1
|
Das D, Deka P, Bhattacharjee K, Das JK, Kuri GC, Bhattaacharjee H, Deori N, Deshmukh S, Paidi R, Deka A. Idiopathic inflammatory diseases of orbit and ocular adnexa: Histopathological and immunochemical analysis. Indian J Ophthalmol 2020; 67:1993-1995. [PMID: 31755435 PMCID: PMC6896574 DOI: 10.4103/ijo.ijo_2120_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To present histopathological and immunohistochemical analysis of idiopathic inflammatory diseases of orbit and ocular adnexa. Methods: Design- A retrospective laboratory-based study. The study was carried out in an ocular pathology laboratory in a tertiary institute of northeast India where analysis of 93 cases was done in 5 years, during the period from 2011 to 2016. Hematoxylin--eosin and special stains were done for the diagnoses. Immunohistochemistry (IHC) panel was also carried out. For infectious pathology, Grocott's methenamine silver (GMS) stain for fungus, tissue Gram's stain for bacteria's, and acid-fast stains for tubercular bacilli were done. IHC panels were done for CD 20 (B-cells), CD-3 (T-cells), CD-45 (Leukocyte common antigen, LCA), BCL-2, CD-138 (Plasma cells), Kappa, Lambda, IgG-4 in tissue, IgG-4 in serum, etc. IHCs were done using kit methods (standardized) and adequate controls were taken for each sample. Results: 93 cases of nonspecific orbital inflammation were reported out of 1,467 specimens. Orbital pseudotumors (idiopathic orbital inflammatory disease, IOID) were seen in 27 cases (sclerosing variety-6); benign lymphoid hyperplasia in two cases; reactive lymphoid hyperplasia in 10 cases; atypical plasma lymphoproliferative reactive (polyclonal immunophenotypically, IgG4 negative) lesions in four cases; IgG-4 related disease in one case; nonspecific inflammatory reactions (conjunctiva, sclera, and lid) in 49 cases. In all the diagnoses, infections and lymphomas were excluded. Conclusion: Biopsy supported study on nonspecific orbital inflammation was important to know the pattern.
Collapse
Affiliation(s)
- Dipankar Das
- Ocular Pathology, Uveitis and Neuro-Ophthalmology Services; Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Panna Deka
- Sri Sankaradeva Nethralaya; Ocular Pathology Service, Guwahati, Assam, India
| | | | | | | | | | | | | | | | - Apurba Deka
- Sri Sankaradeva Nethralaya; Ocular Pathology Service, Guwahati, Assam, India
| |
Collapse
|
2
|
Andreola S, Cattoretti G, Lombardi L, Audisio RA, Regalia E, Bosch JP, Mazzaferro V, Doci R. Inflammatory Pseudotumor of the Liver: Report of Two Cases. TUMORI JOURNAL 2018; 76:517-23. [PMID: 2256202 DOI: 10.1177/030089169007600522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inflammatory pseudotumor of the liver is a very rare lesion. Herein we describe two cases of this entity which occurred in two women aged 22 and 49 years, respectively. Both cases were considered to be clinically malignant and only the histopathologic examination revealed the non-neoplastic nature of the disease. Ultrastructural and immunohistochemical studies further supported the evidence of a reactive disease.
Collapse
Affiliation(s)
- S Andreola
- Division of Pathology and Citology, Istituto Nazionale Tumori, Milano, Italy
| | | | | | | | | | | | | | | |
Collapse
|
3
|
|
4
|
An Inflammatory Pseudotumor Arising from Pterygopalatine Fossa with Invasion to the Maxillary Sinus and Orbital Cavity. Case Rep Otolaryngol 2015; 2015:950823. [PMID: 26167321 PMCID: PMC4488552 DOI: 10.1155/2015/950823] [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: 12/25/2014] [Revised: 05/11/2015] [Accepted: 05/24/2015] [Indexed: 01/08/2023] Open
Abstract
We report a patient who had an inflammatory pseudotumor (IPT) that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site; this is a very rare case. The patient was an 83-year-old woman who suddenly became aware of impairment in the eyesight and visual field of the left eye. CT images showed a neoplastic lesion that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site, and also showed contrast effects. To obtain a definitive diagnosis from histopathological analysis, the lesion was biopsied, and she was diagnosed as the inflammatory pseudotumor with the immunohistochemical study and multiplex polymerase chain reaction-based clonality assays. The patient had a lymphoid-predominant lesion that responded to radiotherapy but corticosteroids were not effective. It is important to scrutinize the pathology to avoid unnecessary and mutilating surgery.
Collapse
|
5
|
Increased CD40+ Fibrocytes in Patients With Idiopathic Orbital Inflammation. Ophthalmic Plast Reconstr Surg 2014; 31:202-6. [PMID: 25098443 DOI: 10.1097/iop.0000000000000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the phenotypic and functional characteristics of peripheral and tissue-infiltrating stem cells called fibrocytes in patients with idiopathic orbital inflammation (IOI). METHODS Seven patients with IOI were studied. In the 3 patients requiring orbital biopsy, fibrocytes were identified in orbital tissue from patients with IOI compared with healthy controls using immunohistochemistry. Fibrocytes from the peripheral blood of all 7 patients and controls were quantified and phenotyped by flow cytometry and immunofluorescence for expression of CD34, alpha smooth muscle actin, CD40, and collagen 1. Quantitation of CD40-mediated interleukin-6 (IL-6) production was measured using enzyme-linked immunosorbent assay. RESULTS Orbital biopsy specimens from patients with IOI demonstrate tissue infiltration by fibrocytes (n = 3). Fibrocytes are present in the peripheral blood of IOI patients (n = 7) but are scarce in healthy donors (n = 19). Fibrocytes from IOI patients express substantial levels of CD40, and ligation of CD40 increases IL-6 expression. CONCLUSIONS Fibrocytes are present in the peripheral blood and orbital tissues of patients with IOI and constitutively express CD40 and express IL-6 in response to ligation. This site-specific predilection of CD34(+) fibrocytes to sites of orbital inflammation and fibrosis may suggest a role in IOI. Moreover, CD40-mediated activation cytokine production may contribute to the proinflammatory and profibrotic features of IOI and may provide a mechanism for future targeted therapy.
Collapse
|
6
|
Intraorbital injection of Rituximab in idiopathic orbital inflammatory syndrome: case reports. Rheumatol Int 2014; 35:183-8. [DOI: 10.1007/s00296-014-3054-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
|
7
|
McElnea EM, Hynes S, Fahy GT. Resolution of idiopathic granulomatous orbital inflammation with intraorbital triamcinolone. BMJ Case Rep 2014; 2014:bcr-2013-009761. [PMID: 24596409 DOI: 10.1136/bcr-2013-009761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 77-year-old man presented with a right lower eyelid swelling. Biopsy and histopathology of the lesion identified idiopathic granulomatous orbital inflammation. Clinical resolution of this patient's orbital mass was achieved with injection of 40 mg triamcinolone acetonide, perilesionally, at three sites in the right orbit. Such treatment may thus form an alternative to oral corticosteroid therapy in the management of granulomatous orbital inflammation.
Collapse
Affiliation(s)
- Elizabeth M McElnea
- Department of Ophthalmology, University College Hospital Galway, Galway, Ireland
| | | | | |
Collapse
|
8
|
Engellenner WJ, Fromowitz FB. Immunohistochemical Detection of Metastatic Breast Carcinoma in the Orbital Region. J Histotechnol 2013. [DOI: 10.1179/his.1992.15.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
9
|
Barham HP, Dishop MK, Prager JD. Idiopathic sclerosing inflammation presenting as sinusitis. ALLERGY & RHINOLOGY 2013; 3:e101-4. [PMID: 23342288 PMCID: PMC3548607 DOI: 10.2500/ar.2012.3.0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Idiopathic sclerosing orbital inflammation is a rare finding that is poorly delineated, immune mediated, and causes severe symptoms and disability. It has been described affecting the orbit in addition to other sites within the head and neck, but has rarely been described presenting as sinusitis. A case report and literature review were performed. A 14-year-old girl with right-sided face and eye pain and pressure for >1 month presented 3 days after endoscopic sinus surgery for presumed acute sinusitis. She subsequently developed ipsilateral vision loss and hypesthesia of the infraorbital nerve. MRI revealed a mildly enhancing soft tissue intensity lesion extending from the right maxillary sinus into the pterygopalatine fossa and orbital apex through the inferior orbital fissure. Biopsy specimens of the lesion were consistent with a sclerosing inflammatory lesion. High-dose steroids led to rapid improvement in vision and pain; however, the patient was unable to tolerate steroid weaning because of recurrence of eye pain and headache. Repeat imaging showed progression of the lesion. Rheumatology was consulted and the patient's steroid therapy was altered and her medications were expanded to include azathioprine. The patient's symptoms improved and subsequent imaging showed a reduction in the size and extent of the lesion. Idiopathic sclerosing inflammation is characterized by primary, chronic, and immunologically mediated fibrosis. Patients typically have a poor response to corticosteroid treatment or radiotherapy. Immunosuppressive therapy in addition to corticosteroids is the recommended treatment.
Collapse
|
10
|
Abstract
Pseudoneoplastic lesions ("pseudotumors") can be seen in virtually all anatomic locations. Some organ sites, such as the lungs and skin, are overrepresented for unknown reasons, and the histologic images seen in pseudoneoplastic lesions are partially overlapping in disparate locations. More than occasionally, the degree of histologic likeness to true neoplasms-often malignant ones-is striking. This overview outlines the spectrum of pseudoneoplastic lesions and divides them into etiologic categories, including reparative, developmental, functional (usually endocrine), iatrogenic, infectious, and idiopathic. Side-by-side pictorial comparisons of selected pseudoneoplastic lesions and their neoplastic mimics are included.
Collapse
Affiliation(s)
- Mark R Wick
- Department of Pathology, University of Virginia Medical Health Sciences Center, Charlottesville, 22908-0214, USA.
| | | |
Collapse
|
11
|
Spoor TC, Ramocki JM. Orbital Inflammations. Semin Ophthalmol 2009. [DOI: 10.3109/08820538909060131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
Inflammatory pseudotumor of the liver successfully treated with nonsteroidal anti-inflammatory drugs: a challenge diagnosis for one not so rare entity. Eur J Gastroenterol Hepatol 2007; 19:1016-20. [PMID: 18049174 DOI: 10.1097/meg.0b013e32821acdd2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inflammatory pseudotumor of the liver is a rare, benign lesion characterized by a well-circumscribed mass of chronic inflammatory cell infiltration and proliferating fibrous tissue. Its etiology remains unclear, although inflammatory processes have been proposed. It is often misdiagnosed as a malignant tumor, and the management has been traditionally surgical. We report the case of a 16-year-old boy who was referred from another hospital with a fever of >38 degrees C with rigor and right upper quadrant pain which he had suffered from for 5 days. The ultrasonographic computed tomography and MRI findings were not diagnostic, and we performed a needle biopsy from the lesion that was consistent with inflammatory pseudotumor (of liver, mixed fibrous tissue and chronic inflammatory cell infiltration). The patient was treated with nonsteroidal anti-inflammatory drugs and had an uneventful clinical course. During follow-up, the lesion subsequently shrank to completely vanish 1 year later.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Sclerosing idiopathic orbital inflammation is a rare, distinct subset of orbital inflammation. No consistent therapeutic regimen has been described and the majority of reports on this disease are case reports or small case series. This review looks at historical and current treatment modalities in an attempt to define the most current, effective management strategy for this disease. RECENT FINDINGS Recently, the largest review to date of these patients was published, detailing clinical findings and responses to the various interventions. Two other case reports of patients who responded completely to therapy appeared in the literature. SUMMARY Sclerosing idiopathic orbital inflammation is a rare disease with an unknown pathogenesis and poor prognosis. Current treatments are disappointing and often have little beneficial effect. There are anecdotal reports of success using combinations of immunosuppression, radiotherapy, and surgery, but a consistent, effective treatment course is lacking. Younger patients and those with a shorter duration of disease seem to have the best prognosis. Further research into the immunologic basis of the disease and a large, controlled study comparing the various sclerosing idiopathic orbital inflammation treatments are needed to determine the most effective treatment regimen.
Collapse
Affiliation(s)
- Paul A Brannan
- University of Cincinnati, Department of Ophthalmology, Cincinnati Eye Institute, Cincinnati, Ohio, USA.
| |
Collapse
|
14
|
Uchida H, Ohta M, Shibata K, Endo Y, Iwaki K, Tominaga M, Ishio T, Kitano S. Laparoscopic splenectomy in patients with inflammatory pseudotumor of the spleen: Report of 2 cases and review of the literature. Surg Laparosc Endosc Percutan Tech 2006; 16:182-6. [PMID: 16804466 DOI: 10.1097/00129689-200606000-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report 2 cases of splenic inflammatory pseudotumor treated by laparoscopic splenectomy. The first patient was a 58-year-old woman who complained of constipation. Computed tomography (CT) showed a well-demarcated mass that measured 4 cm in diameter and was not enhanced. She underwent laparoscopic splenectomy under a preoperative diagnosis of hemangioma. The final histopathologic diagnosis was inflammatory pseudotumor. The second patient was a 29-year-old man who complained of abdominal pain. Computed tomography revealed a demarcated splenic tumor that measured 3 cm in diameter and was not enhanced. Laparoscopic splenectomy was performed. The pathologic and operative diagnoses were both inflammatory pseudotumor. In both cases, the postoperative course was uneventful, and the postoperative hospital stays were 10 and 11 days. Preoperative diagnosis of a splenic inflammatory pseudotumor is very difficult. However, laparoscopic splenectomy is safe and beneficial treatment for this tumor and should be performed in cases in which it is diagnosed.
Collapse
Affiliation(s)
- Hiroki Uchida
- Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
A 5-year-old girl referred for orbital cellulitis was found to have a right orbital mass. Computed tomography revealed a mass occupying the inferotemporal orbit, extending into the maxillary sinus. Biopsy yielded a diagnosis of sclerosing idiopathic orbital inflammation. She was successfully treated with prednisone.
Collapse
Affiliation(s)
- Paul A Brannan
- Department of Ophthalmology, University of Cincinnati, College of Medicine, Ohio, USA
| | | | | |
Collapse
|
16
|
McCall T, Fassett DR, Lyons G, Couldwell WT. Inflammatory pseudotumor of the cavernous sinus and skull base. Neurosurg Rev 2006; 29:194-200. [PMID: 16565875 DOI: 10.1007/s10143-006-0017-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 11/02/2005] [Accepted: 11/04/2005] [Indexed: 11/29/2022]
Abstract
Inflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by a proliferation of connective tissue with an inflammatory infiltrate. Intracranial inflammatory pseudotumors classically involve the cavernous sinus but can also occur in the supratentorial or infratentorial compartments and spinal canal. Symptoms are dependent on location, and, when present in the cavernous sinus, typically include cranial nerve palsies of those nerves in the cavernous sinus. These lesions are rapidly responsive to steroid therapy. Surgery is typically indicated for biopsy only, but complete resection may be justified for lesions outside the cavernous sinus.
Collapse
Affiliation(s)
- Todd McCall
- Department of Neurosurgery, University of Utah, 30 North 1900 East, Suite 3B409, Salt Lake City, UT, 84132, USA
| | | | | | | |
Collapse
|
17
|
Mahdaviani S, Higgins GC, Kerr NC. Orbital pseudotumor in a child with juvenile rheumatoid arthritis. J Pediatr Ophthalmol Strabismus 2005; 42:185-8. [PMID: 15977874 DOI: 10.3928/01913913-20050501-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a child with persistent fevers, arthritis, and parvoviral infection who subsequently developed unilateral orbital pseudotumor, lytic bone lesions, bilateral anterior uveitis, band keratopathy, and migratory polyarthritis. Our working diagnosis was systemic-onset juvenile rheumatoid arthritis, although pseudotumor of the orbit and lytic bone lesions are not found in this disease.
Collapse
MESH Headings
- Arthritis, Juvenile/complications
- Arthritis, Juvenile/diagnostic imaging
- Arthritis, Juvenile/drug therapy
- Child, Preschool
- Drug Therapy, Combination
- Female
- Fibula/diagnostic imaging
- Hand/diagnostic imaging
- Humans
- Naproxen/therapeutic use
- Orbital Pseudotumor/complications
- Orbital Pseudotumor/diagnostic imaging
- Orbital Pseudotumor/drug therapy
- Osteolysis/complications
- Osteolysis/diagnostic imaging
- Parvoviridae Infections/complications
- Parvovirus B19, Human/immunology
- Parvovirus B19, Human/isolation & purification
- Prednisolone/therapeutic use
- Tibia/diagnostic imaging
- Tomography, X-Ray Computed
- Uveitis, Anterior/complications
- Uveitis, Anterior/diagnosis
Collapse
Affiliation(s)
- Sheila Mahdaviani
- Department of Ophthalmology, University of Mississippi, Jackson, Mississippi, USA
| | | | | |
Collapse
|
18
|
Oz Puyan F, Bilgi S, Unlu E, Yalcin O, Altaner S, Demir M, Cakir B. Inflammatory pseudotumor of the spleen with EBV positivity: report of a case. Eur J Haematol 2004; 72:285-91. [PMID: 15089768 DOI: 10.1111/j.0902-4441.2003.00208.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36-yr-old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein-Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.
Collapse
Affiliation(s)
- F Oz Puyan
- Department of Pathology, Trakya University Medical Faculty, Edirne, Turkey.
| | | | | | | | | | | | | |
Collapse
|
19
|
Braun B, Cazorla A, Rivas C, Gárgolas M, Fernández-Guerrero M. Inflammatory pseudotumor of the spleen in a patient with human immunodeficiency virus infection: a case report and review of the literature. Ann Hematol 2003; 82:511-514. [PMID: 12845478 DOI: 10.1007/s00277-003-0662-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2002] [Accepted: 04/05/2003] [Indexed: 11/26/2022]
Abstract
Inflammatory pseudotumor of the spleen (IPS) is a rarely described benign tumoral lesion of unknown etiology and pathogenesis. Diagnosis is complex as clinical manifestations and imaging features are indistinguishable from lymphoproliferative disorders and other malignancies of the spleen. Human immunodeficiency virus (HIV) infection is often combined with several malignancies including non-Hodgkin's lymphoma and Kaposi's sarcoma. However, no HIV infection-associated IPS has been reported so far. We report and discuss a case of IPS in an HIV-infected woman who presented with abdominal pain and multiple lesions in the spleen.
Collapse
Affiliation(s)
- B Braun
- Department of Infectious Diseases, Fundación Jiménez Díaz, Plaza de Cristo Rey, 28023, Madrid, Spain.
| | - A Cazorla
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
| | - C Rivas
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Gárgolas
- Department of Infectious Diseases, Fundación Jiménez Díaz, Plaza de Cristo Rey, 28023, Madrid, Spain
| | - M Fernández-Guerrero
- Department of Infectious Diseases, Fundación Jiménez Díaz, Plaza de Cristo Rey, 28023, Madrid, Spain
| |
Collapse
|
20
|
Häusler M, Schaade L, Ramaekers VT, Doenges M, Heimann G, Sellhaus B. Inflammatory pseudotumors of the central nervous system: report of 3 cases and a literature review. Hum Pathol 2003; 34:253-62. [PMID: 12673560 DOI: 10.1053/hupa.2003.35] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Inflammatory pseudotumors (IPs), mostly benign lesions characterized by fibrotic ground tissue and polyclonal mononuclear infiltrate, may affect all organ systems. IPs originating in the central nervous system (IP-CNS) are very rare, and their distinct histopathologic features are poorly characterized. Three otherwise healthy patients (age 8, 15, and 17 years) presented with focal neurologic symptoms (seizures, n = 2; headaches, n = 1), corresponding to a left temporal, left occipital, and left frontal IP, respectively, extending from meningeal structures into brain tissue. After resection, no recurrence was observed in patient 1 during 5 years of follow-up, whereas patient 2 developed a rapidly progressive local recurrence and a second intracerebral lesion despite antiviral, immunosuppressive, antibiotic, and radiation therapy. In patient 3, who also showed local recurrences, sequential histopathologic investigations revealed transformation to a semimalignant fibrohistiocytic tumor. In this patient, anaplastic lymphoma kinase (ALK) expression was also positive, whereas it was negative in patient 1. A detailed literature analysis confirmed that most IP-CNS arise from dural/meningeal structures (n = 34). Intraparenchymatous (n = 7), mixed intraparenchymatous/meningeal (n = 4), and intraventricular lesions (n = 7) or IP extending per continuitatem from intracerebral to extracerebral sites (n = 5) were rare. The recurrence rate was 40% within 2 years in general. It was increased after incomplete resection and in female patients (multivariate Cox regression model, P < 0.02). Although rare, IP-CNS are important differential diagnoses among tumor-like intracranial lesions. Their potential risk of malignant transformation and high risk of recurrence necessitate close follow-up, especially when resection is incomplete. Prospective multicenter trials are needed to optimize classification and treatment of this rare inflammatory lesion.
Collapse
Affiliation(s)
- Martin Häusler
- Department of Pediatrics, University Hospital, RWTH Aachen, Germany
| | | | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- F Gärtner
- Institute of Pathology and Molecular Immunology, University of Porto, Portugal
| | | | | | | |
Collapse
|
22
|
Abstract
A case of a 45-year-old Japanese man with a splenic inflammatory pseudotumor is described. This benign lesion is rarely reported in the world literature. We preoperatively could not rule out the possibility of a malignant neoplasm, due to the fact that the tumor had grown in size after a 2-year observation. However, after performing a splenectomy, a histological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The clinical and pathological features of such previously reported cases are also reviewed.
Collapse
Affiliation(s)
- S Moriyama
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto University School of Medicine, Japan
| | | | | |
Collapse
|
23
|
Nascimento E, Sant’Ana F, Malm C, Gheller V. Inflamação pseudotumoral do baço em cão. Relato de caso. ARQ BRAS MED VET ZOO 2000. [DOI: 10.1590/s0102-09352000000600003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Descrevem-se pela primeira vez achados anátomo-histopatológicos da inflamação pseudotumoral do baço, caracterizados pela presença de células inflamatórias, neutrófilos, linfócitos, plasmócitos, macrófagos e células gigantes multinucleadas, em uma cadela sem raça definida, de 10 anos de idade.
Collapse
|
24
|
Abstract
Extraocular muscle involvement in orbital disease is most frequently seen as a feature of thyroid orbitopathy (Graves' disease). However, a wide range of other conditions may alter the size, shape, and function of these muscles, with characteristic clinical manifestations or abnormalities visible on orbital imaging. The differential diagnosis of muscle disease can be narrowed by careful analysis of clinical features and ancillary tests. Imaging facilitates recognition in many cases, but in some instances, accurate diagnosis requires biopsy. This review highlights the differential diagnoses for diseases of extraocular muscles based on the clinical and investigative records of 103 patients at our institution combined with data from the world literature. We found that the most common nonthyroid causes of muscle disease were inflammatory, vascular, and neoplastic processes (in decreasing order of frequency). Emphasis is placed on investigations that provide a logical approach to, and appropriate management of, disease of the extraocular muscles.
Collapse
Affiliation(s)
- B Lacey
- Department of Ophthalmology, University of British Columbia and the Vancouver General Hospital, Canada
| | | | | |
Collapse
|
25
|
Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH. Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology 1999; 211:373-9. [PMID: 10228516 DOI: 10.1148/radiology.211.2.r99ma36373] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To correlate computed tomographic (CT) features of inflammatory pseudotumors of the liver with histopathologic results in patients with recurrent pyogenic cholangitis. MATERIALS AND METHODS CT features of 13 cases of inflammatory hepatic pseudotumor in 10 patients with recurrent pyogenic cholangitis were reviewed. Diagnosis was made by means of surgical resection in all patients. CT scans were analyzed for the appearance of masses and ancillary findings in correlation with the histopathologic findings in each resected specimen. RESULTS The masses were 2.0-7.0 cm (mean, 3.5 cm). At nonenhanced CT, the masses appeared as ill-defined, hypoattenuating lesions. At contrast material-enhanced CT, the masses exhibited central hypoattenuating areas with an iso- or hyperattenuating thickened periphery in four cases and a multiseptate appearance with hyperattenuating internal septa and periphery in nine cases. CT-histopathologic correlation showed that the central hypoattenuating area indicated the presence of chronic inflammatory infiltrates with foamy histiocytes, plasmacytes, and lymphocytes, while iso- or hyperattenuating areas in the periphery and internal septa of the mass represented fibroblastic proliferation. All patients had CT features of recurrent pyogenic cholangitis, such as hepatolithiasis, intrahepatic duct stricture and dilatation, common bile duct calculi, pneumobilia, or parenchymal atrophy. CONCLUSION Although CT features are not specific, inflammatory pseudotumor should be included in the differential diagnosis in patients with recurrent pyogenic cholangitis and a hepatic mass detected at CT.
Collapse
Affiliation(s)
- K H Yoon
- Dept of Diagnostic Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Iyer VK, Kapila K, Verma K. Fine-needle aspiration diagnosis of foreign body granulomatous reaction presenting as an orbital mass: case report and review of the literature. Diagn Cytopathol 1998; 19:290-2. [PMID: 9784995 DOI: 10.1002/(sici)1097-0339(199810)19:4<290::aid-dc13>3.0.co;2-i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Foreign body granuloma is a rare cause for an orbital mass. A case with proptosis and an orbital mass on CT scan is presented. Fine-needle aspiration of the mass was performed. Numerous foreign body giant cells were seen which contained polarizable filamentous material. A diagnosis of foreign body granuloma was rendered which was confirmed on histopathology.
Collapse
Affiliation(s)
- V K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
27
|
Lee M, Epstein FJ, Rezai AR, Zagzag D. Nonneoplastic intramedullary spinal cord lesions mimicking tumors. Neurosurgery 1998; 43:788-94; discussion 794-5. [PMID: 9766305 DOI: 10.1097/00006123-199810000-00034] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We report a group of nine patients with atypical, nonneoplastic intramedullary spinal cord lesions. By retrospectively reviewing these patients, we hoped to elucidate characteristics that would identify these patients as harboring nonneoplastic lesions before surgical intervention. METHODS We reviewed the histological findings of 212 patients undergoing surgery for intramedullary spinal cord tumors between 1989 and 1994. We identified nine patients with nonneoplastic lesions (4%); case histories and radiographs were reviewed. RESULTS All patients were evaluated preoperatively using magnetic resonance imaging. The extent of enhancement with gadolinium varied from homogeneous enhancement to no enhancement. All lesions showed marked T2 changes. There was a lack of significant spinal cord expansion associated with the lesions in all cases. All patients underwent surgery. The histology of the surgical specimens showed demyelinating lesions in four patients, sarcoidosis in two patients, amyloid angiopathy in two patients, and a mass of nonneoplastic inflammatory cells of unknown origin in one patient. CONCLUSION Although it was difficult to antecedently distinguish these lesions from neoplastic spinal cord tumors by case history and physical examination, the most consistent clue was absent or minimal spinal cord expansion on the preoperative magnetic resonance images.
Collapse
Affiliation(s)
- M Lee
- Section of Neurosurgery, Medical College of Georgia, Augusta, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Clinical manifestations of Wegener's granulomatosis are nonspecific and indistinguishable from a variety of neoplastic, infectious, and inflammatory diseases. Ophthalmic disease is the presenting feature in nearly one sixth of patients with Wegener's granulomatosis and will ultimately develop in a majority. The discovery of antineutrophil cytoplasmic antibodies, particularly antiproteinase-3, has changed the clinical approach to evaluating patients suspected of having Wegener's granulomatosis. These antibodies are distinguished from other related autoantibodies because they produce a coarse granular pattern of cytoplasmic staining on indirect immunofluorescence with ethanol-fixed neutrophils. Treatment of Wegener's granulomatosis with oral cyclophosphamide and corticosteroids has decreased morbidity and improved survival, but side effects from long-term immunosuppressive therapy are common and sometimes serious. The effectiveness of trimethoprim-sulfamethoxazole in decreasing the number and severity of recurrences of Wegener's granulomatosis is being investigated. It remains to be determined if wide use of trimethoprim-sulfamethoxazole in limited Wegener's granulomatosis could further improve the quality of life for some patients.
Collapse
Affiliation(s)
- L E Harman
- Department of Ophthalmology, University of South Florida, College of Medicine, Tampa, USA
| | | |
Collapse
|
29
|
Okuläre Adnexe: Lider, Tränenapparat und Orbita. ACTA ACUST UNITED AC 1997. [DOI: 10.1007/978-3-642-60402-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
30
|
Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Idiopathic granulomatous orbital inflammation. Ophthalmology 1996; 103:2135-41. [PMID: 9003349 DOI: 10.1016/s0161-6420(96)30378-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to define the clinicotherapeutic aspects of these lesions. METHODS The records of all patients with diagnosis of orbital pseudotumor and orbital sarcoidosis from the Orbital Center Amsterdam in the period between 1976 and 1994 were reviewed to define those with idiopathic granulomatous orbital inflammation. The authors studied the clinicotherapeutic aspects and histopathology of idiopathic granulomatous orbital inflammation by analysis of their own series and the literature. RESULTS Their study group encompassed seven patients with idiopathic granulomatous orbital inflammation. The mean follow-up was 9.5 years (range, 3.5-16.0 years). All had unilateral orbital presentation, with localization in the lacrimal gland in three patients. The lesions clinically presented with signs of mass effect or inflammation or both and were treated successfully with surgery, systemic corticosteroids, a combination of surgery and systemic corticosteroids, or systemic corticosteroids followed by irradiation. Histopathologic analysis showed a spectrum of granulomatous inflammation, admixed with nongranulomatous inflammation and fibrosis. There have been 30 similar cases described in the literature with comparable clinicotherapeutic characteristics. CONCLUSIONS Based on this study and the literature, it appears that idiopathic granulomatous orbital inflammation is more related to orbital pseudotumor than to orbital sarcoidosis.
Collapse
Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
31
|
Abstract
We have reviewed the literature in order to delineate the clinicopathologic definition of orbital pseudotumor, also called idiopathic nonspecific orbital inflammation. The clinical picture of orbital pseudotumor varies widely, with signs of mass effect, inflammation and/or infiltration. On computed tomography, orbital pseudotumor presents as a unilateral focal or diffuse mass. The histopathologic hallmark of orbital pseudotumor is a mixed inflammatory infiltrate with fibrosis of varying degree. Contrary to an old belief, orbital pseudotumor is not related to orbital reactive lymphoid hyperplasia (pseudolymphoma) and is not a lymphoid tumor. Atypical histopathologic findings of orbital pseudotumor include dominant sclerosis, granulomatous inflammation, vasculitis, and tissue eosinophilia. In the absence of systemic fibroinflammatory, granulomatous, and vasculitic disease, these atypical histopathologic patterns can be considered to represent subclasses of orbital pseudotumors rather then distinct entities. Clinical and prognostic characteristics of both histopathologically classical and atypical orbital pseudotumors appear to be heterogeneous. The etiology of orbital pseudotumor is unknown, but infection, autoimmune disorder, and aberrant wound healing have all been put forward as possibilities. In conclusion, orbital pseudotumor is one distinct disease albeit with many clinical and histopathologic guises.
Collapse
Affiliation(s)
- I Mombaerts
- Orbital Center, Department of Ophthalmology, University of Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
32
|
Irie H, Honda H, Kaneko K, Kuroiwa T, Fukuya T, Yoshimitsu K, Aibe H, Hirakata R, Horie Y, Maeda T, Masuda K. Inflammatory pseudotumors of the spleen: CT and MRI findings. J Comput Assist Tomogr 1996; 20:244-8. [PMID: 8606231 DOI: 10.1097/00004728-199603000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our goal was to elucidate the CT and MRI findings of inflammatory pseudotumors of the spleen. METHODS The CT and MRI findings of three patients with inflammatory pseudotumors of the spleen were reviewed and compared with the pathologic findings. RESULTS On the early phase of CT, the masses were hypodense to the normal spleen, and on the delayed phase, they demonstrated delayed enhancement. On T1-weighted MR images, the masses were isointense to the normal spleen, and on T2-weighted images, the masses had heterogeneous low signal intensities. After administration of Gd-DTPA, the masses showed delayed enhancement. CONCLUSION Inflammatory pseudotumors of the spleen were characterized by low signal intensity on T2-weighted MR images and delayed enhancement after contrast material administration on CT and MRI. The fibrous stroma may contribute to these unusual findings.
Collapse
Affiliation(s)
- H Irie
- Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ohshima K, Kikuchi M, Sumiyoshi Y, Kobari S, Yoneda S, Takeshita M, Kimura N. Clonality of benign lymphoid hyperplasia in orbit and conjunctiva. Pathol Res Pract 1994; 190:436-43. [PMID: 7991465 DOI: 10.1016/s0344-0338(11)80205-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to thoroughly characterize the clonal population of lymphoid hyperplasia of the orbit and conjunctiva, we investigated six cases which were histologically proven to be benign lymphoid hyperplasia. We analyzed the clonal rearrangements of the antigen receptors and bcl-2 gene, Epstein-Barr virus (EBV), and human T-cell leukemia virus type 1 (HTLV-I) by Southern blot and/or polymerase chain reaction (PCR), and performed in situ hybridization for mRNA of kappa and lambda immunoglobulin. Five cases showed rearrangements of immunoglobulin heavy chain gene (JH) and/or light chain gene (J kappa), and the monoclonal V-J recombination of JH in PCR. However, the rearranged bands were much more faint than was the germ-line band. We considered the monoclonal population of B cells small. Two of the five cases recurred locally after four and nine years respectively. Because benign lymphoid hyperplasias frequently contain an occult monoclonal B-cell population, a follow-up should be conducted. The remaining case in our investigation showed a rearrangement of the T-cell-receptor gene and proviral DNA of HTLV-I, and it showed rapid progress to adult T-cell leukemia after the biopsy. EBV and bcl-2 gene rearrangements were not observed in any of the six cases we studied.
Collapse
Affiliation(s)
- K Ohshima
- First Department of Pathology, School of Medicine, Fukuoka University, Japan
| | | | | | | | | | | | | |
Collapse
|
34
|
Rootman J, McCarthy M, White V, Harris G, Kennerdell J. Idiopathic sclerosing inflammation of the orbit. A distinct clinicopathologic entity. Ophthalmology 1994; 101:570-84. [PMID: 8127579 DOI: 10.1016/s0161-6420(94)31298-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Idiopathic sclerosing inflammation of the orbit is a poorly delineated, fibrosing, immune-mediated entity resulting in significant ocular disability. To characterize this process and propose more specific and effective therapy, clinical and pathologic findings in 16 cases are reviewed. METHODS The clinical records of 16 patients with biopsy-proven disease were retrospectively reviewed to determine demographic and clinical features, radiologic features, course, management, and outcome. These findings were correlated with pathologic features to describe this unique entity. Immunohistologic characteristics were compared with those of a clinically and histopathologically similar process, retroperitoneal fibrosis. RESULTS The study included 11 male and 5 female patients, ranging in age from 8 to 81 years. Disease onset was usually unilateral (14/16) and chronic (11/15), with two distinct anatomic presentations, lacrimal (11/16) and apical (3/16), characterized by infiltration (15/16), mass effect (12/16), and visual loss (3/16). The most common signs and symptoms were dull pain (13/16), proptosis (11/16), mild inflammation (11/16), restricted motility (9/16), swelling (9/16), and diplopia (8/16). Two features, a sparse, chronic inflammatory infiltrate, the immunopathologic characteristics of which suggested a cell-mediated process, and a desmoplastic stroma of early onset, dominated the pathologic picture. Treatment with corticosteroids (11/16), radiotherapy for steroid failures (8/11), and observation alone (3/16) was inadequate, resulting in blindness in 3/16 cases, restricted movement in 10/16, and complete resolution in only 2/16 patients. CONCLUSION Idiopathic sclerosing inflammation of the orbit is a unique clinicopathologic entity, similar to retroperitoneal fibrosis, that is characterized by primary, chronic, and immunologically mediated fibrosis, poor response to corticosteroid treatment or radiotherapy, and frequent visual disability. Early and aggressive immunosuppressive therapy is recommended.
Collapse
Affiliation(s)
- J Rootman
- Department of Pathology, Vancouver General Hospital, British Columbia, Canada
| | | | | | | | | |
Collapse
|
35
|
Abstract
The case of an 18-year-old man with a tumor of the left lateral ventricle is reported. The mass was observed to be contiguous with the choroid plexus but could be totally removed. Pathological examination disclosed an inflammatory pseudotumor. The authors review the literature on this lesion and related disorders involving the central nervous system and stress the need for a morphological differential diagnosis. Inflammatory pseudotumor should be considered in any case of intraventricular tumor.
Collapse
Affiliation(s)
- J Pimentel
- Laboratory of Neuropathology (Department of Neurology), Hospital de Santa Maria, Lisbon, Portugal
| | | | | |
Collapse
|
36
|
|
37
|
Lyons TJ, Benbow EW, Taylor PM, McCloy RF. Inflammatory pseudotumour of the liver: antecedent causes and clinical experience. J Hepatol 1993; 19:273-8. [PMID: 8301061 DOI: 10.1016/s0168-8278(05)80582-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present a case in which inflammatory pseudotumour of the liver which appears to complicate Caroli's disease. We have reviewed the literature in hepatic inflammatory pseudotumour with particular emphasis on underlying causes. We were able to find 45 reported cases, with adequate clinical data in 42; in these only 7 showed a probable antecedent cause. There were gallstones in another 5, giving a prevalence not significantly different to that within the general population. Hepatic inflammatory pseudotumour typically presents with a history of fever, anorexia, loss of weight, hepatic pain, jaundice and a detectable liver mass (or masses). The diagnosis of inflammatory pseudotumour should be particularly considered when there is a history of previous inflammatory hepato-biliary disease. Preoperative or intra-operative diagnosis might then avoid major hepatic surgery.
Collapse
Affiliation(s)
- T J Lyons
- Department of Pathological Sciences, Medical School, Manchester, UK
| | | | | | | |
Collapse
|
38
|
Hytiroglou P, Brandwein MS, Strauchen JA, Mirante JP, Urken ML, Biller HF. Inflammatory pseudotumor of the parapharyngeal space: case report and review of the literature. Head Neck 1992; 14:230-4. [PMID: 1587741 DOI: 10.1002/hed.2880140311] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Inflammatory pseudotumor of the upper airway is an uncommon lesion of unknown etiology, clinically mimicking a neoplastic process. We document a case of inflammatory pseudotumor of the parapharyngeal space, occurring in a patient with history of cocaine abuse. Corticosteroid treatment was successful in reducing the symptoms. The difficulties in establishing this clinicopathologic diagnosis are discussed and the pertinent literature is reviewed.
Collapse
Affiliation(s)
- P Hytiroglou
- Department of Pathology, Mount Sinai School of Medicine of the City University of New York, New York
| | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- A Garner
- Department of Pathology, Institute of Ophthalmology, London
| |
Collapse
|
40
|
Tomita K, Ohta G, Iarashi M, Ohhori I, Ueno K, Hirose J, Shima K. A case of splenic inflammatory pseudotumor. GASTROENTEROLOGIA JAPONICA 1991; 26:783-7. [PMID: 1765252 DOI: 10.1007/bf02782869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inflammatory pseudotumor of the spleen in a 50-year-old man was encountered in our surgical clinic. This splenic tumor is very rare and in the ninth of the cases in the literature. The removed spleen, weighting 255g, revealed the presence of a firm, circumscribed mass, measuring 4.5 x 4.0 x 4.5 cm, and histologically presenting marked lamination of collagen fibers around the small vessels associated with granulomatous lesions. The implications of its pathogenesis was analyzed with a review of the literature.
Collapse
Affiliation(s)
- K Tomita
- Department of Surgery and Pathology, Toyama Rosai Hospital, Uozu, Japan
| | | | | | | | | | | | | |
Collapse
|
41
|
Kennerdell JS. The Management of Sclerosing Nonspecific Orbital Inflammation. Ophthalmic Surg Lasers Imaging Retina 1991. [DOI: 10.3928/1542-8877-19910901-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
McNicholas MM, Power WJ, Griffin JF. Idiopathic inflammatory pseudotumour of the orbit: CT features correlated with clinical outcome. Clin Radiol 1991; 44:3-7. [PMID: 1815546 DOI: 10.1016/s0009-9260(05)80216-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Idiopathic orbital pseudotumour is an inflammatory condition which usually presents as an orbital mass. The response to treatment is variable and often unpredictable. In this study we have assessed the spectrum of computed tomographic (CT) appearances in 17 patients. Four categories of orbital pseudotumour were identified by CT based on the location and extent of the inflammatory process within the orbit. Patients within each of the four categories had broadly similar clinical outcomes. CT was valuable in identifying certain prognostic features enabling better clinical and therapeutic planning.
Collapse
Affiliation(s)
- M M McNicholas
- Department of Diagnostic Radiology, St Vincent's Hospital, Dublin
| | | | | |
Collapse
|
43
|
Lopez JOSEI, Eizaguirre BEATRIZ, Nevado MANUEL, Ruiz-Jaureguizuria JUANC. Inflammatory pseudotumor of the liver. APMIS 1990. [DOI: 10.1111/j.1699-0463.1990.tb05029.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Abstract
Clinicopathologic analysis of nine patients with inflammatory pseudotumor of the liver was reported. The age of the patients varied from 22 to 83 years old, with a male to female ratio of 8 to 1. They complained of intermittent fever and abdominal pain, and laboratory data on admission suggested an inflammatory process. The solitary or multiple, well-defined space-occupying lesions were displayed by recently advanced imaging techniques. Partial hepatectomy, laparotomy, needle biopsy, or autopsy was performed in all nine patients with diagnoses of hepatocellular carcinoma, metastatic liver tumor, or liver abscess. Histologically, these lesions were composed of dense hyalinized fibrosis and/or infiltrating inflammatory cells constituting large numbers of foamy histiocytes, lymphocytes, and plasma cells. Obliterating phlebitis of relatively large branches of the portal vein was found, thus providing a diagnostic clue to distinction from the primary hepatic cancer by imagings. Considering the clinicopathologic features and the patients' histories, in which four patients had been in the Southeast Asian countries or India, it is possible that infection of microorganisms through the portal vein could participate in these lesions as a cause. Two patients died of causes probably related to this lesion, indicating poor prognosis in some patients, in contrast to the generally fair prognosis of previously published cases.
Collapse
Affiliation(s)
- R Horiuchi
- Department of Pathology, Nihon University School of Medicine, Japan
| | | | | | | |
Collapse
|
45
|
Gray RE, Jenkins EA, Hall MA, Kanski JJ, Ansell BM. Recurrent acute proptosis in atypical systemic lupus erythematosus. Clin Rheumatol 1989; 8:528-32. [PMID: 2612122 DOI: 10.1007/bf02032109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A patient is described who developed acute proptosis, a rare complication of systemic lupus erythematosus, 16 years after the onset of the disease. Treatment with intravenous methylprednisolone produced rapid improvement, but swelling recurred a few days later. Intravenous corticosteroid was again effective and was continued orally without further episodes of proptosis. This patient is unusual in the long period of mild disease before the development of systemic complications, and in having antibodies to nuclear ribonucleoprotein but persistently normal titres of DNA-binding antibodies in her serum.
Collapse
Affiliation(s)
- R E Gray
- Department of Rheumatology, Wexham Park Hospital, Slough, England
| | | | | | | | | |
Collapse
|
46
|
Patrinely JR, Osborn AG, Anderson RL, Whiting AS. Computed tomographic features of nonthyroid extraocular muscle enlargement. Ophthalmology 1989; 96:1038-47. [PMID: 2771351 DOI: 10.1016/s0161-6420(89)32785-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
While Graves' disease is the most common cause of enlarged extraocular muscles, other disorders may masquerade as dysthyroid orbitopathy. The authors conducted a retrospective analysis of the computed tomographic (CT) scans of 60 patients with nonthyroid enlarged extraocular muscles to establish the differential radiographic features of these disorders. The diseases were classified as primary or local invasion of neoplasm (26%), inflammatory (25%), metastatic tumor (20%), vascular (13%), infection (12%), and acromegaly (3%). The inflammatory cases demonstrated more bilateral involvement (40%) and less involvement of the tendons (47%) than previously appreciated. The relatively high incidence of these features in the inflammatory group is important because both features have been considered pathognomonic for Graves' disease. Primary and metastatic tumors produced a nodular muscle enlargement with sharp borders and frequent bone changes. Certain tumors showed a predilection for certain muscle groups. Vascular cases involved multiple unilateral muscles and usually enlarged the superior ophthalmic vein. Infectious cases usually demonstrated fusiform muscle enlargement with blurred margins, whereas acromegaly caused moderate enlargement of all recti. Although certain diagnosis-specific radiographic patterns are described, no feature is pathognomonic for any disorder.
Collapse
Affiliation(s)
- J R Patrinely
- Oculoplastic and Orbital Surgery Service, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030
| | | | | | | |
Collapse
|
47
|
Abstract
Inflammatory pseudotumors (plasma cell granulomas) are localized lesions consisting of a fibrous stroma, chronic inflammatory infiltrate with a predominance of plasma cells, and an absence of anaplasia, which can mimic malignant disease by their gross appearance. Reported in many sites, they are most frequently described in the lung. Twelve cases involving the liver and biliary tract have previously been reported. Here, a 77-year-old man who presented with fever and malaise was found to have a lesion in the left lobe of the liver, which, on exploration, was found to be an inflammatory pseudotumor. This patient, and each of those previously reported, has recovered uneventfully. Because of the benign course of this lesion, hepatectomy should be considered only in those instances in which the mass effect of the lesion is producing symptoms or in those cases in which a firm histologic diagnosis cannot be made preoperatively or by frozen section intraoperatively.
Collapse
Affiliation(s)
- S B Standiford
- Surgical Service, Veterans Administration Medical Center, East Orange, New Jersey
| | | | | |
Collapse
|
48
|
Abstract
The clinical and pathologic findings of three cases of splenic inflammatory pseudotumor are described, and differential diagnostic features are discussed. This benign lesion is extremely rare, only four having been previously reported. Inflammatory pseudotumors often pose diagnostic difficulties because they form infiltrative masses which have clinical and gross pathologic features that suggest malignancy. Although these lesions are usually easily recognizable microscopically as benign processes, the admixed component of lymphoid and other hematopoietic cells may sometimes raise the question of a lymphoreticular malignancy, requiring immunohistologic studies for resolution in some cases. Alternatively, pseudotumors may be mistaken for infectious granulomatous processes, sarcoidosis, or hamartomas.
Collapse
Affiliation(s)
- K Sheahan
- Hematopathology section, Mallory Institute of Pathology, Boston, MA 02118
| | | | | |
Collapse
|
49
|
Abstract
A case of inflammatory pseudotumour of spleen in which plasma cells were the predominant cell type, is described. It presented as multiple nodules in the spleen of a 37 year old woman who died of myocardial infarction, and was an incidental finding at necropsy. Plasma cells were the dominant cell type, and the admixture of other cells within the mass and the lack of a monotypic light chain/immunoglobulin phenotype on immunohistochemical analysis precluded a diagnosis of malignant disease. The potential for misinterpretation of this lesion as a neoplasm is considerable and its recognition may therefore be of great clinical importance.
Collapse
Affiliation(s)
- R F McMahon
- Department of Pathology, University of Manchester
| |
Collapse
|
50
|
Abstract
Posterior scleritis must be considered in the differential diagnosis of many ocular conditions, including angle closure glaucoma, choroidal folds, optic disk edema, circumscribed fundus mass, choroidal detachment, and exudative retinal detachment. Because it is rare, a high index of suspicion is necessary. Anterior scleritis, pain, or a history of collagen-vascular disease, when present, help to alert the clinician to the correct diagnosis. Posterior scleritis affects women more often than men, but annular ciliochoroidal effusion and choroidal folds are more common in men. Exudative macular detachment and a circumscribed fundus mass are more common in women. This paper reviews the world literature on posterior scleritis and describes findings in a series of 43 patients seen at Wills Eye Hospital. It stresses the clinical features and ancillary diagnostic tests that help to establish the diagnosis.
Collapse
Affiliation(s)
- W E Benson
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| |
Collapse
|