf N, Tumuluri K. Paediatric Orbital Juvenile Xanthogranuloma: A Case Series and Review of the Literature. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00389. [PMID: 38687290 DOI: 10.1097/iop.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Juvenile xanthogranuloma (JXG) is a subtype of histiocytosis characterised histologically by foamy non-Langerhan cells with Touton giant cells. It typically manifests as a single self-limiting cutaneous nodule in the paediatric population. Orbital JXG is extremely rare, and its clinical course and management are not well understood or defined. Herein we present 3 cases of orbital JXG and provide a detailed literature review. METHODS Review of 3 cases with orbital JXG and literature review of all published cases. RESULTS Three presented cases demonstrate the heterogeneous clinical course of orbital JXG. Although centred around the use of steroids, there is neither robust evidence nor consensus on its management. The wider JXG literature is currently concentrated around the classification of JXG with respect to histiocytosis, especially the exclusion of extracutaneous JXG as separate diseases. This separation is based on clinical, histopathological, and molecular findings. It is unclear where orbital JXG best fits in this emerging classification of JXG. CONCLUSION Our review of the cases and literature on orbital JXG show that it may manifest with variable clinical course and its molecular pathogenic mechanism may be different to that of the cutaneous JXG.
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Affiliation(s)
- Ming-Han H Lee
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
| | - Ebony J Smith
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- Department of Ophthalmology, Sunshine Coast University Hospital, Queensland
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne
- Department of Ophthalmology, Royal Children's Hospital
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria
| | - Nicole Graf
- School of Medicine, The University of Sydney
- Department of Histology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Krishna Tumuluri
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
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Eppley SE, Silkiss RZ. Bilateral primary orbital xanthogranulomas: A case report and comparison of xanthomatous conditions. J Clin Lipidol 2023; 17:587-591. [PMID: 37716832 DOI: 10.1016/j.jacl.2023.08.001] [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: 04/23/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
This report describes an unusual and diagnostically challenging case of subcutaneous soft tissue xanthogranulomas of bilateral orbits of a 58-year-old female patient seen in a private oculoplastics practice. Accurate and timely diagnosis is crucial in xanthogranulomatous diseases so that any systemic manifestations can be identified and addressed in a multidisciplinary fashion. Periorbital xanthogranuloma is a frequent early manifestation of adult xanthogranulomatous disease, and its association with life-threatening systemic disease requires accurate diagnosis and prompt work-up. This case describes an otherwise asymptomatic patient who presented with bilateral orbital masses causing visually significant ptosis, initially diagnosed as soft tissue xanthomas, and later identified as xanthogranulomas. It is important for physicians of all fields, from primary care to surgical subspecialty, to be aware that xanthogranulomatous disease may first present as periorbital lesions and/or orbital masses, and that further work-up for vision and life-threatening systemic disease is warranted.
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Affiliation(s)
- Sarah E Eppley
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA.
| | - Rona Z Silkiss
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA
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Bacorn C, Gokoffski KK, Lin LK. Clinical correlation recommended: accuracy of clinician versus radiologic interpretation of the imaging of orbital lesions. Orbit 2020; 40:133-137. [PMID: 32279603 DOI: 10.1080/01676830.2020.1752742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To assess the accuracy of radiographic interpretation between the clinician and radiologist when compared to histopathology of orbital lesions. Methods: A retrospective chart review of patients at the University of California Davis Eye Center who underwent orbitotomy from 1/1/2000 to 5/22/2019 was performed. Charts with a preoperative imaging report, preoperative clinical assessment including the clinician's interpretation of imaging, and histopathologic diagnosis were included. The specific diagnoses were grouped into related classes of pathology for the analysis. The clinical and radiologic assessments were compared against the final histopathologic diagnosis for concordance. A concordance analysis was performed. Results: 242 patients (mean age 49 years, 53.5% female) were reviewed. Of these records 185 documented the clinician's clinical impression, the radiology report, as well as the histopathology report. The clinician's preoperative assessment had substantial agreement [kappa = 0.72 (0.65,0.79)] with the final histopathologic result and was correct in 75.7% (140/185) of cases whereas the radiology report was correct in 52.4% (97/185) with a moderate level of agreement [kappa = 0.47 (0.39, 0.55)]. In 49.2% (91/185) of cases the final histopathology correlated with both the clinical impression and radiology report [kappa = 0.58 (0.55, 0.61)]. Conclusions: The accurate interpretation of orbital imaging is a challenge and histopathologic examination remains the gold standard for diagnosis. While orbital imaging is a valuable diagnostic tool the interpretation of these studies is most accurate when conducted in the context of the patient's medical history, clinical exam, and with the physician most familiar with various orbital lesions.
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Affiliation(s)
- Colin Bacorn
- Department of Ophthalmology and Vision Science, University of California Davis Health , Sacramento, California, USA
| | - Kimberly K Gokoffski
- Department of Ophthalmology, University of Southern California , Los Angeles, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health , Sacramento, California, USA
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Nelson CA, Zhong CS, Hashemi DA, Ashchyan HJ, Brown-Joel Z, Noe MH, Imadojemu S, Micheletti RG, Vleugels RA, Wanat KA, Rosenbach M, Mostaghimi A. A Multicenter Cross-Sectional Study and Systematic Review of Necrobiotic Xanthogranuloma With Proposed Diagnostic Criteria. JAMA Dermatol 2020; 156:270-279. [PMID: 31940000 PMCID: PMC6990734 DOI: 10.1001/jamadermatol.2019.4221] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/07/2019] [Indexed: 11/14/2022]
Abstract
Importance Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking. Objective To evaluate the characteristics of NXG and propose diagnostic criteria. Design, Setting, and Participants This multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria. Main Outcomes and Measures Demographic factors, comorbidities, clinical features, and treatment response. Results Of 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-κ (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG. Conclusions and Relevance Necrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.
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Affiliation(s)
- Caroline A. Nelson
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David A. Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hovik J. Ashchyan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zoe Brown-Joel
- University of Iowa Carver College of Medicine, Iowa City
| | - Megan H. Noe
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert G. Micheletti
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A. Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Singh M, Gautam N, Kaur M, Yadav D, Gupta P. Intravenous rituximab for the treatment of relapsing adult-onset asthma with periocular xanthogranuloma. Can J Ophthalmol 2018; 54:e115-e118. [PMID: 31109495 DOI: 10.1016/j.jcjo.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Natasha Gautam
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Yadav
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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9
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Diagnosis and Management of Pediatric Orbital Diseases. Int Ophthalmol Clin 2018. [PMID: 29517648 DOI: 10.1097/iio.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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MRI Findings of Adult-Onset Orbital Xanthogranulomatous Disease : A Case Report. Clin Neuroradiol 2018; 28:601-604. [PMID: 29427029 DOI: 10.1007/s00062-018-0673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
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Luemsamran P, Rootman J, White VA, Nassiri N, Heran MKS. The role of biopsy in lacrimal gland inflammation: A clinicopathologic study. Orbit 2017; 36:411-418. [PMID: 28816552 DOI: 10.1080/01676830.2017.1352608] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the causes of lacrimal gland inflammation based on histopathology and systemic evaluation. METHODS This is a retrospective case series study. From the University of British Columbia Orbit Clinic between January 1976 and December 2008, we reviewed the medical records of 60 patients who presented with inflammatory features of the lacrimal gland (i.e., erythema, edema, or tenderness) in which the diagnoses were not possible clinically and on imaging alone. As was our routine practice, all these patients underwent lacrimal gland biopsy before starting any treatment. RESULTS The histopathologic findings of the 60 patients showed that 37 (61.7%) had identifiable types of lacrimal inflammation including 10 with Sjogren's syndrome, seven with sarcoidal reaction, six with feature of granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), five with lymphoma, two with sclerosing inflammation, two with IgG4-related dacryoadenitis, and one patient each with infectious dacryoadenitis, myoepithelial carcinoma, xanthogranuloma, eosinophilic angiocentric fibrosis, and eosinophilic allergic granulomatous nodule. The histopathologic findings of the remaining 23 (38.3%) patients showed nonspecific inflammation of the lacrimal gland. 23 patients (38.3%) had associated systemic diseases. 48 patients (80%) were treated successfully and 10 (16.7%) had recurrence of inflammation. CONCLUSIONS We recommend that in patients presenting with lacrimal gland inflammation (i.e., erythema, edema, tenderness) in which the specific diagnosis cannot be made clinically and on imaging, biopsy is warranted for accurate diagnosis and appropriate treatment. We found that the majority of these patients (61.7%) had specific histopathology, and 38% had systemic diseases.
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Affiliation(s)
- Panitee Luemsamran
- a Department of Ophthalmology, Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Jack Rootman
- b Department of Ophthalmology and Visual Sciences , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada.,c Department of Pathology and Laboratory Medicine , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada.,d Jules Stein Eye Institute , University of California at Los Angeles , USA
| | - Valerie A White
- c Department of Pathology and Laboratory Medicine , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada
| | - Nariman Nassiri
- d Jules Stein Eye Institute , University of California at Los Angeles , USA
| | - Manraj K S Heran
- e Department of Radiology , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada
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13
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Ginat DT, Vargas SO, Silvera VM, Volk MS, Degar BA, Robson CD. Imaging Features of Juvenile Xanthogranuloma of the Pediatric Head and Neck. AJNR Am J Neuroradiol 2016; 37:910-6. [PMID: 26744443 DOI: 10.3174/ajnr.a4644] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/10/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis primarily affecting children. The purpose of this study was to characterize the imaging features of histologically confirmed pediatric head and neck juvenile xanthogranuloma. MATERIALS AND METHODS A retrospective review was performed of medical records and imaging of histologically confirmed head and neck juvenile xanthogranuloma. RESULTS Ten patients (6 girls, 4 boys) 1 month to 12 years of age were imaged with ultrasound only (n = 1), CT only (n = 2), CT and ultrasound (n = 1), MR imaging only (n = 3), or MR imaging and CT (n = 3). Masses were solitary in 9 patients and multiple in 1. Solitary masses were located in the external auditory canal, infra-auricular region, infratemporal fossa with intracranial extension, frontal scalp, and subperiosteal space eroding the calvaria and along the dura. One patient with disseminated disease had scalp-, calvarial-, and dural-based masses. Clinical presentation included a mass or alteration in function. On sonography, juvenile xanthogranuloma appeared hypoechoic. On contrast-enhanced CT, masses appeared homogeneous and isoattenuating with muscle and sometimes eroded bone. On MR imaging, compared with the cerebral cortex, the masses appeared hyper- or isointense on T1 and hypo- or isointense on T2, had decreased diffusivity, and enhanced homogeneously. Juvenile xanthogranuloma was not included in the differential diagnosis in any case. CONCLUSIONS Head and neck juvenile xanthogranuloma has varied manifestations. Mild hyperintensity on T1, hypointensity on T2 compared with the cerebral cortex, decreased diffusivity, and homogeneous enhancement are characteristic. Awareness of these features should prompt radiologists to include juvenile xanthogranuloma in the differential diagnosis of pediatric head and neck masses.
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Affiliation(s)
- D T Ginat
- From the Departments of Radiology (D.T.G., V.M.S., C.D.R.)
| | - S O Vargas
- Pathology (S.O.V.) Harvard Medical School (S.O.V., V.M.S., M.S.V., B.A.D., C.D.R.), Boston, Massachusetts
| | - V M Silvera
- From the Departments of Radiology (D.T.G., V.M.S., C.D.R.) Harvard Medical School (S.O.V., V.M.S., M.S.V., B.A.D., C.D.R.), Boston, Massachusetts
| | - M S Volk
- Otolaryngology (M.S.V.) Harvard Medical School (S.O.V., V.M.S., M.S.V., B.A.D., C.D.R.), Boston, Massachusetts
| | - B A Degar
- Pediatric Oncology (B.A.D.), Boston Children's Hospital, Boston, Massachusetts Department of Pediatric Oncology (B.A.D.), Dana-Farber Cancer Institute, Boston, Massachusetts Harvard Medical School (S.O.V., V.M.S., M.S.V., B.A.D., C.D.R.), Boston, Massachusetts
| | - C D Robson
- From the Departments of Radiology (D.T.G., V.M.S., C.D.R.) Harvard Medical School (S.O.V., V.M.S., M.S.V., B.A.D., C.D.R.), Boston, Massachusetts.
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14
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Adult orbital xanthogranulomas: clinical features and management. Eur J Ophthalmol 2015; 25:288-92. [PMID: 25612656 DOI: 10.5301/ejo.5000555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Adult-onset asthma with periocular xanthogranuloma and adult-onset xanthogranuloma are 2 rare subtypes of non-Langerhans cell histiocytic disorder and much remains unknown regarding optimal treatment. The authors describe their experience in the management of these 2 disease subtypes. METHODS This is a retrospective case series with histopathologically proven orbital xanthogranuloma over a period of 12 years. Clinical, imaging, and histopathologic features; associated systemic conditions; treatment modality; and outcome during follow-up of 6 adult patients who had adult-onset asthma with periocular xanthogranuloma and adult-onset xanthogranuloma were reviewed. RESULTS The age range was 29-75 years (median 56 years). The duration of symptoms and signs varied from 10 months to 9 years. All patients had bilateral and asymmetric involvement. Palpebral swelling with yellow discoloration and upper eyelid ptosis were the most common signs. Adult-onset asthma was present in 2 patients. Imaging studies demonstrated ill-defined infiltrative lesions involving the preseptal area, lacrimal glands, extraocular muscles, retrobulbar fat, and optic nerves. The median follow-up was 50 months. Complete regression of all clinical signs was obtained at 8 months, whereas imaging findings disappeared at 18 months with treatment. No recurrence was observed. CONCLUSIONS Treatment consisting of debulking as much affected soft tissue as possible followed by a 3-day course of intravenous pulse methylprednisolone administration and then by oral prednisone for at least 6 months may provide adequate regression of the granulomas without recurrence and satisfactory cosmesis in patients with adult orbital xanthogranuloma with and without asthma.
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Sanz-Marco E, España E, López-Prats MJ, Chirivella-Casanova M, Aviño J, Díaz-Llopis M. [Necrobiotic xanthogranuloma. Differential diagnosis, treatment and systemic involvement. Case report]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2014; 89:186-189. [PMID: 24269389 DOI: 10.1016/j.oftal.2012.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 10/07/2012] [Accepted: 11/07/2012] [Indexed: 06/02/2023]
Abstract
CASE REPORT A 48-year-old male was referred to our hospital for further evaluation of eyelid edema with bilateral yellowish ulcerated nodules. Suspecting a xanthogranulomatosis, imaging tests and biopsy were performed with diagnosis of necrobiotic xanthogranuloma. IgG monoclonal gammapathy was diagnosed in a systemic study. Systemic corticosteroids and cyclosporine were initiated unsuccessfully; therefore intra-lesional injections of triamcinolone were started, which controlled the orbital disease. DISCUSSION Necrobiotic xanthogranuloma is a rare condition that usually affects the eyelids and anterior orbit. Its diagnosis is important as it is associated with malignant lymphoproliferative processes. Intra-lesional corticosteroids were effective in our patient.
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Affiliation(s)
- E Sanz-Marco
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España.
| | - E España
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España; Facultad de Óptica, Universidad de Valencia, Valencia, España
| | - M J López-Prats
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España
| | | | - J Aviño
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España
| | - M Díaz-Llopis
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España; Centro de Investigación de Enfermedades Raras (CIBERER), Valencia, España
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Zahir ST, Sharahjin NS, Vahedian H, Akhavan A. Juvenile xanthogranuloma presenting as a large neck mass and ocular complications: a diagnostic and therapeutic dilemma. BMJ Case Rep 2014; 2014:bcr-2013-202683. [PMID: 24810447 DOI: 10.1136/bcr-2013-202683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that originates from dendritic cells. Dendritic cells can accumulate in the skin of the head, neck, trunk, arms and legs. They may also involve other tissues such as the bones, lung, liver, heart, bone marrow, central nervous system, spleen and large intestine in rare cases. We report a rare case of juvenile xanthogranuloma in a 16-year-old girl who presented with a neck mass and left-sided ptosis 2.5 months previously. Excisional biopsy of the neck lesion revealed proliferated histiocytes admixed with numerous eosinophils and multinucleated giant cells that simulate eosinophilic granuloma; however, the histiocytes were negative for CD1a, CD123 and S-100 protein and positive for CD68 and CD14. The course of the disease led to treatment of the patient with chemotherapy, followed by low-dose radiotherapy.
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Affiliation(s)
- Shokouh Taghipour Zahir
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Islamic Republic of Iran
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Orbital Xanthogranuloma in an Adult Patient With Xanthelasma Palpebrarum and Hypercholesterolemia. Ophthalmic Plast Reconstr Surg 2014; 30:e6-8. [DOI: 10.1097/iop.0b013e3182873d13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chuka OM, Darlinton ADC. Juvenile xanthogranuloma presenting as bilateral non-infiltrative extraconal superior orbital tumour in a 27 year old nigerian woman: features, management and outcome. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2012; 5:129-35. [PMID: 23071425 PMCID: PMC3468420 DOI: 10.4137/ccrep.s10138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Orbital masses in adults are often caused by systemic diseases or are associated with systemic manifestations. Juvenile xanthogranuloma as a cause is rare and unreported in Africa. We present clinical features, management, and outcomes of bilateral orbital adult onset juvenile xanthogranuloma. Case Presentation: A 27 year old Nigerian woman presented with bilateral upper-lid lumps having lasted 5 months. These increased in size for about 1 month and stopped. Lid swelling was preceded by itchy eyes, redness of conjunctiva, and occasional mild pain. There were no visual or systemic symptoms. The lumps were firm, slightly mobile, not tender, and not attached to skin but rather to deeper structures. There was restriction on up-gaze but no proptosis or diplopia. Hematological, biochemical, and X-ray investigations were normal. Prednisolone tablets 10 mg daily for two weeks were not useful. Tissue biopsy was invaluable in diagnosis of this rare condition and disclosed juvenile xanthogranuloma. Partial surgical excision was done under lidocaine infiltration. No recurrence has occurred in 40 months of follow-up. No systemic disease has manifested. Conclusion: Juvenile xanthogranuloma can present as bilateral superior orbital tumor in adults; functional and cosmetic aims were achieved by sub-total excision.
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Affiliation(s)
- Okosa Michael Chuka
- Department of Ophthalmology, Nnamdi Azikiwe University Teaching Hospital, Guinness Eye Centre, Onitsha, Nigeria, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus
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20
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Civit T, Colnat-Coulbois S, Marie B. [Histiocytic disorders with orbital involvement]. Neurochirurgie 2010; 56:142-7. [PMID: 20226484 DOI: 10.1016/j.neuchi.2010.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
The eosinophilic granuloma of bone is the most common type of histiocytic disorder involving the orbital area. Imaging data typically show bony defects with an intra-orbital soft-tissue extension. Surgical debulking is most often required. Rosai-Dorfman disease is commonly associated with uni- or bilateral orbital locations. The other histiocytic disorders are very rare, but some have a poor prognosis such as Erdheim-Chester disease.
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Affiliation(s)
- T Civit
- Département de neurochirurgie, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France.
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Jung WS, Ahn KJ, Park MR, Kim JY, Choi JJ, Kim BS, Hahn ST. The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa. Korean J Radiol 2007; 8:336-42. [PMID: 17673845 PMCID: PMC2627159 DOI: 10.3348/kjr.2007.8.4.336] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.
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Affiliation(s)
- Won Sang Jung
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Kook Jin Ahn
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Mi Ra Park
- Department of Ophthalmology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Jae Jeong Choi
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Bum Soo Kim
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
| | - Seong Tai Hahn
- Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
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Hayden A, Wilson DJ, Rosenbaum JT. Management of orbital xanthogranuloma with methotrexate. Br J Ophthalmol 2006; 91:434-6. [PMID: 17135338 PMCID: PMC1994743 DOI: 10.1136/bjo.2006.109587] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy of methotrexate (MTX) treatment for the periorbital findings in adult-onset xanthogranuloma (AOX). METHODS The medical records of three patients with AOX, with and without asthma, who were treated with MTX at Oregon Health & Science University, Portland, Oregon, USA were examined. Diagnosis of AOX was made by biopsy in all patients. The patients were evaluated between February 1998 and July 2006. All patients had failed prior medical and/or surgical treatment. MTX was administered at 10-20 mg/week with folate supplementation and a course of corticosteroids. Efficacy was assessed on the basis of improvement in skin discoloration, involvement of the visual axis and patients' report of inflammation. RESULTS All three patients were started on MTX, but one patient discontinued treatment after 3 weeks due to nausea. With follow-up as long as 3 years, the two patients who continued treatment lost the yellow discoloration of their skin, and they reported significantly less inflammation and ptosis after treatment. Oral corticosteroids could be reduced or discontinued. CONCLUSIONS AOX is a rare, persistent disease that commonly involves the preseptal fat. MTX is a therapeutic option for this illness.
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Affiliation(s)
- Ashley Hayden
- Keck School of Medicine, Los Angeles, California, USA
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23
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Affiliation(s)
- Jack Rootman
- Department of Ophthalmology and Visual Sciences, University of British Columbia and the Vancouver General Hospital, Canada.
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24
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Sivak-Callcott JA, Rootman J, Rasmussen SL, Nugent RA, White VA, Paridaens D, Currie Z, Rose G, Clark B, McNab AA, Buffam FV, Neigel JM, Kazim M. Adult xanthogranulomatous disease of the orbit and ocular adnexa: new immunohistochemical findings and clinical review. Br J Ophthalmol 2006; 90:602-8. [PMID: 16622091 PMCID: PMC1857051 DOI: 10.1136/bjo.2005.085894] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Adult xanthogranulomatous disease involving the ocular tissues is rare and poorly understood. Adult onset xanthogranuloma (AOX), adult onset asthma and periocular xanthogranuloma (AAPOX), necrobiotic xanthogranuloma (NBX), and Erdheim-Chester disease (ECD) are the four syndromes within this disorder, which is diagnosed by characteristic histopathology. Experience with eight cases prompted a multi-institutional effort to study the histopathology, immunohistochemistry, clinical findings, and systemic associations in this disorder. METHODS 22 cases, including histopathological slides, were compiled. Published reports were identified by an English language Medline search (1966-2005) and review of reference citations. Each case in this series and the literature was classified as one of four syndromes and then analysed for age onset, sex, skin xanthoma, orbital location, immune dysfunction, internal organ and bone lesions, treatment, and outcome. The histopathology in each of these cases was reviewed by two pathologists. Immunhistochemical stains (CD3, CD4, CD8, L26) were performed in 14 cases where unstained slides were available. RESULTS 137 cases were compiled. There was no sex or age difference between syndromes. AOX, AAPOX, NBX affect the anterior orbit, ECD tends to be diffuse and intraconal. Skin lesions are found in all the syndromes. Immune dysfunction was noted in all cases of AAPOX and NBX; 11% of NBX and all ECD patients had internal organ disease. Treatment included surgery, corticosteroids, other chemotherapeutic agents, radiotherapy, and combinations of these. No AOX or AAPOX deaths occurred; 66% of ECD patients died. All 22 cases had xanthoma cells; most had Touton giant cells. Lymphocytes were present in all cases and occurred as aggregates (mostly in AAPOX) or diffuse populations mixed with fibroblasts (mostly in ECD). Immunohistochemistry revealed the majority of these to be CD8+. Necrosis was most marked in NBX. CONCLUSION Adult xanthogranuloma of the orbit is rare, making prospective evaluation or meta-analysis impossible. The best treatment is unknown but seems to be with multiagent chemotherapy guided by histopathological, immunohistochemical, and systemic findings.
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Affiliation(s)
- J A Sivak-Callcott
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, 26505, USA.
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Cruz AAV, de Alencar VM, Falcão MF, Elias J, Chahud F. Association Between Erdheim-Chester Disease, Hashimoto Thyroiditis, and Familial Thrombocytopenia. Ophthalmic Plast Reconstr Surg 2006; 22:60-2. [PMID: 16418672 DOI: 10.1097/01.iop.0000197021.98742.09] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 28-year-old woman presented with progressive proptosis of the left eye. She had a history of familial thrombocytopenia and Hashimoto thyroiditis. CT of the orbits demonstrated a bilateral diffuse intraconal and extraconal infiltration. Biopsy from the left intraconal area revealed the typical histopathology of xanthogranuloma with a mixture of foamy histiocytes, Touton giant cells, and eosinophils. Systemic examination revealed a mediastinal and retroperitoneal infiltration with a focal lesion in the left kidney. A biopsy of the retroperitoneal area showed histopathology identical to that of the orbital lesion. A review of the literature indicated that the association between non-Langerhans histocytoses and immunologic dysfunctions is not uncommon. We hypothesize that Erdheim-Chester disease may be linked to an abnormal interaction between T-lymphocytes and macrophages similarly to the macrophage activation syndromes.
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Affiliation(s)
- Antonio Augusto V Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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26
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Sivak-Callcott JA, Lim WK, Seah LL, Oestreicher J, Rossman D, Nijhawan N, Rootman J, White V, Williams HJ, Chang WWL, DiBartolomeo A, Howarth D. Xanthogranulomatous disease in the lacrimal gland. Br J Ophthalmol 2005; 89:1375-7. [PMID: 16170141 PMCID: PMC1772896 DOI: 10.1136/bjo.2004.063578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Karcioglu ZA, Sharara N, Boles TL, Nasr AM. Orbital xanthogranuloma: clinical and morphologic features in eight patients. Ophthalmic Plast Reconstr Surg 2004; 19:372-81. [PMID: 14506422 DOI: 10.1097/01.iop.0000083642.15174.83] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical and morphologic features of patients with orbital xanthogranuloma (XG) with or without Erdheim-Chester disease (E-Cd). METHODS Retrospective, noncomparative case series. A review of 8 consecutive histopathologically proven cases of orbital XG from 3 medical centers. Four male and four female patients with ages ranging from 23 to 79 years presented with 4 bilateral and 4 unilateral orbital XGs. RESULTS Age at diagnosis, ocular and systemic manifestations, histopathologic and radiologic features, type of treatment, and prognosis were evaluated for each patient. Six of 8 patients had proptosis and 2 presented with afferent pupillary defect and severe extraocular motility limitations. Other signs and symptoms included eyelid retraction, mechanical ptosis, and chemosis. Planar xanthomas of eyelids were present in 3 individuals. CT and MRI showed infiltrating soft tissue masses within the orbit in 7 and 2 patients, respectively. Histopathology revealed proliferation of foamy histiocytes intermingled with Touton and multinucleated giant cells and lymphocytes. The absence of Birbeck granules within the histiocytic elements of the tumor, indicating that the cell of origin is a non-Langerhans histiocyte, was documented with electron microscopy in 3 cases. The most common treatment was surgical excision combined with oral corticosteroids. Two patients with E-Cd with involvement of the long bones of the upper and lower extremities and retroperitoneal region died of kidney failure within approximately 1 year of diagnosis. CONCLUSIONS Orbital XG is a proliferative lesion of the non-Langerhans histiocytes, which may present as a solitary orbital lesion or may be associated with a systemic condition known as E-Cd with very poor prognosis.
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Affiliation(s)
- Zeynel A Karcioglu
- Tulane University Health Sciences Center, Departments of Ophthalmology and Pathology, New Orleans, Louisiana, USA
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Abstract
Orbital inflammation is a common problem in adults and children, accounting for the majority of all orbital processes. The presentation may be acute, subacute, or insidious. When the onset is acute, the process can be mistaken for orbital cellulitis. In insidious cases, such as the sclerosing subtype of inflammation, the chronic painless course may prompt concerns about a neoplastic infiltration such as lymphoma. Orbital inflammation can be divided into nonspecific, idiopathic, and other specific diagnoses. The differential diagnosis includes allergic, infectious (fungal, mycobacterial, and parasitic), and neoplastic (lymphoma or metastatic) disease. Orbital inflammation impacts neurologists and neuro-ophthalmologists because all of the entities can cause afferent dysfunction (decreased vision, abnormal color perception, afferent pupillary defect, and visual field defect) and dysmotility. The pattern of motility deficit may mimic the more familiar cranial nerve palsies. Advances in the diagnosis and management of nonspecific orbital inflammation and the specific entities that cause orbital inflammation are discussed.
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Affiliation(s)
- Kimberly P Cockerham
- Neuro-ophthalmology, Orbital Disease and Plastic Reconstruction, Allegheny General Hospital, 420 East North Avenue, Suite 116, Pittsburgh, PA 15212, USA.
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29
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Tang WK, Lee KC, Chong LY. Three patients with orbital xanthogranuloma and non-progressive haematological abnormalities. Australas J Dermatol 2003; 44:185-9. [PMID: 12869043 DOI: 10.1046/j.1440-0960.2003.00675.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Orbital xanthogranuloma is a rare dermatological condition characterized by its bilateral and rather symmetrical subcutaneous granulomatous infiltration around the eyes. It shares morphological similarities with other xanthogranulomatous diseases such as juvenile or adult type xanthogranuloma, necrobiotic xanthogranuloma and cutaneous infiltration in Erdheim-Chester disease, and should be differentiated from them. Three elderly Chinese patients with this condition were found to have underlying haematological abnormalities: normochromic normocytic anaemia, thrombocytopenia or eosinophilia. Their skin lesions remained localized and associated haematological abnormalities stable for up to 7 years. Haematological abnormalities were also reported in previous cases and this finding is unlikely to be coincidental; however, its clinical significance remains unknown.
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Affiliation(s)
- W K Tang
- Dermatology Clinic, Social Hygiene Service, Department of Health, Queen Elizabeth Hospital, Hospital Authority, Hong Kong.
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Dehner LP. Juvenile xanthogranulomas in the first two decades of life: a clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations. Am J Surg Pathol 2003; 27:579-93. [PMID: 12717244 DOI: 10.1097/00000478-200305000-00003] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile xanthogranulomas (JXG) is a histiocytic disorder, primarily but not exclusively seen throughout the first two decades of life and principally as a solitary cutaneous lesion. This study is a retrospective clinical and pathologic review of 174 cases documenting the cutaneous and extracutaneous manifestations in patients presenting from the neonatal period to 20 years of age (mean 3.3 years; median 1 year). There was a male predominance (99 male:75 female) in all categories of clinical presentation, but especially notable in the group with multiple cutaneous lesions (12 male:1 female). A solitary cutaneous lesion accounted for 67% of all cases, followed by a solitary subcutaneous or deep soft tissue mass (28 cases, 16%), multiple cutaneous lesions (13 cases, 7%), a solitary extracutaneous, nonsoft tissue lesion (9 cases, 5%), and multiple cutaneous and visceral-systemic lesions (8 cases, 5%). The recorded deaths due to disease included two neonates with systemic JXG who developed hepatic failure and thrombocytopenia and at autopsy had giant cell-neonatal hepatitis in addition to JXG in the liver and other visceral sites. A third death in a 3-month-old boy with a retroperitoneal-pelvic JXG occurred after failure to control severe hypercalcemia. The characteristic Touton giant cell in variable numbers was a consistent feature of the cutaneous lesions; however, these cells were either absent or present in reduced numbers in the various extracutaneous lesions when compared with JXG in the skin. Spindle cells intermingled among the mononuclear cells or forming short fascicles were seen in both cutaneous and extracutaneous lesions. Immunohistochemistry was performed on all extracutaneous lesions, and the constituent cells, regardless of their individual morphologic features, were uniformly positive for vimentin, CD68, and factor XIIIa and negative for S-100 protein and CD1a. It is widely held that JXG is a proliferative disorder of dendrocytes, possibly dermal dendrocytes; thus, its clinical and pathologic similarities to Langerhans cell histiocytosis are not entirely unexpected in light of the most recently proposed international classification of histiocytic disorders, which includes JXG and Langerhans cell histiocytosis together as "dendritic cell-related" histiocytoses.
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, Missouri, 63110, USA.
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