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Rana K, Juniat V, Patel S, Selva D. Extraocular muscle enlargement. Graefes Arch Clin Exp Ophthalmol 2022; 260:3419-3435. [PMID: 35713708 PMCID: PMC9581877 DOI: 10.1007/s00417-022-05727-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022] Open
Abstract
Extraocular muscle enlargement can occur secondary to a range of orbital and systemic diseases. Although the most common cause of extraocular muscle enlargement is thyroid eye disease, a range of other inflammatory, infective, neoplastic, and vascular conditions can alter the size and shape of the extraocular muscles. Imaging with computed tomography and magnetic resonance imaging plays an essential role in the workup of these conditions. This article provides an image-rich review of the wide range of pathology that can cause enlargement of the extraocular muscles.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia. .,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Valerie Juniat
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Behzadi F, Suh CH, Jo VY, Shanmugam V, Morgan EA, Guenette JP. Imaging of IgG4-Related Disease in the Head and Neck: A Systematic Review, Case Series, and Pathophysiology Update. J Neuroradiol 2021; 48:369-378. [PMID: 33516733 DOI: 10.1016/j.neurad.2021.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
This systematic review aims to clarify and comprehensively detail the sometimes variable published imaging features as well as the pathogenesis, clinical diagnostic criteria, and treatment options of IgG4-Related Diseases (IgG4-RD) in the head and neck to aid the radiologist in diagnosing relapse and new sites of disease. A literature search in PubMed and EMBASE for reported cases of IgG4-RD was performed in December 2019. Case reports or series of IgG4-RD in the head and neck in adults that included sufficient imaging and pathology findings were included. This yielded 50 reports. IgG4-RD locations included the orbits, thyroid, pituitary gland, paranasal sinuses, salivary and parotid glands, larynx, pharynx, cervical lymph nodes, meninges, and skull base. Most lesions demonstrated non-specific homogenous CT attenuation, diffuse enhancement, isointense/low T2 signal intensity, and low T1 signal intensity. 6 cases from our institution followed previously reported imaging patterns.
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Affiliation(s)
- Fardad Behzadi
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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Identification of Markers Predicting Clinical Course in Patients with IgG4-Related Ophthalmic Disease by Unbiased Clustering Analysis. J Clin Med 2020; 9:jcm9124084. [PMID: 33348892 PMCID: PMC7766793 DOI: 10.3390/jcm9124084] [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: 11/07/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: To describe the clinical features of patients with immunoglobulin G4 (IgG4)-related ophthalmic disease (IgG4-ROD) grouped by unbiased cluster analysis using peripheral blood test data and to find novel biomarkers for predicting clinical features. Methods: One hundred and seven patients diagnosed with IgG4-ROD were divided into four groups by unsupervised hierarchical cluster analysis using peripheral blood test data. The clinical features of the four groups were compared and novel markers for prediction of clinical course were explored. Results: Unbiased cluster analysis divided patients into four groups. Group B had a significantly higher frequency of extraocular muscle enlargement (p < 0.001). The frequency of patients with decreased best corrected visual acuity (BCVA) was significantly higher in group D (p = 0.002). Receiver operating characteristic (ROC) curves for the prediction of extraocular muscle enlargement and worsened BCVA using a panel consisting of important blood test data identified by machine learning yielded areas under the curve of 0.78 and 0.86, respectively. Clinical features were compared between patients divided into two groups by the cutoff serum IgE or IgG4 level obtained from ROC curves. Patients with serum IgE above 425 IU/mL had a higher frequency of extraocular muscle enlargement (25% versus 6%, p = 0.004). Patients with serum IgG4 above 712 mg/dL had a higher frequency of decreased BCVA (37% versus 5%, p ≤ 0.001). Conclusion: Unsupervised hierarchical clustering analysis using routine blood test data differentiates four distinct clinical phenotypes of IgG4-ROD, which suggest differences in pathophysiologic mechanisms. High serum IgG4 is a potential predictor of worsened BCVA, and high serum IgE is a potential predictor of extraocular muscle enlargement in IgG4-ROD patients.
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Inaba H, Ariyasu H, Takeshima K, Iwakura H, Akamizu T. Comprehensive research on thyroid diseases associated with autoimmunity: autoimmune thyroid diseases, thyroid diseases during immune-checkpoint inhibitors therapy, and immunoglobulin-G4-associated thyroid diseases. Endocr J 2019; 66:843-852. [PMID: 31434818 DOI: 10.1507/endocrj.ej19-0234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Various thyroid diseases are associated with autoimmunity. Major autoimmune thyroid diseases are Graves' disease (GD) and Hashimoto's thyroiditis (HT). Thyrotropin receptor is an autoantigen in GD, and its immunogenicity has been examined. Immune-checkpoint inhibitor (ICI) is recently widely used for treatment of malignant tumors, but cases of thyroid diseases during ICI treatment have been increasing. Thyroid diseases during ICI therapy have been investigated in immunological and clinical aspects, and their Japanese official diagnostic guidelines were established. In addition, serum and tissue immunoglobulin-G4 levels have been examined in association with clinicopathological characteristics in GD, HT, and Riedel's thyroiditis. We review these diseases associated with thyroid autoimmunity and comprehensively discuss their potential application in future research and therapeutic options.
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Affiliation(s)
- Hidefumi Inaba
- The First Department of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan
| | - Hiroyuki Ariyasu
- The First Department of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan
| | - Ken Takeshima
- The First Department of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan
| | - Hiroshi Iwakura
- The First Department of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan
| | - Takashi Akamizu
- The First Department of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan
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Aquilina N, Bugeja V, Zahra C. A Case of Orbital Myositis Presenting With Dizziness. Open Access Maced J Med Sci 2018; 6:1278-1281. [PMID: 30087737 PMCID: PMC6062292 DOI: 10.3889/oamjms.2018.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Orbital myositis is an idiopathic, inflammatory, non-infectious condition, typically confined to more than one extraocular muscle and usually targeting young females in their third decade. CASE REPORT: We describe a case of orbital myositis uncommonly afflicting an adult male. He initially presented with a sensation of dizziness when turning his head and mobilising, together with right-sided orbital pain that failed to respond to the vestibular sedative cinnarizine. Failure to resolve and development of diplopia initially prompted a working diagnosis of ocular myasthenia gravis. On further investigation using HESS charting, paresis in the inferior and medial rectus and superior oblique ocular muscles of the right eye were elicited correlating with clinical examination. However, the lack of response to low dose steroids and acetylcholinesterase inhibitors, together with a negative screen for myasthenia antibodies, precluded a diagnosis of ocular myaesthenia gravis from being made. Other investigations included a high creatinine kinase and lactate dehydrogenase which indicated pathology in the extraocular muscles themselves. An MRI scan showed normal extraocular muscle thickness while excluding other orbital pathology. Exclusion of a variety of other conditions subsequently led to a diagnosis of orbital myositis. CONCLUSION: Response to high dose steroids consolidated this diagnosis with a rapid response ascertained clinically by resolution of pseudo-vertigo and pain, as well as the ophthalmoplegia with follow-up on HESS charting. We aim to raise awareness of this rare condition that carries a good response to steroids.
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Takeishi M, Oshitari T, Ota S, Baba T, Yamamoto S. The Case of IgG4-related Ophthalmic Disease Accompanied by Compressive Optic Neuropathy. Neuroophthalmology 2018; 42:246-250. [DOI: 10.1080/01658107.2017.1389962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Marie Takeishi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshiyuki Oshitari
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satomi Ota
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Martin CS, Sirbu AE, Betivoiu MA, Florea S, Barbu CG, Fica SV. Serum immunoglobulin G4 levels and Graves' disease phenotype. Endocrine 2017; 55:478-484. [PMID: 27819113 DOI: 10.1007/s12020-016-1157-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/24/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We investigated, at diagnosis, the relationship between serum immunoglobulin G4 levels and the main characteristics of Graves' disease: hyperthyroidism severity, goiter size, presence of active Graves' ophthalmopathy, antithyroid antibodies status, and titer. METHODS This prospective study included 80 newly diagnosed Graves' disease patients. The main parameters measured at diagnosis: thyroid-stimulating hormone, free thyroxine, free triiodothyronine, total triiodothyronine, thyroglobulin, antithyroid peroxidase antibodies, anti-thyroglobulin antibodies, thyroid-stimulating hormone receptor antibodies, immunoglobulin G4. RESULTS In Graves' disease patients, serum immunoglobulin G4 levels were higher than in general population (p = 0.028) and higher in men compared to women (p = 0.002). Only one female patient with intense hypoechoic goiter, high anti-thyroglobulin antibody, and antithyroid peroxidase antibody titers had an elevated serum immunoglobulin G4 level at diagnosis. Patients with immunoglobulin G4 levels above the 75th percentile (>237.52 mg/dl, N = 20) were younger at Graves' ophthalmopathy onset (p < 0.001), had higher antithyroid peroxidase antibody (p = 0.01), and anti-thyroglobulin antibody levels (p = 0.006) and required shorter duration of the first methimazole treatment cycle (p = 0.041) than patients with immunoglobulin G4 below the 75th percentile. At diagnosis, patients with immunoglobulin G4 levels above the 90th percentile (>286.28 mg/dl, N = 8) had lower total triiodothyronine values (p = 0.001) than patients with IgG below the 90th percentile. No significant correlations were found between smoking status (p = 0.58), goiter size (p = 0.50), the presence of ophthalmopathy (p = 0.42) or thyroid-stimulating hormone receptor antibody titers (p = 0.45) and the mean value of immunoglobulin G4 levels at diagnosis. CONCLUSIONS Our data suggest that Graves' disease patients with elevated immunoglobulin G4 levels at diagnosis have a phenotype characterized by higher anti-thyroglobulin antibody and antithyroid peroxidase antibody titers, less severe T3 hyperthyroidism, younger age at ophthalmopathy onset and require a shorter duration of the first methimazole treatment cycle.
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Affiliation(s)
- Carmen Sorina Martin
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Endocrinology Department, Elias Hospital, Marasti Avenue 17, 011461, Bucharest, Romania.
| | - Anca Elena Sirbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Endocrinology Department, Elias Hospital, Marasti Avenue 17, 011461, Bucharest, Romania
| | | | - Suzana Florea
- Laboratory Department, Elias Hospital, Marasti Avenue 17, 011461, Bucharest, Romania
| | - Carmen Gabriela Barbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Endocrinology Department, Elias Hospital, Marasti Avenue 17, 011461, Bucharest, Romania
| | - Simona Vasilica Fica
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Endocrinology Department, Elias Hospital, Marasti Avenue 17, 011461, Bucharest, Romania
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Takahashi Y, Takahashi E, Hiromatsu Y, Kakizaki H. Immunoglobulin G4-positive staining of orbital lesions in thyroid eye disease: Report of two cases. Mod Rheumatol 2016; 28:893-896. [PMID: 27142342 DOI: 10.3109/14397595.2016.1174421] [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] [Indexed: 11/13/2022]
Abstract
We report two cases with immunoglobulin G4 (IgG4)-positive staining of orbital lesions and thyroid eye disease (TED). Case 1 was a 63-year-old male with right upper eyelid swelling due to right lacrimal gland enlargement. Case 2 was a 49-year-old male with bilateral proptosis due to multiple orbital masses. Both the biopsied right lacrimal gland in Case 1 and the orbital masses on both sides in Case 2 showed infiltration of immunoglobulin-G4-positive plasma cells.
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Affiliation(s)
- Yasuhiro Takahashi
- a Department of Oculoplastic , Orbital and Lacrimal Surgery, Aichi Medical University Hospital , Nagakute , Aichi , Japan
| | - Emiko Takahashi
- b Department of Pathology , Aichi Medical University Hospital , Nagakute , Aichi , Japan , and
| | - Yuji Hiromatsu
- c Division of Endocrinology and Metabolism, Department of Medicine , Kurume University School of Medicine , Kurume , Fukuoka , Japan
| | - Hirohiko Kakizaki
- a Department of Oculoplastic , Orbital and Lacrimal Surgery, Aichi Medical University Hospital , Nagakute , Aichi , Japan
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Mulholland GB, Jeffery CC, Satija P, Côté DWJ. Immunoglobulin G4-related diseases in the head and neck: a systematic review. J Otolaryngol Head Neck Surg 2015; 44:24. [PMID: 26092582 PMCID: PMC4482182 DOI: 10.1186/s40463-015-0071-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/05/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Immunoglobulin G4 related disease (IgG4-RD) is a poorly understood chronic inflammatory disorder affecting the middle-aged and elderly that can present to the otolaryngologist. We aim to summarize the current literature regarding the manifestations and management of IgG4-RD in the head and neck. METHODS Pubmed and EMBASE were searched using the term relevant search algorithm utilizing keywords such as: IgG4 related disease, head and neck, orbit, salivary glands, sialadenitis, Kuttner, angiocentric eosinophilic fibrosis, submandibular, lacrimal, thyroid, dacryoadenitis, nasal, sinus, and Mikulicz's. Reference lists were searched for identification of relevant studies. Case reports, original research and review articles published in English from 1964 to 2014 whose major topic was IgG4-RD affecting the head and neck were included. Data regarding patient demographics, presentation, histopathology, management and treatment outcomes of IgG4-RD were extracted. Level of evidence was also assessed and data were pooled where possible. Three independent reviewers screened eligible studies; extracted relevant data and discrepancies were resolved by consensus, where applicable. Descriptive and comparative statistics were performed. RESULTS Fourty-three articles met our inclusion criteria. IgG4-RD most often presents as a mass lesion in the head and neck region. Common diagnostic features include: (1) elevated serum IgG4 level, (2) marked infiltration of exocrine glands by IgG4-positive plasma cells with fibrosis, and (3) marked improvement with corticosteroid therapy and additional immunosuppressive therapy in corticosteroid refractory cases. Early diagnosis and involvement of rheumatology is important in management. CONCLUSIONS IgG4-RD is a challenging non-surgical disease that has multiple manifestations in the head and neck. It must be distinguished from various mimics including malignancy, systemic diseases, and infectious. Otolaryngology-Head and Neck surgeons should be aware of this condition and its management.
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Affiliation(s)
- Graeme B Mulholland
- Division of Otolaryngology-Head and Neck Surgery, 1E4 Walter MacKenzie Centre, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, 1E4 Walter MacKenzie Centre, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Paras Satija
- Division of Otolaryngology-Head and Neck Surgery, 1E4 Walter MacKenzie Centre, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - David W J Côté
- Division of Otolaryngology-Head and Neck Surgery, 1E4 Walter MacKenzie Centre, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
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Tokura Y, Yagi H, Yanaguchi H, Majima Y, Kasuya A, Ito T, Maekawa M, Hashizume H. IgG4‐related skin disease. Br J Dermatol 2014; 171:959-67. [DOI: 10.1111/bjd.13296] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Y. Tokura
- Department of Dermatology Hamamatsu University School of Medicine 1‐20‐1 Handayama Higashi‐ku Hamamatsu 431‐3192 Japan
| | - H. Yagi
- Section of Dermatology Shizuoka General Hospital 4‐27‐1 Kita‐Andou Aoi‐ku Shizuoka 420‐8527 Japan
| | - H. Yanaguchi
- Department of Dermatology Hamamatsu University School of Medicine 1‐20‐1 Handayama Higashi‐ku Hamamatsu 431‐3192 Japan
| | - Y. Majima
- Section of Dermatology Shizuoka General Hospital 4‐27‐1 Kita‐Andou Aoi‐ku Shizuoka 420‐8527 Japan
| | - A. Kasuya
- Department of Dermatology Hamamatsu University School of Medicine 1‐20‐1 Handayama Higashi‐ku Hamamatsu 431‐3192 Japan
| | - T. Ito
- Department of Dermatology Hamamatsu University School of Medicine 1‐20‐1 Handayama Higashi‐ku Hamamatsu 431‐3192 Japan
| | - M. Maekawa
- Laboratory Medicine Hamamatsu University School of Medicine 1‐20‐1 Handayama Higashi‐ku Hamamatsu 431‐3192 Japan
| | - H. Hashizume
- Section of Dermatology Shimada Municipal Hospital 1200‐5 Noda Shimada 427‐8502 Japan
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