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Gosangi B, Lang P, Johnson M, Zukerman R, Tu L, Traube L, Bader AS, Rubinowitz AN. Disorders with Ophthalmic and Thoracic Involvement. Radiographics 2024; 44:e230132. [PMID: 38870047 DOI: 10.1148/rg.230132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
A variety of systemic conditions involve the thorax and the eyes. While subtle or nonspecific eye symptoms can be the initial clinical manifestation of some disorders, there can be additional manifestations in the thorax that lead to a specific diagnosis and affect patient outcomes. For instance, the initial clinical manifestation of Sjögren syndrome is dry eye or xerophthalmia; however, the presence of Sjögren lung disease represents a fourfold increase in mortality. Likewise, patients with acute sarcoidosis can initially present with pain and redness of the eye from uveitis in addition to fever and parotitis. Nearly 90% of patients with sarcoidosis have thoracic involvement, and the ophthalmologic symptoms can precede the thoracic symptoms by several years in some cases. Furthermore, a diagnosis made in one system can result in the screening of other organs as well as prompt genetic evaluation and examination of family members, such as in the setting of Marfan syndrome or Ehlers-Danlos syndrome. Multimodality imaging, particularly CT and MRI, plays a vital role in identification and characterization of these conditions. While it is helpful for ophthalmologists to be knowledgeable about these conditions and their associations so that they can order the pertinent radiologic studies, it is also important for radiologists to use the clues from ophthalmologic examination in addition to imaging findings to suggest a specific diagnosis. Systemic conditions with thoracic and ophthalmologic manifestations can be categorized as infectious, inflammatory, autoimmune, neoplastic, or hereditary in origin. The authors describe a spectrum of these conditions based on their underlying cause. ©RSNA, 2024.
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Affiliation(s)
- Babina Gosangi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Patrick Lang
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Michele Johnson
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Ryan Zukerman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Long Tu
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Leah Traube
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Anna S Bader
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
| | - Ami N Rubinowitz
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (B.G., P.L., M.J., L. Tu, L. Traube, A.S.B., A.N.R.); and Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (R.Z.)
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Urrutia YA, Fezza T, Kosek K, Fezza JP. Case Series of Orbital Lymphoma: Cardinal Presentations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5913. [PMID: 38911582 PMCID: PMC11191000 DOI: 10.1097/gox.0000000000005913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/01/2024] [Indexed: 06/25/2024]
Abstract
Periorbital lymphomas may present with nonspecific symptoms and may disguise as other ocular conditions, which may result in a missed diagnosis. The purpose of his case series is to add to the existing literature and raise awareness of this rare and lethal cancer so early detection and treatment can be instituted. A retrospective review of four diverse cases of periorbital lymphoma is described, highlighting the important role of plastic surgeons in early recognition and prompt diagnosis through extensive examination, imaging studies, and biopsies. The histological subtype and site of lesion play a critical role in the prognosis of patients with periorbital lymphoma. This article also underscores the significance of early detection and a multidisciplinary team approach.
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Affiliation(s)
- Yordan A. Urrutia
- From the Florida State University College of Medicine, Tallahassee, Fla
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3
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McHugh A, Wauchope J, Kieran S, Moran T, O'Duffy F. Ocular lymphoma: overcoming a diagnostic challenge with an endoscopic sinus approach. Ir J Med Sci 2024; 193:555-563. [PMID: 37526870 DOI: 10.1007/s11845-023-03460-0] [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: 03/11/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Ocular lymphomas are rare, indolent tumours that pose a diagnostic challenge. Patients may be asymptomatic or present with symptoms of increased orbital mass. An index of suspicion is required alongside an understanding of the diagnostics and staging required to facilitate expedited multi-disciplinary work-up and management. METHODS A comprehensive literature review was performed. We present a series of three cases, each presenting their own diagnostic challenge. RESULTS Although ocular lymphomas are notoriously difficult to diagnose histologically, our case series show procurement of a diagnostic histological sample using an image-guided endoscopic sinus approach. CONCLUSIONS Although not typically involved in the diagnosis or management, the otolaryngologist may encounter ocular lymphoma masquerading as sinus disease or with disseminated disease at other sites in the head and neck. Endoscopic sinus surgery is considered a safe, effective approach for achieving a histological diagnosis in these cases.
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Affiliation(s)
- Alison McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - Stephen Kieran
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tom Moran
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
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4
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Loap P, Kirova Y, Dendale R. Primary ophthalmic natural killer/T-cell lymphoma: A population-based study. Bull Cancer 2024; 111:310-313. [PMID: 38199833 DOI: 10.1016/j.bulcan.2023.11.010] [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: 08/22/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Ophthalmic lymphomas, a subgroup of extra-nodal lymphomas, have seen an increase in incidence in recent decades. Of these, the NK/T-cell lymphoma (NKTL) subtype is particularly aggressive. Though prevalent mostly in Asian patients, data on ophthalmic NKTL is still limited, especially in the western population. This study aimed to provide an additional analysis of primary ophthalmic NKTL using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A retrospective analysis was performed on the SEER database covering records from 2000 to 2020. Patients diagnosed with extranodal NKTL originating primarily from an ophthalmic structure were identified. RESULTS Out of 4540 ophthalmic lymphomas registered in the SEER database between 2000 and 2020, 9 cases (0.2%) corresponded to ophthalmic NKTL, occurring in patients with a median age of 67 years. The majority of these patients underwent chemotherapy (88.8%) and radiotherapy (66.6%). The 6-month overall survival (OS) and cancer-specific survival (CSS) were both at 50.8%, dropping significantly at the 2-year follow-up. CONCLUSION Primary orbital NKTL has a notably severe prognosis. An early diagnosis is important due to the aggressive nature of NKTL.
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Affiliation(s)
- Pierre Loap
- Institut Curie, département d'oncologie radiothérapie, Paris, France.
| | - Youlia Kirova
- Institut Curie, département d'oncologie radiothérapie, Paris, France
| | - Rémi Dendale
- Institut Curie, département d'oncologie radiothérapie, Paris, France
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5
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Tagami M, Kasashima H, Kakehashi A, Yoshikawa A, Nishio M, Misawa N, Sakai A, Wanibuchi H, Yashiro M, Azumi A, Honda S. Stromal area differences with epithelial-mesenchymal transition gene changes in conjunctival and orbital mucosa-associated lymphoid tissue lymphoma. Front Oncol 2024; 14:1277749. [PMID: 38322414 PMCID: PMC10845137 DOI: 10.3389/fonc.2024.1277749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Purpose To examine the molecular biological differences between conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma and orbital MALT lymphoma in ocular adnexa lymphoma. Methods Observational case series. A total of 129 consecutive, randomized cases of ocular adnexa MALT lymphoma diagnosed histopathologically between 2008 and 2020.Total RNA was extracted from formalin-fixed paraffin-embedded tissue from ocular adnexa MALT lymphoma, and RNA-sequencing was performed. Orbital MALT lymphoma gene expression was compared with that of conjunctival MALT lymphoma. Gene set (GS) analysis detecting for gene set cluster was performed in RNA-sequence. Related proteins were further examined by immunohistochemical staining. In addition, artificial segmentation image used to count stromal area in HE images. Results GS analysis showed differences in expression in 29 GS types in primary orbital MALT lymphoma (N=5,5, FDR q-value <0.25). The GS with the greatest difference in expression was the GS of epithelial-mesenchymal transition (EMT). Based on this GS change, immunohistochemical staining was added using E-cadherin as an epithelial marker and vimentin as a mesenchymal marker for EMT. There was significant staining of vimentin in orbital lymphoma (P<0.01, N=129) and of E-cadherin in conjunctival lesions (P=0.023, N=129). Vimentin staining correlated with Ann Arbor staging (1 versus >1) independent of age and sex on multivariate analysis (P=0.004). Stroma area in tumor were significant difference(P<0.01). Conclusion GS changes including EMT and stromal area in tumor were used to demonstrate the molecular biological differences between conjunctival MALT lymphoma and orbital MALT lymphoma in ocular adnexa lymphomas.
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Affiliation(s)
- Mizuki Tagami
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Japan
| | - Hiroaki Kasashima
- Molecular Oncology and Therapeutics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Anna Kakehashi
- Department of Molecular Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Atsuko Yoshikawa
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Japan
| | - Mizuho Nishio
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norihiko Misawa
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Atsushi Sakai
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hideki Wanibuchi
- Department of Molecular Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masakazu Yashiro
- Molecular Oncology and Therapeutics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Azumi
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Japan
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Tejani AS, Berson E, Phillip J, Feltrin FS, Bazan C, Raj KM, Agarwal AK, Maldjian JA, Lee WC, Yu FF. Diffusion-weighted imaging of the orbit. Clin Radiol 2024; 79:10-18. [PMID: 37926649 DOI: 10.1016/j.crad.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Orbital lesions compose a heterogeneous group of pathologies that often present with non-specific imaging findings on conventional magnetic resonance imaging (MRI) sequences (T1-and T2-weighted). Accordingly, the application of diffusion MRI offers an opportunity to further distinguish between lesions along this spectrum. Diffusion-weighted imaging (DWI) represents the simplest and most frequent clinically utilised diffusion imaging technique. Recent advances in DWI techniques have extended its application to the evaluation of a wider spectrum of neurological pathology, including orbital lesions. This review details the manifestations of select orbital pathology on DWI and underscores specific situations where diffusion imaging allows for increased diagnostic sensitivity compared to more conventional MRI techniques. These examples also describe preferred management for orbital lesions identified by DWI.
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Affiliation(s)
- A S Tejani
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - E Berson
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - J Phillip
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F S Feltrin
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Bazan
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - K M Raj
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A K Agarwal
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J A Maldjian
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W-C Lee
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F F Yu
- Department of Raddsiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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7
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Yotsuyanagi T, Tomita N, Saiki Y, Uchida A, Uemura Y, Suzuki Y, Hirakawa T, Kato M, Nakamura N, Arai A. Leukemic-phase mucosa-associated lymphoid tissue lymphoma. Int J Hematol 2023; 118:758-765. [PMID: 37700187 DOI: 10.1007/s12185-023-03654-3] [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: 03/23/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
A 78-year-old man presenting with leukocytosis was admitted to our hospital. The patient was asymptomatic and showed no lymphadenopathy. Peripheral blood flow cytometry revealed a leukemic-phase B-cell lymphoma with medium-to-large abnormal cells with reticulum. Positron emission tomography/computed tomography revealed abnormal uptake in the right orbit, bone marrow, and spleen. We performed immunological staining and fluorescence in situ hybridization on tissues extracted from the right orbit and bone marrow, which led to the diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma. Polymerase chain reaction analysis of immunoglobulin heavy chain rearrangements in the right orbital mass and bone marrow suggested that they were identical clones. Based on these collective findings, the diagnosis of leukemic-phase MALT lymphoma was confirmed, with sites of involvement including the bone marrow, peripheral blood, right orbit, and spleen. This is a highly rare case of leukemic MALT lymphoma.
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Affiliation(s)
- Takayuki Yotsuyanagi
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Naoto Tomita
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yusuke Saiki
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akiko Uchida
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yu Uemura
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshinori Suzuki
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsuneaki Hirakawa
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masayuki Kato
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University, Isehara, Kanagawa, Japan
| | - Ayako Arai
- Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
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Nogués-Castell J, Feu-Basilio S, Felguera García Ó, Fernández de Larrea C, Oliver-Caldés A, Balagué Ponz O, Fassi JM. Bilateral orbital plasmacytomas as first sign of extramedullary progression post CAR-T therapy: case report and literature review. Front Oncol 2023; 13:1217714. [PMID: 37637047 PMCID: PMC10450026 DOI: 10.3389/fonc.2023.1217714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Plasma cell leukemia (PCL) is an aggressive and rare form of plasma cell dyscrasia characterized by peripheral blood expression, poor prognosis, and high relapse rates. Extramedullary plasmacytomas are common in this entity and can affect various organs and soft tissues. Chimeric antigen receptor-T-cell (CAR-T) therapy is a novel immunotherapy for hematological malignancies with promising results. However, it is not indicated for PCL, and experience in this condition is limited. This case is a rare presentation of bilateral orbital plasmacytomas after CAR-T therapy in a patient with PCL history. Case presentation We present the case of a 51-year-old female patient with a history of previous primary PCL treated with CAR-T therapy achieving complete response and without evidence of systemic progression. Six months after the treatment, she developed subacute proptosis and ptosis on the left eye.An orbital CT scan was performed and showed an orbital tumor in both eyes. A surgical biopsy with histological examination revealed plasma cells, consistent with a plasmacytoma. PET-CT and MRI confirmed the presence of tumors in both orbits. The patient was treated with dexamethasone and chemotherapy along with palliative radiation therapy to the left orbit which had a good response. Conclusion Orbital involvement in multiple myeloma and PCL is rare, with plasmacytomas being more common in other parts of the body. In this report, we present a case of a patient with PCL history, treated with multiple therapeutic lines including CAR-T therapy, who presented bilateral orbital plasmacytomas as the first sign of extramedullary progression after the treatment. This case should be considered by specialist to be aware that the orbits are a possible location of extramedullary progression.
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Affiliation(s)
- Javier Nogués-Castell
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Silvia Feu-Basilio
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Óscar Felguera García
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Aina Oliver-Caldés
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Olga Balagué Ponz
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
- Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jessica Matas Fassi
- Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut D’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica (FCRB), Universitat de Barcelona, Barcelona, Spain
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Ma N, Wang P, Zhang S, Ning X, Guo C, Zhang Q, Cheng Q, Zhao J, Li Y. Surgical resection and orbital iodine-125 brachytherapy for orbital malignancy: a novel treatment for orbital lymphoma. Int Ophthalmol 2023; 43:1945-1955. [PMID: 36906873 DOI: 10.1007/s10792-022-02594-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/12/2022] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Orbital lymphoma is one of the most common adult orbital malignancies, accounting for approximately 10% of all orbital tumors. This study aimed to analyze the effects of surgical resection and orbital iodine-125 brachytherapy implantation for orbital lymphoma. PATIENTS AND METHODS This was a retrospective study. Clinical data of 10 patients were collected from October 2016 to November 2018 and followed up to March 2022. Patients underwent the primary surgery for maximal safe removal of the tumor. After a pathologic diagnosis of a primary orbital lymphoma was established, iodine-125 seed tubes were designed based on the tumor size and invasion range, and direct vision was placed into the nasolacrimal canal or/and under the orbital periosteum around the resection cavity during the secondary surgery. Then, follow-up data, including the general situation, ocular condition, and tumor recurrence, were recorded. RESULTS Of the 10 patients, the pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (6 cases), small lymphocytic lymphoma (1 case), mantle cell lymphoma (2 cases), and diffuse large B-cell lymphoma (1 case). The number of seeds implanted ranged from 16 to 40. The follow-up period ranged between 40 and 65 months. All patients in this study were alive and well had tumors that were completely controlled. No tumor recurrences or metastases occurred. Three patients had dry eye syndrome and two patients had abnormal facial sensation. No patient had radiodermatitis involving the skin around the eye, and no patient had radiation-related ophthalmopathy. CONCLUSIONS Based on preliminary observations, iodine-125 brachytherapy implantation appeared to be a reasonable alternative to external irradiation for orbital lymphoma.
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Affiliation(s)
- Nan Ma
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Ping Wang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shaobo Zhang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiaona Ning
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Chenjun Guo
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qiong Zhang
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qilin Cheng
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
| | - Yangjun Li
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
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10
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Valizadeh G, Manta AI, Conrad D, Schlect D, Sullivan TJ. Granulomatosis with polyangiitis-associated sclerokeratitis in a case of ocular adnexal B-cell lymphoma. Orbit 2023:1-3. [PMID: 36714979 DOI: 10.1080/01676830.2023.2172191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
We describe the first reported case of granulomatosis polyangiitis (GPA)-associated sclerokeratitis in a patient with treated ocular adnexal lymphoma (OAL). The patient presented with pain and decreased vision in the left eye over several weeks. Past medical history was significant for recent bilateral relapsing OAL that was treated successfully with radiotherapy. Examination of the eyes revealed sectoral scleritis and peripheral ulcerative keratitis. Magnetic resonance imaging (MRI) of the orbits excluded recurrence of OAL and serum antineutrophil cytoplasmic autoantibody (ANCA) titres confirmed the diagnosis of GPA. Disease was poorly responsive to systemic steroids, azathioprine and rituximab. Ultimately, resolution was achieved with successive subconjunctival dexamethasone and subconjunctival triamcinolone injections. This case highlights the need to consider ocular inflammation in patients with a history of malignant hemopathies.
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Affiliation(s)
- Ghazal Valizadeh
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alexandra I Manta
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Diana Conrad
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David Schlect
- Genesis Care, The Wesley Hospital, Brisbane, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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11
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Kalicińska E, Giza A, Zaucha JM, Giebel S, Zimowska‐Curyło D, Andrasiak I, Spychałowicz W, Wojnar J, Balcerzak A, Romejko‐Jarosińska J, Paszkiewicz‐Kozik E, Knopińska‐Posłuszny W, Rybka J, Jabłonowska P, Wróbel T. A survey across orbital lymphoma in Poland: Multicenter retrospective study of polish lymphoma research group (PLRG). Cancer Med 2022; 12:3036-3045. [PMID: 36161781 PMCID: PMC9939129 DOI: 10.1002/cam4.5223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of histopathological subtypes, the clinical stage at presentation and treatment modalities in Polish patients with orbital lymphoma (OL) and to determine prognostic outcomes. METHODS The retrospective study of 107 patients with OL treated in a 14-year period in Polish hematological centers. The analysis included histopathological subtype, disease clinical advancement, treatment modalities, progression-free survival (PFS), and overall survival (OS). RESULTS The median patient age was 60 years (range 51-71). Mucosa-associated lymphoid tissue (MALT) lymphoma accounted for slightly more than half of all cases of orbital lymphoma (51%). The second most common subtype was diffuse large B-cell lymphoma (DLBCL) (29%). Primary orbital lymphoma was diagnosed in 48% of all patients. According to the Ann Arbor, localized stage IE of orbital lymphoma was diagnosed only in 39% of all patients. Systemic involvement was observed in more than half of all patients (52%). The median follow-up period was 30 months (range 0-160 months). Patients with non-MALT lymphoma had a significantly inferior PFS compared to patients with MALT lymphoma, (p = 0.047). Patients with primary orbital lymphoma had a superior PFS compared to patients with secondary orbital lymphoma [median PFS 104.5 months vs. 33.4 months], (p = 0.069). Younger patients with MALT lymphoma were characterized by superior PFS (median PFS not reached) compared to other studied subgroups of patients (older patients with MALT lymphoma, younger and older non-MALT lymphoma patients) with a median PFS of 30.5, 32.2, 32.6 months respectively (p = 0.039). Patients treated with chemotherapy alone had inferior PFS compared to patients treated with combined therapies (p = 0.034). The median PFS across patients who received chemotherapy alone was 23.7 months, whereas across other patients was 73.9 months. CONCLUSIONS Secondary lymphoma accounts for more than half of the orbital lymphoma in Polish population. The advanced clinical stage of the disease (non-IE according to Ann Arbor) concerns two-thirds of the overall population of patients with orbital lymphomas and one-third of MALT lymphoma patients. The high incidence of advanced stages of orbital lymphoma may indicate the need for combined treatment. Combined orbital lymphoma treatment is associated with superior PFS compared to chemotherapy alone in overall population of patients with orbital lymphoma.
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Affiliation(s)
- Elżbieta Kalicińska
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWrocław Medical UniversityWrocławPoland
| | - Agnieszka Giza
- Department of HematologyJagiellonian University Medical CollegeKrakówPoland
| | - Jan Maciej Zaucha
- Department of Hematology and TransplantologyMedical University of GdańskGdańskPoland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and OncohematologyMaria Sklodowska‐Curie National Research Institute of OncologyGliwicePoland
| | | | | | - Wojciech Spychałowicz
- Department of Internal Medicine and OncologySilesian Medical UniversityKatowicePoland
| | - Jerzy Wojnar
- Department of Internal Medicine and OncologySilesian Medical UniversityKatowicePoland
| | - Andrzej Balcerzak
- Department of Hematology and Bone Marrow TransplantationPoznan University of Medical SciencePoznańPoland
| | | | | | | | - Justyna Rybka
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWrocław Medical UniversityWrocławPoland
| | - Paula Jabłonowska
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWrocław Medical UniversityWrocławPoland
| | - Tomasz Wróbel
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWrocław Medical UniversityWrocławPoland
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12
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Chen YQ, Yue ZF, Chen SN, Tong F, Yang WH, Wei RL. Primary diffuse large B-cell lymphoma of orbit: A population-based analysis. Front Med (Lausanne) 2022; 9:990538. [PMID: 36186798 PMCID: PMC9520977 DOI: 10.3389/fmed.2022.990538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Primary orbital lymphoma (POL) accounts for an essential part of adult orbital malignancies. Nevertheless, it remains a relatively rare lymphoid malignancy, accounting for <1% of all non-Hodgkin's lymphoma (NHL) cases. Orbital diffuse large B-cell lymphoma (DLBCL) is one of the most prevalent subtypes of POL that confers the worst outcomes. The prognostic determinants of orbital DLBCL remain unknown. Therefore, a retrospective analysis was conducted by investigating the Surveillance, Epidemiology, and End Results (SEER) database for independent predictive factors for the prognosis of orbital DLBCL. Materials and methods Using the SEER program, we acquired patient data including demographics, clinical characteristics, and treatment strategies. Our cohort included cases of primary orbital DLBCL diagnosed from 2000 to 2017. We conducted Kaplan-Meier analyses to visualize the overall survival (OS) and cause-specific survival (CSS). The Cox proportional hazard regression models were applied to assess the effects of these prognostic factors on OS and CSS. Results The present cohort included 332 patients with orbital DLBCL. Age was the most impacted variable by orbital DLBCL. Three independent prognostic variables of orbital DLBCL were identified on diagnosis: advanced age, no radiation treatment, and late-stage (Stage IV). Moreover, patients who underwent chemotherapy demonstrated a greater OS when compared with those who did not. In orbital DLBCL, being unmarried was also a poor prognostic factor. Conclusion The current study is the largest population-based case series of orbital DLBCL. The age at the time of diagnosis, marital status, absence of chemotherapy or radiotherapy, and tumor stage were all found to be correlated with worse prognosis.
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Affiliation(s)
- Yu-Qing Chen
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Zi-Fan Yue
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Sai-Nan Chen
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Fei Tong
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Wei-Hua Yang
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- Eye Hospital, Nanjing Medical University, Nanjing, China
- Wei-Hua Yang
| | - Rui-Li Wei
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
- *Correspondence: Rui-Li Wei
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Patil S, Colby K, Lazzaro D. MALT Lymphoma Presenting with Peripheral Ulcerative Keratitis. Int Med Case Rep J 2022; 15:485-490. [PMID: 36120701 PMCID: PMC9477148 DOI: 10.2147/imcrj.s361865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sachi Patil
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
- Correspondence: Sachi Patil, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA, Tel +1 (631)-793-2594, Email
| | - Kathryn Colby
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
| | - Douglas Lazzaro
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
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14
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Nair JR, Syed R, Chan IYM, Gorelik N, Chankowsky J, del Carpio-O'Donovan R. The forgotten lacrimal gland and lacrimal drainage apparatus: pictorial review of CT and MRI findings and differential diagnosis. Br J Radiol 2022; 95:20211333. [PMID: 35522773 PMCID: PMC10996330 DOI: 10.1259/bjr.20211333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
The lacrimal gland is a bilobed serous gland located in the superolateral aspect of the orbit. Lacrimal system pathologies can be broadly divided into pathologies of the lacrimal gland and those of the nasolacrimal drainage apparatus. These include distinct congenital, infectious, inflammatory, and benign, indeterminate, and malignant neoplastic lesions. Trauma and resultant fractures affecting lacrimal drainage apparatus is not part of this review; only non-traumatic diseases will be discussed. CT is the initial modality of choice because of its ability to delineate lacrimal system anatomy and demonstrate most lacrimal drainage system abnormalities and their extent. It also assesses bony architecture and characterizes any osseous changes. MRI is helpful in further characterizing these lesions and better assessing involvement of the surrounding soft tissue structures. In this pictorial review, we will review the anatomy of the lacrimal system, describe CT/MRI findings of the common and uncommon lacrimal system abnormalities and discuss relevance of imaging with regards to patient management.
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Affiliation(s)
- Jaykumar Raghavan Nair
- Department of Diagnostic Radiology, McGill University Health
Centre, Montreal, Quebec,
Canada
- St. Michael’s Hospital,
Toronto, Ontario, Canada
- Department of Medical Imaging, University of
Toronto, Toronto, Ontario,
Canada
- Temerty Faculty of Medicine, University of
Toronto, Toronto, Ontario,
Canada
| | - Raza Syed
- Temerty Faculty of Medicine, University of
Toronto, Toronto, Ontario,
Canada
| | | | - Natalia Gorelik
- Department of Diagnostic Radiology, McGill University Health
Centre, Montreal, Quebec,
Canada
| | - Jeffrey Chankowsky
- Department of Diagnostic Radiology, McGill University Health
Centre, Montreal, Quebec,
Canada
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15
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A deep learning model combining multimodal radiomics, clinical and imaging features for differentiating ocular adnexal lymphoma from idiopathic orbital inflammation. Eur Radiol 2022; 32:6922-6932. [PMID: 35674824 DOI: 10.1007/s00330-022-08857-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the value of deep learning (DL) combining multimodal radiomics and clinical and imaging features for differentiating ocular adnexal lymphoma (OAL) from idiopathic orbital inflammation (IOI). METHODS Eighty-nine patients with histopathologically confirmed OAL (n = 39) and IOI (n = 50) were divided into training and validation groups. Convolutional neural networks and multimodal fusion layers were used to extract multimodal radiomics features from the T1-weighted image (T1WI), T2-weighted image, and contrast-enhanced T1WI. These multimodal radiomics features were then combined with clinical and imaging features and used together to differentiate between OAL and IOI. The area under the curve (AUC) was used to evaluate DL models with different features under five-fold cross-validation. The Student t-test, chi-squared, or Fisher exact test was used for comparison of different groups. RESULTS In the validation group, the diagnostic AUC of the DL model using combined features was 0.953 (95% CI, 0.895-1.000), higher than that of the DL model using multimodal radiomics features (0.843, 95% CI, 0.786-0.898, p < 0.01) or clinical and imaging features only (0.882, 95% CI, 0.782-0.982, p = 0.13). The DL model built on multimodal radiomics features outperformed those built on most bimodalities and unimodalities (p < 0.05). In addition, the DL-based analysis with the orbital cone area (covering both the orbital mass and surrounding tissues) was superior to that with the region of interest (ROI) covering only the mass area, although the difference was not significant (p = 0.33). CONCLUSIONS DL-based analysis that combines multimodal radiomics features with clinical and imaging features may help to differentiate between OAL and IOI. KEY POINTS • It is difficult to differentiate OAL from IOI due to the overlap in clinical and imaging manifestations. • Radiomics has shown potential for noninvasive diagnosis of different orbital lymphoproliferative disorders. • DL-based analysis combining radiomics and imaging and clinical features may help the differentiation between OAL and IOI.
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Holloway CL, Pickles T, Croteau NS, Wai ES. Treatment Outcomes of Low-grade Lymphoma of the Orbit. Clin Oncol (R Coll Radiol) 2022; 34:e298-e304. [PMID: 35210133 DOI: 10.1016/j.clon.2022.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
AIMS Radiation therapy can be used with curative intent in patients with low-grade orbital non-Hodgkin's lymphoma (NHL) stages IE and IVE (limited to the bilateral orbits). This study evaluated local control and survival outcomes of patients with unilateral or bilateral orbital lymphoma treated in a provincial population. MATERIALS AND METHODS The study subjects were 176 patients with low-grade orbital or conjunctival lymphoma referred for management from 1980 to 2016. Demographic, tumour and treatment characteristics were abstracted by chart review. Recurrence-free survival (RFS) and overall survival were assessed with competing risks analysis and Gray's test. RESULTS The median follow-up was 8.5 years (range 0.4-29.5 years). The median age at diagnosis was 65 years (range 20-97 years). The most common histological subtype was mucosa-associated lymphoid tissue (MALT) (73%). Stage IVE accounted for 20.5% of the cohort. Orbital radiation therapy was used in 122 patients with stage IE (87%) and 12 patients with stage IVE (28%). The median dose was 25 Gy (range 2-35 Gy). Other treatments were antibiotics (seven patients), chemotherapy (10 patients), radioimmunotherapy (six patients), surgery (three patients) and observation (16 patients). Within the group treated with orbital external beam radiation therapy (EBRT) there were no local recurrences. Among those with stage IE NHL, EBRT was associated with improved local RFS (P ≤ 0.001) but did not have an impact on contralateral or distant RFS. In patients with stage IVE NHL limited to the bilateral orbit, bilateral EBRT was associated with improved RFS (P = 0.012) but did not affect distant recurrences or overall survival. CONCLUSION There were no local recurrences after EBRT for stage IE and IVE orbital low-grade NHL. The treatments offered over the study period varied, but only EBRT for stage IVE disease improved RFS. This supports EBRT as the preferred primary treatment for patients with localised orbital low-grade lymphoma, including those with bilateral disease.
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Affiliation(s)
- C L Holloway
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada.
| | - T Pickles
- Radiation Oncology, University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - N S Croteau
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | - E S Wai
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada
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Lakerveld M, van der Gijp A. Orbital Muscle Enlargement: What if It’s Not Graves’ Disease? CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00392-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
To provide the radiologist with tools to recognize findings atypical for Graves’ ophthalmopathy and differentiate between the most important and common alternative causes of extraocular muscle enlargement on CT and MR imaging.
Recent findings
We introduce five ‘red flags’ representing features that are atypical for Graves’ ophthalmopathy: unilateral disease, atypical pattern of muscle involvement, adjacent structure involvement, restricted diffusion, and absence of pain.
Summary
About 95% of the cases with extraocular enlargement are due to Graves’ ophthalmopathy, other causes are less well known and recognized. The ‘red flags’ may aid in recognizing and suggesting alternative diagnoses.
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Alnaim AF, Alhawsawi A, AlSomali A, Jannadi R, Alsolami SM, Alotaibi HA. Conjunctival Pediatric-Type Follicular Lymphoma in a Young Male: Literature Review and Case Report. Cureus 2022; 14:e22023. [PMID: 35308723 PMCID: PMC8919763 DOI: 10.7759/cureus.22023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/02/2022] Open
Abstract
Pediatric-type follicular lymphoma is a disease that affects the lymph nodes of the head and neck in the adult and pediatric patient groups. Ocular involvement is exceedingly rare, especially in the pediatrics age group; therefore, keeping a high clinical suspicion is warranted. Here, we report a rare conjunctival pediatric-type follicular lymphoma in a 15-year-old boy presenting with progressive swelling over the medial aspect of the left bulbar conjunctiva for two months. On examination, the mass was firm, mobile, well encapsulated, wide-based, and had a negative transillumination. An excisional biopsy was performed, and histopathological examination and immunohistochemistry studies revealed lymphoid tissue that was positive for CD20, CD79a, BCL6, and CD10; and negative for BCL2 and MUM1. The CD21 and CD23 positivity highlighted the presence of an expanded follicular dendritic cell meshwork. The patient was diagnosed with conjunctival pediatric-type follicular lymphoma and referred to an oncology center for further examination and treatment. This lymphoma is rare, requiring high clinical suspicion, and thus, reporting the case detail is important and valuable for ophthalmologists and general pediatrics practitioners alike.
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Primary non-Hodgkin’s lymphoma of the orbit: treatment outcomes from India. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396921000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Primary non-Hodgkin’s lymphoma (NHL) of the orbit is rare. Orbital NHLs show good response to both radiotherapy (RT) and chemotherapy, and hence, the emphasis should be to ensure maximum cure rate with minimum morbidity. In this study, we present the clinical profile and treatment outcomes of patients with NHL who had initial presentation in the orbit.
Materials and methods:
In this retrospective analysis, case records of patients with a diagnosis of NHL of the orbit were analysed from January 2005 to January 2015. Patients were worked up and staged according to the Ann Arbor system. Patients with large tumours were initially given chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriamycin and prednisolone) three weekly for 4–6 cycles. Patients with residual disease were given RT 20–30 Gy at 2 Gy per fraction. RT when given as a primary treatment consisted of 36–45 Gy at 1·8–2 Gy per fraction on either Cobalt 60 machine or linear accelerator.
Results:
A total of 52 patients with diagnosis of orbital NHL were included in this study. Median age at presentation was 57 years (range 13–71). Left, right and bilateral orbit was involved in 21 (40%), 28(54%) and 3(6%) patients, respectively. Low- and high-grade pathology was seen in 39(75%) and 13(25%) patients, respectively. On immunohistochemistry, 23(44%) tumors were CD 20 positive. After staging, 33 (63%) patients had stage I disease. Median tumour size was 4·0 × 3·2 × 1·5 cm (1·7 × 1·7 × 1·4 cm to 5·8 × 4·0 × 4·7 cm). Primary RT was given to 7(13%) patients. Upfront chemotherapy was given in 45(86·5%) patients, out of which 24 had stage I disease. RT consolidation was done in 26 (50%) patients for residual disease after chemotherapy. Median follow-up was 88 months (range 29–183 months). Relapse occurred in 6(9·6%) patients; 2 local; 2 local + distant and in 2 distant alone. These patients were successfully salvaged with systemic chemotherapy and local RT. One patient died due to neutropenia. Overall survival in this series was 96%.
Conclusions:
Excellent local control was achieved with initial chemotherapy followed by RT for primary orbital NHL with minimal toxicity. We recommend a dose of 36–40 Gy for definitive RT and 30 Gy for lymphoma following chemotherapy using 2 Gy/fraction for Indian patients who present with bulky tumours. RT should be incorporated in treatment of orbital NHL whenever possible as it is safe, effective and is associated with minimal complications.
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Abouelatta M, Shalaby OS, Awara A, Kikkawa D, Eldesouky M. Review article: Diagnosis and management of enlarged extraocular muscles. Taiwan J Ophthalmol 2022. [DOI: 10.4103/2211-5056.360560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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21
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Posttreatment Magnetic Resonance Imaging Surveillance of Head and Neck Cancers. Magn Reson Imaging Clin N Am 2021; 30:109-120. [PMID: 34802574 DOI: 10.1016/j.mric.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Treatment strategies and recommended surveillance imaging differ for head and neck cancers depending on subsite and neoplasm type, and pose confusion for referring physicians and interpreting radiologists. The superior soft tissue resolution offered by magnetic resonance imaging is most useful in the surveillance of cancers with high propensities for intraorbital, intracranial, or perineural disease spread, which most commonly include those arising from the sinonasal cavities, nasopharynx, orbits, salivary glands, and the skin. This article discusses recommended surveillance protocoling and reviews treatment approaches, common posttreatment changes, and pearls for identifying disease recurrence in a subsite-based approach.
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22
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Xu L, Tang X, Jiang N, Zhang S, Cao Y, Sun X. Radiation Therapy Efficacy and Toxicity for Orbital and Ocular Adnexal Mucosa-Associated Lymphoid Tissue (OAMALT): A Single-Center, Retrospective Study of 32 Cases. Cancer Manag Res 2021; 13:8017-8024. [PMID: 34707410 PMCID: PMC8544123 DOI: 10.2147/cmar.s334396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Lymphomas of the orbit and ocular adnexa are histologically heterogeneous and their incidence rate has been increasing lately. However, because of their rarity and diversity, few cases have been analyzed. This study evaluated patients with orbital and ocular adnexal mucosa-associated lymphoid tissue (OAMALT), who received radiotherapy, and categorized their clinical characteristics, treatment outcomes, and complications. Patients and Methods We collected data on clinical presentation, age, sex, imaging, tumor location, treatment methods, pathological diagnosis, cataract incidence, cataract incidence periods, overall survival (OS), and disease-free survival (DFS) from 32 patients with orbital involvement and pathologically confirmed marginal zone B-cell lymphoma of MALT who were treated between 2009 and 2018. Twenty-two patients received 20 Gy/10 Fr using intensity-modulated radiation therapy (IMRT) plus 14 Gy/7 Fr using a 6–14-MeV electron beam therapy using a lens-sparing approach. Ten patients received 32 Gy/16 Fr or 34 Gy/17 Fr using IMRT without the lens shield technique. Kaplan–Meier analysis was used to estimate DFS and OS. Results The median follow-up time was 83.4 ± 24.5 months. No patient had local recurrence, although three patients developed distant metastases. The 5-year and 10-year OS rates were both 100%. The 5-year and 10-year DFS rates were 96.7% and 74.2%, respectively. Overall, 11 (32.4%) of the 34 lenses developed cataracts. The estimated 5-year, 7-year, and 10-year cumulative cataract rates were 6.9%, 30.9%, and 60.8%, respectively. The median cumulative cataract incidence period was 107.0 months. Age was the only significant parameter associated with cataract formation. Conclusion A radiation dose of 32–34 Gy yields excellent local control, DFS, and OS for OAMALT. Some patients may have systemic relapse, and better identification of these patients is necessary. Reducing the prescription radiation dose or using better radiation techniques to spare the ipsilateral lens could reduce cataract formation.
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Affiliation(s)
- Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xinyu Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Nan Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Sheng Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yuandong Cao
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
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Orbital Lymphoma Masquerading as Orbital Cellulitis. Case Rep Ophthalmol Med 2021; 2021:8832783. [PMID: 34540302 PMCID: PMC8445722 DOI: 10.1155/2021/8832783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/13/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands. Orbital malignancies often represent a diagnostic dilemma for clinicians given their varying and atypical presentations. Objective To report a case of orbital lymphoma mimicking orbital cellulitis. Case A 66-year-old male patient presented with sudden onset of painful proptosis with visual impairment in the left eye for 15 days. On ocular examination, best-corrected visual acuity was 6/12 in the right eye and 2/60 in the left eye, abaxial proptosis with hypertropia, swollen and erythematous eyelids, restricted extraocular movement in all cardinal position of gaze, conjunctival congestion with chemosis and tortuous vessels, sluggish pupillary reaction, and chorioretinal folds in the inferior quadrants. The case was diagnosed as left eye orbital cellulitis, and the patient was treated with broad-spectrum intravenous antibiotics and oral steroids. No clinically discernible response was noted despite 7 days of antibiotics and steroids. Contrast-enhanced computed tomography (CECT) orbit showed features suggestive of orbital lymphoma involving the ipsilateral maxillary and ethmoid sinuses. ENT consultation with diagnostic nasal endoscopy and biopsy was done. Histopathological reports showed features of non-Hodgkin lymphoma. Conclusion Orbital malignancies masquerading as orbital cellulitis can pose a diagnostic dilemma. A multidisciplinary approach involving ENT consultation, radiological investigation, and pathological sampling can help achieve a timely diagnosis and appropriate management.
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Sang NV, Duc NM, My TTT, Trung HV, Quyen HTD, Lenh BV. A case report of secondary bilateral orbital lymphoma in a child. Radiol Case Rep 2021; 16:1669-1671. [PMID: 34007380 PMCID: PMC8111464 DOI: 10.1016/j.radcr.2021.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Abstract
Lymphoma is one of the most common cancers of the orbital and lacrimal glands, after squamous cell carcinoma and melanoma. Based on cell origin, most lymphoma cases are classified as non-Hodgkin lymphoma. Orbital lymphoma can be either primary or secondary. The clinical manifestations of lymphoma are diverse, with the most common symptoms being bilateral or unilateral proptosis, limited eye motility, swelling, pain, changes in visual acuity, and diplopia. In this article, we describe the case of a 6-year-old male who presented with bilateral rapid orbital swelling for 10 days. This patient underwent surgical biopsy, and the final diagnosis was bilateral orbital secondary non-Hodgkin lymphoma.
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Affiliation(s)
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 02, Ho Chi Minh City, Vietnam.,Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Thieu-Thi Tra My
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Hoang-Van Trung
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Huynh-Thi Do Quyen
- Department of Radiology, Oncology Hospital at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bui-Van Lenh
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
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25
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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26
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Hunt S, Pereni I, Ford R, Garrott H. Lymphoma and inflammatory disorders presenting in the orbit- a comparison of characteristics from a 10-year series in a tertiary hospital. Orbit 2021; 41:315-320. [PMID: 33645420 DOI: 10.1080/01676830.2021.1892771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background/aims: To explore differences in clinical presentations and outcomes between patients with biopsy-proven orbital lymphoma and orbital inflammatory disease.Methods: Clinical records of all patients who underwent orbital biopsy at Bristol Eye Hospital during a 10-year period were reviewed. Comparisons were made between patients diagnosed with orbital lymphoma and orbital inflammatory disease (OID).Results: 35 patients were diagnosed with orbital lymphoma, undergoing 40 biopsies over the 10-year period studied. 62 patients had OID, undergoing 66 biopsies. Sub-analysis identified six patients with sarcoidosis, four with granulomatosis polyangiitis (GPA), eight with IgG4-related orbital disease, and 44 with idiopathic orbital inflammation (IOI). Patients with sarcoidosis and IOI were statistically younger at presentation than those with lymphoma, with means of 44 and 52 years, respectively, compared with 71 years. Lid swelling/puffiness was more common in OID than lymphoma. More patients with lymphoma lost vision during follow-up than those with OID.Conclusions: Although younger age of presentation and presence of lid swelling are more likely to indicate orbital inflammation than orbital lymphoma, orbital biopsy remains the gold standard to distinguish these two entities. In the case of orbital inflammation, identification of a specific diagnosis allows appropriate ongoing referral and investigations for potential systemic involvement and helps guide immunosuppressive treatment.
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Affiliation(s)
- Samantha Hunt
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Ioana Pereni
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Rebecca Ford
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Helen Garrott
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
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27
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To Explore MR Imaging Radiomics for the Differentiation of Orbital Lymphoma and IgG4-Related Ophthalmic Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6668510. [PMID: 33628805 PMCID: PMC7884128 DOI: 10.1155/2021/6668510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/29/2020] [Accepted: 01/23/2021] [Indexed: 12/28/2022]
Abstract
Among orbital lymphoproliferative disorders, about 55% of diagnosed cancerous tumors are orbital lymphomas, and nearly 50% of benign cases are immunoglobulin G4-related ophthalmic disease (IgG4-ROD). However, due to nonspecific characteristics, the differentiation of the two diseases is challenging. In this study, conventional magnetic resonance imaging-based radiomics approaches were explored for clinical recognition of orbital lymphomas and IgG4-ROD. We investigated the value of radiomics features of axial T1- (T1WI-) and T2-weighted (T2WI), contrast-enhanced T1WI in axial (CE-T1WI) and coronal (CE-T1WI-cor) planes, and 78 patients (orbital lymphoma, 36; IgG4-ROD, 42) were retrospectively reviewed. The mass lesions were manually annotated and represented with 99 features. The performance of elastic net-based radiomics models using single or multiple modalities with or without feature selection was compared. The demographic features showed orbital lymphoma patients were significantly older than IgG4-ROD patients (p < 0.01), and most of the patients were male (72% in the orbital lymphoma group vs. 23% in the IgG4-ROD group; p = 0.03). The MR imaging findings revealed orbital lymphomas were mostly unilateral (81%, p = 0.02) and wrapped eyeballs or optic nerves frequently (78%, p = 0.02). In addition, orbital lymphomas showed isointense in T1WI (100%, p < 0.01), and IgG4-ROD was isointense (60%, p < 0.01) or hyperintense (40%, p < 0.01) in T1WI with well-defined shape (64%, p < 0.01). The experimental comparison indicated that using CE-T1WI radiomics features achieved superior results, and the features in combination with CE-T1WI-cor features and the feature preselection method could further improve the classification performance. In conclusion, this study comparatively analyzed orbital lymphoma and IgG4-ROD from demographic features, MR imaging findings, and radiomics features. It might deepen our understanding and benefit disease management.
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28
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Ko KWS, Bhatia KS, Ai QYH, King AD. Imaging of head and neck mucosa-associated lymphoid tissue lymphoma (MALToma). Cancer Imaging 2021; 21:10. [PMID: 33436095 PMCID: PMC7805088 DOI: 10.1186/s40644-020-00380-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALToma) arises in extranodal sites in the head and neck. Chronic inflammatory, infectious or autoimmune conditions are implicated in its pathogenesis. Within the head and neck, MALToma is often multifocal and indolent and the imaging appearances may be mistaken for non-malignant disease in the head and neck. The aim of this article is to illustrate the varied radiological and clinical features of MALToma in the head and neck, an awareness of which is needed for timely and correct diagnosis to guide subsequent disease management.
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Affiliation(s)
- K W S Ko
- Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, SAR, China
| | - Kunwar S Bhatia
- Department of Imaging, St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
| | - Qi Yong H Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, SAR, China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, SAR, China.
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29
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Stephen N, Manivannan P, Gochhait D, Sreerekha J, Ramasubramanian N, Srinivas BH, Kar R, Kasturi N, Basu D, Siddaraju N. The utility of fine needle aspiration cytology in orbital haematolymphoid neoplasms. Cytopathology 2020; 32:217-226. [PMID: 33125778 DOI: 10.1111/cyt.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orbital hematolymphoid lesions are rare and usually encountered in elderly patients. Orbital lesions are not easy to biopsy: hence fine needle aspiration cytology (FNAC) can be a very good diagnostic modality for these lesions. MATERIALS AND METHODS Cases of orbital masses subjected to FNAC dating from 2013 to 2020 were retrieved from our archives. A total of 16 cases with biopsy confirmation were included. All clinical details, the type of procedure, details of the immunocytochemistry (ICC) performed on smear, follow-up biopsy, and their haematological work-up were analysed in detail. RESULTS Sixteen biopsy-confirmed cases had been diagnosed as orbital haematolymphoid lesions on cytomorphology and further categorised with ancillary studies including ICC. In twelve instances, the cytology impression was congruent with the histopathological diagnosis and eight of the sixteen cases (50%) proved to be primary orbital lymphoma. Four were secondary orbital lymphomas and the remaining four included one case each of plasmacytoma, myeloid sarcoma, Rosai-Dorfman disease and angiolymphoid hyperplasia with eosinophilia. CONCLUSION FNAC is a minimally invasive procedure for diagnosing most of the haematolymphoid orbital lesions and it has a rapid turnaround time. The accuracy of cytomorphology combined with ICC on smears/cell blocks can be as good as a biopsy for exact categorisation. Additionally, aspirate smears are preferred samples for cytogenetics compared to formalin-fixed tissue blocks, as molecular cytogenetics techniques are frequently employed for diagnostic, prognostic, and therapeutic purposes.
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Affiliation(s)
- Norton Stephen
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prabhu Manivannan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jinkala Sreerekha
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Niranjini Ramasubramanian
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Rakhee Kar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debdata Basu
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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30
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Jui-Chi Chang R, Kuang V, Meyer J, Chang E, Roberts-Thomson SJ, McKelvie P, Hardy TG, Pick ZS. Orbital giant cell myositis is an unusual and potentially lethal cause of bilateral ophthalmoplegia - A case report and literature review. Orbit 2020; 41:354-360. [PMID: 33297808 DOI: 10.1080/01676830.2020.1856144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We present a case of orbital giant cell myositis (OGCM), presenting with bilateral subacute progressive ophthalmoplegia and optic nerve dysfunction. An early extraocular muscle biopsy confirmed the diagnosis and guided appropriate management. Comprehensive investigation excluded any underlying systemic disease, including myocarditis. Twenty two months after presentation, the patient remains well on azathioprine with complete resolution of orbital signs.
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Affiliation(s)
| | - Vivian Kuang
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
| | - Joos Meyer
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
| | - Ewan Chang
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | | | - Penny McKelvie
- Department of Anatomical Pathology, St. Vincent's Hospital, Parkville, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Zelda S Pick
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
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31
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Chowdhury Z, Sharma JD, Kakoti LM, Sarma A, Ahmed S, Hazarika M. Experience with Orbital Tumors from a Tertiary Cancer Centre of North East India: A Pathology Perspective. J Lab Physicians 2020; 12:171-177. [PMID: 33268934 PMCID: PMC7684989 DOI: 10.1055/s-0040-1721148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The orbit is an anatomically complex structure comprising the globe, extraocular muscles, fat, vascular, nervous, glandular, and connective tissues. A wide variety of neoplasms can arise from different orbital structures, which can create a diagnostic challenge to the pathologists. No formal study has been conducted in this regard in North East India. Aim and Objectives This article aims to document the pattern and prevalence of orbital tumors in our institute and assess the utility of histopathological examination (HPE) and immunohistochemistry (IHC) in the precise diagnosis of these neoplasms. Materials and Methods A retrospective analysis of orbital tumors was performed over a period of 5 years from 2013 to 2018 in the department of pathology at a tertiary cancer center of North East India following all the guidelines of the institutional ethics committee. Results A total of 35 cases of orbital neoplasms, evaluated by HPE and IHC, were found, all of them being malignant tumors. The age range was 4 months to 85 years. Male to female ratio was 1.5:1. The most common tumor found was lymphoma, accounting for 10 cases (28.6%), all of which were non-Hodgkin lymphoma (NHL). All these cases except one occurred in adults, thus making it the most common tumor in adults in this study. Diffuse large B cell lymphoma, not otherwise specified, was the most common NHL, followed by follicular lymphoma, mature T cell NHL, extranodal marginal zone lymphoma, and B cell lymphoblastic lymphoma. Rhabdomyosarcoma and poorly differentiated/undifferentiated carcinoma jointly were the second most common tumors, totaling seven cases (21.21%) each. This was followed by melanoma (three cases), myeloid sarcoma (three cases), Ewing sarcoma/peripheral neuroectodermal tumor (PNET) (three cases), neuroblastoma (one case), and angiosarcoma (one case). Among these, rhabdomyosarcoma, granulocytic sarcoma, Ewing sarcoma/PNET, and neuroblastoma exclusively troubled the children. IHC markers including the lymphoma panel, and soft tissue ones were crucial in the precise diagnosis of the neoplasms encountered. Conclusion A variety of malignant orbital tumors may be seen in clinical practice. Management of these tumors requires a multidisciplinary approach. HPE in conjunction with IHC evaluation is of utmost importance in the veracious recognition of orbital tumors for their proper management.
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Affiliation(s)
- Zachariah Chowdhury
- Department of Pathology, Homi Bhabha Cancer Hospital/MPMMCC (Tata Memorial Hospital), Varanasi, Uttar Pradesh, India
| | - Jagannath Dev Sharma
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Lopa Mudra Kakoti
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Anupam Sarma
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Shiraj Ahmed
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Munlima Hazarika
- Department of Medical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
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32
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Primary Orbital Lymphoma – A Challenging Diagnosis. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and purpose: The occurrence of primary orbital lymphoma comprises approximately 1% of non-Hodgkin’s lymphoma and 8% of extranodal lymphoma. The vast majority of orbital lymphomas are of B-cell origin, of which extranodal marginal zone B-cell lymphoma is the most common subtype. The purpose of this paper was to present the diagnostic challenges in a case of orbital lymphoma. Case presentation: An 84-year -old woman with orbital tumour was operated on after a long period of inappropriate treatment. It was later diagnosed as B-cell lymphoma.
Conclusion: Orbital lymphoma can be easily mistaken for another ocular disease due to the slowly progressing non-specific complaints of the patients. We should be alert to the possibility of this ocular diagnosis when we are presented with an elderly patient with proptosis.
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33
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Lee JY, Kim HJ, Kwon E, Choi JY, Oh HJ, Kim JS. Inferior Divisional Oculomotor Nerve Palsy Due to Orbital Lymphoma. J Clin Neurol 2020; 16:711-713. [PMID: 33029984 PMCID: PMC7541985 DOI: 10.3988/jcn.2020.16.4.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ju Young Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Research Administration Team, Seoul National Univertisy Bundang Hospital, Seongnam, Korea
| | - Eunjin Kwon
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hui Jong Oh
- The MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, Daegu, Korea
| | - Ji Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, College of Medicine, Seoul National University, Seoul, Korea.
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34
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Hirji SH, Maeng MM, Tooley AA, Soderquist C, Annunziata J, Kazim M. Orbital marginal cell lymphoma and mantle cell lymphoma subclone in patient with monoclonal gammopathy of unknown significance. Orbit 2020; 40:247-251. [PMID: 32363993 DOI: 10.1080/01676830.2020.1760312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Indolent lymphomas have the potential to transform into more aggressive phenotypes. This phenomenon is best exemplified by the transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma into diffuse large B-cell lymphoma. However, it is less common to find multiple small cell lymphomas in the orbit, particularly mantle cell lymphoma. We present a case of an extranodal marginal zone lymphoma arising in the orbit that acquired a subclonal t(11;14) (q13;32) CCND1-IGH translocation, giving rise to a subclone of mantle cell lymphoma. The management of this tumor was targeted towards the more aggressive mantle cell subclone. The tumor exhibited an incomplete response to rituximab alone. To the best of the authors' knowledge, this represents the first such case to be described irrespective of site of origin.
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Affiliation(s)
- Sitara H Hirji
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michelle M Maeng
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Andrea A Tooley
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Craig Soderquist
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Joseph Annunziata
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Michael Kazim
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
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35
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Ahmed OM, Ma AK, Ahmed TM, Pointdujour-Lim R. Epidemiology, outcomes, and prognostic factors of orbital lymphoma in the United States. Orbit 2020; 39:397-402. [PMID: 31894706 DOI: 10.1080/01676830.2019.1704032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We performed an epidemiological study of orbital lymphoma in the United States to determine how histological subtypes confer differing prognosis, and understand other factors associated with survival. METHODS All patients in the Surveillance, Epidemiology and End Results database diagnosed with a histologically confirmed orbital lymphoma between 1973 and 2014 were included. Exclusion criteria included diagnosis at autopsy and the presence of other malignancies. Measures included patient demographic information, histological subtype and treatment modalities. Outcomes included overall and disease specific survival. RESULTS Of the 1504 cases identified, 702 were male (46.7%, mean age: 64.4 years, standard deviation [SD]: 15.3) and 802 were female (53.3%, mean age: 67.5 years, SD: 14.3). Mucosal associated lymphoid tissue (MALT) (49.5%) and diffuse large B cell lymphoma (DLBCL) (19.5%) were the two most common histologic subtypes. MALT lymphoma conferred the best prognosis (10-year cancer specific survival [CSS] 90.2%, 95% Confidence Interval [CI] 87.4% - 93.1%) and DLBCL conferred the worst prognosis (10-year CSS 68.6%, 95% CI 62.5% - 75.3%) (p < .001, log-rank test). Older age (Hazard Ratio [HR]: 3.71, 95% Confidence Interval [CI]: 2.94-4.66, p < .001), male sex (HR: 1.22, 95% CI: 1.039-1.441, p = .015), no radiation (HR: 1.72, 95% CI: 1.46-2.02, p < .001) and DLBCL histology were significant predictors of worse overall survival. CONCLUSIONS DLBCL histology confers the worst outcomes whereas MALT lymphoma confers the best outcome in orbital lymphoma. Age, gender, and radiation treatment also influence survival. These epidemiological results can be used clinically to communicate outcomes on the basis of patient characteristics and disease histology.
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Affiliation(s)
- Osama M Ahmed
- Yale University School of Medicine , New Haven, Connecticut, USA
| | - Anthony K Ma
- Yale University School of Medicine , New Haven, Connecticut, USA
| | - Taha M Ahmed
- Department of Medicine, Aga Khan University , Karachi, Pakistan
| | - Renelle Pointdujour-Lim
- Yale University School of Medicine , New Haven, Connecticut, USA.,Smilow Yale Cancer Center, Yale University School of Medicine , New Haven, Connecticut, USA
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36
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Orbital Diffuse Large B-Cell Lymphoma Initially Presenting as Neovascular Glaucoma. Ophthalmic Plast Reconstr Surg 2019; 36:e12-e13. [PMID: 31593042 DOI: 10.1097/iop.0000000000001498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orbital lymphoma can result in rapid loss of vision if not diagnosed and treated in a timely manner. This patient presented with rapid visual loss and on examination had a rubeosis iridis with a hyphema as well as neovascular glaucoma with vitreous hemorrhage. His medical history included systemic diffuse large B-cell lymphoma and a workup ultimately revealed an orbital mass in the body of the optic nerve. Optic nerve biopsy demonstrated diffuse large B-cell lymphoma. To the authors' knowledge, neovascular glaucoma as the presentation of an extraocular diffuse large B-cell lymphoma has not been reported previously. Lymphomas of the orbit and its adnexa constitute roughly 1% of all non-Hodgkin lymphoma. Most cases are marginal-zone B-cell lymphomas, with the second most common being diffuse large B-cell lymphomas. Orbital lymphomas can rapidly progress to complete visual loss when not diagnosed early. The authors report a patient who presented with rapid visual loss due to hyphema, rubeosis iridis, neovascular glaucoma and vitreous hemorrhage secondary to orbital diffuse large B-cell lymphoma. Research methods were adherent to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. The collection and evaluation of protected patient health information was Health Insurance Portability and Accountability Act compliant.The authors report a case of lymphoma metastatic to the optic nerve masquerading as neovascular glaucoma with vitreous hemorrhage.
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37
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Jung JH, Oh EH, Shin DH, Choi SY, Choi KD, Choi JH. Orbital Lymphoma Presenting with Inferior Rectus Palsy. J Clin Neurol 2019; 15:398-400. [PMID: 31286714 PMCID: PMC6620445 DOI: 10.3988/jcn.2019.15.3.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Kwang Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Jae Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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38
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Primary extranodal lymphoma of the glands. Literature review and options for best practice in 2019. Crit Rev Oncol Hematol 2019; 135:8-19. [PMID: 30819450 DOI: 10.1016/j.critrevonc.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 01/01/2023] Open
Abstract
Primary extranodal non-Hodgkin's lymphomas (EN-NHL) are a heterogeneous group of malignancies that involve numerous entities with significant difference in terms of tumor site locations, prognostic factors, biology expression, and therapeutic options. In the literature, many EN-NHL types were reported from limited series which only allowed narrow views for elucidating prognostic factors and defining the role of loco-regional therapies in the era of new systemic and biologically targeted therapies. The Rare Cancer Network (RCN), an international multidisciplinary consortium, has published a number of reports on several EN-NHL sites which included many gland locations. In this review, we will focus on the recent literature for a selected number of EN-NHL types in both exocrine and endocrine gland locations. We aim to provide renewed and clear messages for the best practice in 2019 for diagnosis, histopathology, treatments, and also their prognostic implications. We believe that better understanding of molecular and genetic characteristics of these particular diseases is crucial for an appropriate management in the era of personalized treatment developments.
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39
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Borkar AU, Jain K, Jain VK. A large primary orbital lymphoma with proptosis: A case report and review. Surg Neurol Int 2019; 9:249. [PMID: 30603233 PMCID: PMC6293602 DOI: 10.4103/sni.sni_270_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/01/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Primary orbital lymphomas are a rare subset of tumors constituting 1–2% of non-Hodgkin's lymphoma. They are mostly indolent B-cell lymphomas presenting with gradual progressive proptosis, decreased visual acuity, restricted ocular mobility, and diplopia. The role of surgery is mainly for obtaining a biopsy. Most of these tumors require multimodality treatment including chemotherapy, radiation, or both, which have major role. Case Description: We report one such case of marginal zone lymphoma of the orbit in a female with significant proptosis who was treated with multimodality treatment, including surgical excision as a major treatment modality. Decompression of symptomatic proptosis was followed by chemotherapy and radiation. Conclusion: Primary orbital lymphoma is a rare clinical entity with diverse clinical outcomes. It can be successfully managed with surgical excision for decompression of mechanical proptosis followed by chemotherapy, radiation, or both.
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Affiliation(s)
- Ashwin U Borkar
- Department of Neurosurgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Kapil Jain
- Department of Neurosurgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Vijendra K Jain
- Department of Neurosurgery, Max Superspeciality Hospital, Saket, New Delhi, India
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40
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Brovkina AF. [Clinical features of malignant orbital lymphoma]. Vestn Oftalmol 2019; 135:4-12. [PMID: 31714507 DOI: 10.17116/oftalma20191350514] [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] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The occurrence of malignant lymphoma (ML) among patients with malignant orbital tumors ranges between 10 and 37.3% making early diagnosis clarification crucial for timely treatment. PURPOSE To study clinical features of ML with consideration of its morphological type and localization in the orbit. MATERIAL AND METHODS Clinical picture of primary malignant orbital lymphoma of 34 patients (36 orbits) was examined retrospectively with consideration of the tumor's morphotype. Median observation time was 6 years. Patients aged between 34 and 84 years, female to male ratio was 1.27:1. RESULTS The final diagnoses were: small cell MALT-type ML (23 patients), large cell B-lymphoma (5 patients), diffuse malignant lymphoma (5 patients), T-cell lymphoma (1 female patient). Systemic changes developed in 29.41% of cases after 6.7 years on average. 23.53% of patients has died. Clinical signs of MALT-type ML were described with consideration of tumor's localization in the orbit, and clinical features of B-cell, large cell, diffuse and T-cell lymphoma were shown. Signs helping differentiate ML from false tumor, composite tear gland tumor and malignant orbital tumor were established. CONCLUSION Despite the higher prevalence of malignant MALT-type lymphoma, primary malignant orbital lymphoma is characterized by unfavorable vital prognosis: in a third of all cases, signs of systemic lesion develop in 6.7 years on average. Clinical picture of MALT-type ML is defined by tumor's localization in the orbit. Recurrence of MALT-type ML after combined treatment (surgical, radiotherapy, polychemotherapy) happens in every fourth case among patients with tumor primarily localized in the orbital cellular tissues or in the tear gland. Describing clinical features of primary malignant orbital lymphoma allows faster diagnosis clarification reducing the number of orbital diseases that require differential diagnositcs.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Continuous Professional Education, Department of Ophthalmology, 2/1 Barricadnaya St., Moscow, Russian Federation, 125993
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41
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Sritrakoon N, Siripattarapravat K, Maneesaay P, Amuzie CJ, Thayananuphat A. Morphological characterization of canine retrobulbar lymphoma. Open Vet J 2018; 8:367-373. [PMID: 30425960 PMCID: PMC6203897 DOI: 10.4314/ovj.v8i4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022] Open
Abstract
This report characterized seven cases of canine retrobulbar lymphoma that have been diagnosed during 2008 to 2014 by immunophenotyping of CD3 and Pax5. Classification of lymphoma were performed according to the revised WHO guidelines. Four retrobulbar lymphomas were of T-cell origin, while the others were of B-cell. Out of 7 cases, four subtypes were diagnosed in this study; T-cell-rich large B-cell lymphoma (3/7), T-cell lymphoblastic lymphoma (2/7), peripheral T-cell lymphoma (1/7), and cutaneous nonepitheliotropic lymphoma (1/7). T-cell-rich large B-cell lymphoma was found to be the most frequent subtype found.
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Affiliation(s)
- Natthanet Sritrakoon
- Ophthalmology Unit, Kasetsart University Veterinary Teaching Hospital, Bangkok, 10900, Thailand
| | - Kannika Siripattarapravat
- Department of Pathology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Phudit Maneesaay
- Department of Pathology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | | | - Aree Thayananuphat
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
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42
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Cavaillé M, Ponelle-Chachuat F, Uhrhammer N, Viala S, Gay-Bellile M, Privat M, Bidet Y, Bignon YJ. Early Onset Multiple Primary Tumors in Atypical Presentation of Cowden Syndrome Identified by Whole-Exome-Sequencing. Front Genet 2018; 9:353. [PMID: 30233642 PMCID: PMC6127642 DOI: 10.3389/fgene.2018.00353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022] Open
Abstract
A family with an aggregation of rare early onset multiple primary tumors has been managed in our oncogenetics department: the proband developed four early onset carcinomas between ages 31 and 33 years, including acral melanoma, bilateral clear cell renal carcinoma (RC), and follicular variant of papillary thyroid carcinoma. The proband's parent developed orbital lymphoma and small intestine mucosa-associated lymphoid tissue (MALT) lymphoma between 40 and 50 years old. Whole-exome-sequencing (WES) of the nuclear family (proband, parents, and sibling) identified in the proband a de novo deleterious heterozygous mutation c.1003C > T (p.Arg335∗) in the phosphatase and tensin homolog (PTEN) gene. Furthermore, WES allowed analysis of the nuclear family's genetic background, and identified deleterious variants in two candidate modifier genes: CEACAM1 and MIB2. CEACAM1, a tumor suppressor gene, presents loss of expression in clear cell RC and is involved in proliferation of B cells. It could explain in part the phenotype of proband's parent and the occurrence of clear cell RC in the proband. Deleterious mutations in the MIB2 gene are associated with melanoma invasion, and could explain the occurrence of melanoma in the proband. Cowden syndrome is a hereditary autosomal dominant disorder associated with increased risk of muco-cutaneous features, hamartomatous tumors, and cancer. This atypical presentation, including absence of muco-cutaneous lesions, four primary early onset tumors and bilateral clear cell RC, has not been described before. This encourages including the PTEN gene in panel testing in the context of early onset RC, whatever the histological subtype. Further studies are required to determine the implication of CEACAM1 and MIB2 in the severity of Cowden syndrome in our proband and occurrence of early onset MALT lymphoma in a parent.
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Affiliation(s)
- Mathias Cavaillé
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Flora Ponelle-Chachuat
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nancy Uhrhammer
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Sandrine Viala
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Mathilde Gay-Bellile
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Maud Privat
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Yannick Bidet
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Yves-Jean Bignon
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France.,Département d'Oncogénétique, Centre Jean Perrin, Clermont-Ferrand, France
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Affiliation(s)
- Miho Yasuda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Kosuke Kimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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44
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Primary orbital lymphoma: A case report and review of the literature. J Fr Ophtalmol 2017; 40:e415-e416. [DOI: 10.1016/j.jfo.2017.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/20/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022]
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Jakobiec FA, Homer N, Zakka FR, Curtin HD, Fay A. Clinicopathologic and Magnetic Resonance Imaging Analysis of a Multifocal Orbital Lymphoid Tumor. Ocul Oncol Pathol 2017; 4:82-89. [PMID: 30320086 DOI: 10.1159/000478731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/14/2017] [Indexed: 01/21/2023] Open
Abstract
Objective To distinguish between a multifocal orbital lymphoid tumor and a major simulator represented by a diffuse lymphaticovenous malformation. Methods We performed a comparison of clinical and radiographic (magnetic resonance imaging [MRI]) findings of these two disparate entities and demonstrated how a misdiagnosis can be prevented. Results Orbital lymphoid tumors develop in adults at around 60 years of age, whereas extensive lymphaticovenous malformations are generally detected in the first decade. Despite these differences, this is the first description of clinical confusion between them. MRI with gadolinium injection in the current lymphoid tumor displayed a low signal on T2-weighted images, rapid and uniform enhancement, and reduced diffusion. Lymphaticovenous malformations are heterogeneous, display poor or only focal perfusion, and fail to exhibit diminished diffusion. Newer techniques such as diffusion-weighted imaging and dynamic contrast-enhanced imaging may be able to provide additional differential diagnostic information. The final pathologic diagnosis was an extranodal marginal zone lymphoma. Conclusions Despite the obvious distinctions between orbital lymphoid tumors and lymphaticovenous malformations, several clinical radiologic specialists misdiagnosed the present orbital lesion as a vascular lesion. A combined clinicoradiographic analysis should obviate such errors and facilitate the correct diagnosis in the future.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Natalie Homer
- Orbital and Oculoplastics Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Fouad R Zakka
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Hugh D Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Aaron Fay
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
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46
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Parlin A, Dumitrescu A, Nunery WT, Timoney PJ, Sokol JA. Retrospective chart review of the use of imaging and biopsy in the diagnosis of optic nerve sheath meningiomas and intra-conal orbital lymphomas at a single institution. Orbit 2017; 36:392-396. [PMID: 28812914 DOI: 10.1080/01676830.2017.1337198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Optic nerve sheath meningiomas (ONSM) and intra-conal orbital lymphomas are common entities on the differential of a retrobulbar optic nerve involving space-occupying lesion. In this study, we compare the pre-surgical diagnosis, based on clinical presentation and neuroimaging, to the surgical pathology results of intra-conal orbital lymphomas and ONSM. This is an IRB approved retrospective chart review of orbital lymphomas and optic nerve sheath meningiomas biopsied by a single surgeon over a 4-year period at a single institution. Pre-surgical diagnosis and surgical pathology were compared. Fifteen cases of orbital lymphoma were identified. Fourteen were excluded based on extra-conal location. The single histologically confirmed intra-conal orbital lymphoma had a pre-surgical diagnosis of ONSM. Four cases of optic nerve sheath meningioma were identified. Three of the 4 cases of histologically confirmed ONSM had a pre-surgical diagnosis of ONSM. One of the 4 had a pre-surgical diagnosis of lymphoma. Diagnosis based on surgical pathology differed from the pre-surgical diagnosis in 2 out of 5 cases showing that clinical diagnosis does not always correlate with histologic diagnosis. Although both diseases are typically managed with radiation therapy, the treatment dosage and systemic disease implications are very different. These findings emphasis the importance of biopsy in the diagnosis of orbital lesions surrounding the optic nerve.
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Affiliation(s)
- Anna Parlin
- a Department of Ophthalmology , University of Kansas School of Medicine, Prairie Village, Kansas, USA
| | | | - William T Nunery
- c Department of Ophthalmology , University of Louisville, Louisville, Kentucky, USA
| | - Peter J Timoney
- d Department of Ophthalmology , University of Kentucky , USA
| | - Jason A Sokol
- a Department of Ophthalmology , University of Kansas School of Medicine, Prairie Village, Kansas, USA
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Briscoe D, Safieh C, Ton Y, Shapiro H, Assia EI, Kidron D. Characteristics of orbital lymphoma: a clinicopathological study of 26 cases. Int Ophthalmol 2017; 38:271-277. [PMID: 28364339 DOI: 10.1007/s10792-017-0457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluation of the medical data of patients with orbital and adnexal lymphoma. DESIGN Cohort study of all cases diagnosed with orbital or adnexal lymphoma at Meir Medical Center between 1993 and 2007. PARTICIPANTS Twenty-six patients, with intraorbital or subconjunctival masses with orbital involvement, were examined and followed up between 1 and 8 years. MATERIALS AND METHODS Examined data included: clinical presentation, age, gender, imaging, tumor location, surgical management, and pathological diagnosis. RESULTS Presenting signs and symptoms included proptosis, eyelid lesions, tearing, chemosis, decreased visual acuity, ptosis, pain, squint, and optic nerve compression. In five cases, lymphoma was misdiagnosed on neuroimaging. Bone changes were seen in four patients. All cases were B cell lymphomas; with the majority (22 cases) of small B cell type; consisting of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and two cases of small cell lymphoma. One small cell lymphomas was of follicular type on a background of CLL, and the other was CLL/SLL type. Fourteen cases were primary orbital disease, and 12 cases were systemic disease. Macroscopic appearance of lymphoma at open biopsy was characteristic in most cases. Flow cytometry phenotyping gave rapid reliable diagnosis of the disease. CONCLUSIONS Epiphora or chemosis in the presence of an orbital mass should alert the ophthalmologist to suspect lymphoma. Lymphoma may be easily misinterpreted on neuroimaging for other diseases. Bone changes seen on CT are more common than is generally perceived. Macroscopic appearance at open biopsy was characteristic.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel. .,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
| | - Christine Safieh
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Hava Shapiro
- Department of Haematocytology, Meir Medical Center, Kfar Saba, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Dvora Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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48
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Yuen CA, Pula JH, Mehta M. Primary Ocular Adnexal Extranodal Marginal Zone Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Presenting as Orbital Apex Syndrome. Neuroophthalmology 2017; 41:94-98. [PMID: 28348632 DOI: 10.1080/01658107.2016.1263343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
A 75-year-old female with a past medical history significant for prior stroke and atrial fibrillation presented with acute onset of orbital apex syndrome with chemosis and periorbital ecchymosis. Following initial treatment to relieve intraocular pressure, she began spontaneously haemorrhaging retro-orbitally. Preliminary investigation with neuroimaging demonstrated a left orbital mass with extension into the orbital apex. A provisional diagnosis of cavernous haemangioma was made. She was treated with transorbital resection of the orbital mass. Subsequent histopathology revealed a diagnosis of ocular adnexal non-Hodgkin lymphoma of histologic type extranodal marginal zone of mucosa-associated lymphoid tissue (MALT lymphoma). MALT lymphoma should be considered in cases of orbital apex syndrome.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, University of Chicago , Chicago, Illinois, USA
| | - John H Pula
- Department of Neurology, NorthShore University HealthSystem , Chicago, Illinois, USA
| | - Milap Mehta
- Department of Ophthalmology, NorthShore University HealthSystem , Chicago, Illinois, USA
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Prasad GL, Hegde A, Menon G, Mathew M. Primary Orbital Follicular Lymphoma: A Case Report and Review. J Clin Diagn Res 2017; 11:XD01-XD03. [PMID: 28511490 PMCID: PMC5427416 DOI: 10.7860/jcdr/2017/24674.9400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/20/2016] [Indexed: 01/22/2023]
Abstract
Orbital Lymphomas (OL) constitute a heterogeneous group of lymphoproliferative disorders of the orbit. They are predominantly of the Mucosa-Associated Lymphoid Tissue (MALT) subtype. Radiotherapy is the mainstay of treatment in localized orbital tumours, while chemotherapy is reserved for systemic disease. Authors report a case of a primary orbital lymphoma of follicular subtype (stage 1E) in a 54-year-old female managed by surgery and adjuvant radiotherapy.
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Affiliation(s)
- G Lakshmi Prasad
- Assistant Professor, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Ajay Hegde
- Registrar, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Girish Menon
- Professor and Head, Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Mary Mathew
- Professor, Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
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Sriram PR. A Rare Case of Aggressive, Huge Primary Orbital Lymphoma with Intracranial Extension and Bone Invasion. Asian J Neurosurg 2017; 12:766-768. [PMID: 29114307 PMCID: PMC5652119 DOI: 10.4103/1793-5482.185055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Primary orbital lymphoma is a rare entity with only 1% of extranodal lymphomas. They usually present to ophthalmologist and surgical reserved for biopsy or tissue diagnosis. We present a patient who was referred to neurosurgery for a rapid growing orbital lymphoma. It grows from a small nodule in the eyelid to a huge, aggressive, disfiguring lesion invading bone and dura with intracranial extension within 3 months. The patient was treated with total surgical excision followed by systemic chemotherapy.
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Affiliation(s)
- Prabu Rau Sriram
- Department of Neurosurgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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