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Blandford AD, Yordi S, Kapoor S, Yeaney G, Cotta CV, Valent J, Perry JD, Singh AD. Ocular Adnexal Amyloidosis: A Mass Spectrometric Analysis. Am J Ophthalmol 2018; 193:28-32. [PMID: 29890159 DOI: 10.1016/j.ajo.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Ocular adnexal amyloidosis (OAA) may represent localized manifestation of an underlying systemic process. Accurate identification of the amyloid fibrils can guide the systemic evaluation and treatment. The aim of this study was to characterize subtypes of OAA using immunohistochemistry and mass spectrometric analysis and to correlate with ocular involvement and systemic association. DESIGN Retrospective case series. METHODS Review of patients with OAA subtyped by immunohistochemistry and mass spectrometric analysis at the Cleveland Clinic from June 1995 to June 2017. RESULTS While immunohistochemistry identified AL amyloid protein in 67% (4/6) of specimens tested, mass spectrometry identified AL amyloid protein in all specimens (10/10). AL lambda was identified in 5 (50%) samples, kappa in 3 (30%), and both kappa and lambda light chains in 2 (20%). The 5 cases of conjunctival amyloidosis were either AL lambda only (3 cases) or both lambda and kappa (2 cases). There were 3 cases that had associated systemic involvement. Two of these had eyelid skin involvement and AL kappa amyloidosis and the other patient had uveal involvement and AL lambda amyloidosis. CONCLUSIONS Primary amyloidosis-AL is the most common form diagnosed by mass spectrometric analysis in patients with OAA. Immunohistochemistry is ineffective in the characterization of the amyloid deposits in a significant number of cases. Evaluation to exclude systemic involvement or associated underlying lymphoproliferative disorder is warranted.
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Affiliation(s)
| | - Sari Yordi
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Saloni Kapoor
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gabrielle Yeaney
- Department of Anatomic Pathology, R. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Claudiu V Cotta
- Department of Laboratory Medicine, R. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason Valent
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Abstract
Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disease in which orbital involvement can have devastating outcomes. Through a case report and review of the ophthalmic literature, we explore orbital findings, disease progression, and treatment options. Cases of orbital involvement in Erdheim-Chester disease were identified in the ophthalmic literature with a PubMed query and review of cited references. A total of 14 publications reporting 19 separate cases that included ophthalmic examination data were identified. Patient ages ranged from 26-77 years with a mean age of 50 years. Seventy-four percent (14/19) were men. Vision progression to no light perception was found in 32% (6/19) of the patients. Reviewed cases reported a variety of medical and surgical treatment approaches, however, only 53% reported cases (10/19) demonstrated disease improvement or stabilization. Erdheim-Chester disease with orbital involvement is a devastating disease with a poor prognosis. Awareness of this entity by the ophthalmologist is important as orbital signs and symptoms may manifest early, and orbital biopsy is often crucial to the definitive diagnosis.
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Affiliation(s)
- Helen Merritt
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Margaret L Pfeiffer
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Karina Richani
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
- b Robert Cizik Eye Clinic , Houston , Texas , USA
| | - Margaret E Phillips
- a Ruiz Department of Ophthalmology and Visual Science , The University of Texas Health Science Center at Houston , Houston , Texas , USA
- b Robert Cizik Eye Clinic , Houston , Texas , USA
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Abstract
Classically, granuloma annulare (GA) is a cutaneous disorder localized to the dorsum of the hands and/or feet in children and young adults. Very rarely it can present on the face and rarer still on periorbital structures such as the eyelid and orbital rim. Diagnosis hinges on clinical presentation and histological features, such as palisading granulomas with central destruction of collagen, presence of mucin and lymphohistiocytic infiltration. The etiology of this condition remains unknown, but may involve a delayed-type hypersensitivity reaction, malignancy and/or infection. Herein is the first reported case of an intraorbital GA in an 86-year-old male patient who presented with right eye proptosis.
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Affiliation(s)
- Dianne Barrett
- a Department of Ophthalmology , Edward S. Harkness Eye Institute, Columbia University , New York , New York , USA
| | - Carisa Petris
- a Department of Ophthalmology , Edward S. Harkness Eye Institute, Columbia University , New York , New York , USA
| | | | - Kathleen Oktavec
- a Department of Ophthalmology , Edward S. Harkness Eye Institute, Columbia University , New York , New York , USA
| | - Mahesh Mansukhani
- c Department of Pathology and Cell Biology , Columbia University Medical Center , New York , New York , USA
| | - Michael Kazim
- a Department of Ophthalmology , Edward S. Harkness Eye Institute, Columbia University , New York , New York , USA
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Abstract
BACKGROUND Rosai-Dorfman disease is a rare idiopathic histiocytic proliferation disorder that typically presents with painless cervical lymphadenopathy. We report our experience with the management of a case of Rosai-Dorfman disease with compressive optic neuropathy. CASE Rosai-Dorfman disease involving the bilateral orbital and paranasal sinuses was diagnosed in a 14-year-old boy. Diagnosis was based on the characteristic histopathologic features of sinus histiocytosis, composed of large, round S-100 protein-positive histiocytes with striking emperipolesis. The boy received chemotherapy to resolve the bilateral proptosis and compressive optic neuropathy in the right eye, but this treatment failed. Orbital debulking surgery using the Lynch approach was performed. OBSERVATIONS Corneal exposure was resolved and visual acuity recovered from 14/20 to 20/20 after partial removal of the tumor mass. There were no complications after surgery. During the 22 months of follow-up, orbital tumor masses redeveloped to cause lagophthalmos again, but did not cause visual impairment. CONCLUSIONS Rosai-Dorfman disease is a rare disorder, especially in Asia. The disease is usually chronic with spontaneous remission and is refractory to treatment. Partial removal of tumor masses is a workable way to improve visual acuity and correct corneal exposure. Before carrying out this procedure, we discussed with the parents of the patient the potential complications that might follow surgery and secured their permission before proceeding further.
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Affiliation(s)
- Shu-Ya Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taiwan
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van Zyl T, Stagner AM, Jakobiec FA, Yoon MK. Histopathologic features of a resolving orbital Langerhans cell histiocytosis. Graefes Arch Clin Exp Ophthalmol 2015; 253:2341-3. [PMID: 26134307 DOI: 10.1007/s00417-015-3086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/05/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tavé van Zyl
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Anna M Stagner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye & Ear Infirmary, 243 Charles Street, Suite 328, Boston, MA, 02114, USA
| | - Frederick A Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
- David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye & Ear Infirmary, 243 Charles Street, Suite 328, Boston, MA, 02114, USA.
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Schuler M, Hansen C, Winand R, Stover C, Otto E, Beyer J, Kahaly G. Urinary and plasma glycosaminoglycans in endocrine ophthalmopathy. Dev Ophthalmol 2015; 25:58-67. [PMID: 8359354 DOI: 10.1159/000422424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Schuler
- 3rd Department of Medicine and Endocrinology, Johannes Gutenberg University Hospital, Mainz, FRG
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Affiliation(s)
- R S Bahn
- Department of Internal Medicine, Mayo Clinic/Foundation, Rochester, Minn
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Werdich XQ, Jakobiec FA, Curtin HD, Fay A. A clinical, radiologic, and immunopathologic study of five periorbital intraosseous cavernous vascular malformations. Am J Ophthalmol 2014; 158:816-826.e1. [PMID: 25034115 DOI: 10.1016/j.ajo.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To correlate the clinical, radiographic, histopathologic, and immunohistochemical features of 5 primary periorbital intraosseous cavernous vascular malformations. DESIGN Retrospective interventional case series. METHODS Clinical and operative records and radiographic images were reviewed. Histopathologic slides were evaluated with hematoxylin-eosin, trichrome, and elastin stains. Immunohistochemical studies were performed with a spectrum of monoclonal antibodies directed at antigens of vascular cells. RESULTS Three men and 2 women ranged in age from 36 to 64 years. Vision was unaffected and there was no proptosis or globe displacement. The slow-growing lesions measured 13-25 mm in greatest diameter (mean 16.4 mm). Computed tomographic studies revealed that 2 lesions were situated in the maxillary bone, 2 in the frontal, and 1 in the zygoma, all anteriorly and with circumscribed, lucent, honeycombed, or sunburst characteristics. Histopathologically the lesions were composed of cavernous or telangiectatic channels; 1 showed advanced fibrotic vascular involution. Immunohistochemistry demonstrated CD31/34 positivity for vascular endothelium and D2-40 negativity for lymphatic endothelium. A typically thin mural myofibroblastic cuff was smooth muscle actin positive, weakly calponin positive, and desmin negative. Glucose transporter-1 and Ki-67 were negative in the endothelium. CONCLUSIONS Intraosseous vascular lesions resemble orbital cavernous venous malformations (not true hemangiomas), except that their vascular walls are thinner owing to the constraints imposed by neighboring bone spicules, which limit the amount of interstitium from which mural myofibroblasts can be recruited. The bony trabeculae conferred the honeycomb or sunburst appearances observed radiographically. En bloc excision of these lesions was successful and avoided complications (mean follow-up, 46 months).
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Affiliation(s)
- Xiang Q Werdich
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Hugh D Curtin
- Department of Radiology, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Aaron Fay
- Ophthalmic Plastic Surgery, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Pawlowski P, Mysliwiec J, Mrugacz M, Zak J, Bakunowicz-Lazarczyk A, Rejdak R, Wysocka J, Gorska M. Elevated percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in active Graves' orbitopathy. Graefes Arch Clin Exp Ophthalmol 2014; 252:641-5. [PMID: 24562464 PMCID: PMC3968517 DOI: 10.1007/s00417-014-2580-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/27/2013] [Accepted: 01/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate if conjunctival epithelial cells’ expression of HLA-DR and ICAM-1 could be helpful as early topical markers of inflammation in Graves’ orbitopathy (GO). Methods The ocular examination evaluated a clinical activity score (CAS) by assessment of clinical features, (e.g., eyelid or conjunctival inflammation, lid width, lid closure, proptosis, ocular motility). Conjunctival epithelial cell specimens for flow-cytometric evaluations of ICAM-I and HLADR expression were collected by impression cytology from ten eyes with active GO (CAS ≥ 4 and duration ≤ 12 months), from 15 eyes with Graves’ disease (GD) without active GO (CAS 0–2) and from 15 normal specimens without any ocular disorders. Results The percentage of HLA-DR + conjunctival epithelial cells was significantly elevated in patients with active GO comparing to GD without active GO and healthy controls, 10.7 % (8.5–17.7) and 7.78 % (3.92–10.1) (p < 0.05) vs. control 4.89 % (3.5–5.5) (p < 0.005), respectively. The expression of ICAM − 1+ conjunctival epithelial cells was greater only in patients with GO vs. controls, 5.5 % (4.8–7.03) and 1.46 % (0.69–2.51) (p < 0.005), respectively. Conclusion The percentage of HLA-DR+ and ICAM-1+ conjunctival epithelial cells in patients with the active GO may serve as a topical inflammation marker in Graves’ orbitopathy.
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Affiliation(s)
- P Pawlowski
- Department of Pediatric Ophthalmology with Strabismus Treatment Unit, Medical University of Bialystok, 17 Waszyngtona Str, 15-274, Bialystok, Poland,
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Qu Q, Wang X, Teng L, Zhang Q. [Five cases of invasive rhino-orbital-skull base aspergillosis with orbit apex syndrome initial presentation]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010; 24:396-399. [PMID: 20669647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Although rare, invasive rhino-orbital-skull base aspergillosis usually is fatal and necessitates prompt diagnosis, surgical intervention and antifungal treatment. METHOD A case series of 5 patients, with review of treatments and outcomes. RESULT Five patients initially presented with orbital apex syndrome without apparent rhino-sinus disease. Histologic examination revealed invasive aspergillosis. Four patients underwent transnasal endoscopic surgical exploration of rhino-orbital-skull base, and three of them simultaneously underwent optic nerve decompression. One patient underwent the rhinopharyngeal biopsy. Following surgical debridement and antifungal drug, Two patients achieved various degree of recovery, 1 patient (case 5) showed vision improvement, from counting fingers to 0.1 and symptom-free during 65 months follow-up. One patient (case 1) showed no recovery of vision from no light perception, but symptom-free during 43 months follow-up. Other three patients respectively died of massive intracranial spread (case 3), postoperative brainstem hemorrhage (case 2) and sepsis (case 4). CONCLUSION Invasive sino-orbital-skull base aspergillosis often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. The endoscopic surgical exploration and biopsy often are necessary to rule out fungal sinus infection before considering steroid use, especially in immunocompromised individuals. The patients with invasive rhino-orbital-skull base aspergillosis usually have a poor prognosis.
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Affiliation(s)
- Qiuyi Qu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital University of Medical Science, Beijing, 100053, China
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Ebrahimi KB, Ren S, Green WR. Floretlike Cells in In Situ and Prolapsed Orbital Fat. Ophthalmology 2007; 114:2345-9. [PMID: 17822769 DOI: 10.1016/j.ophtha.2007.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 06/02/2007] [Accepted: 06/04/2007] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Orbital pleomorphic lipoma has been rarely reported in the literature. Although floretlike cells are characteristic of pleomorphic lipoma, they are not pathognomonic. We reviewed cases of prolapsed orbital fat and exenteration specimens to determine the significance of presence of these cells in the diagnosis of orbital pleomorphic lipoma. DESIGN Retrospective interventional case series with clinicopathologic correlation. PARTICIPANTS Seventy-two specimens of 45 patients with prolapsed orbital fat and 74 exenteration specimens as controls. INTERVENTION Histologic review of the specimens including light microscopy, Masson trichrome staining, immunostaining for S100, CD34, CD68, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay, and transmission electron microscopy and review of clinical records and analysis of the data with generalized estimation equation. MAIN OUTCOME MEASURE Evidence of histologic abnormalities in histologic specimens and clinical and demographic data. RESULTS Floretlike cells were present in 31 of 72 (43%) specimens of prolapsed orbital fat and in 12 of 74 (16%) orbital exenterations. Fewer than 6 florets were present in twenty 40x high-power fields in 15 (48%), 6 to 10 in 9 (29%), and >10 in 7 (23%) specimens. The florets stained positive for CD34 but not for S100 or CD68. TUNEL assay revealed significant nuclear pyknosis, and transmission electron microscopy disclosed spindle-shaped cells with abundant rough endoplasmic reticulum and no basement membrane. The mean age of patients with prolapsed orbital fat with florets was 67 years (range, 52-86). Of 31 samples, 29 (94%) were from males. Of 30 samples, 29 (97%) were located in the superotemporal conjunctiva; only one was located in the lower lid. There was significant association between the presence of florets and location of the prolapsed orbital fat (P = 0.0013) and gender (P = 0.0015). CONCLUSION Floretlike cells may be present in in situ and prolapsed orbital fat as a degenerative process. What some have called "orbital pleomorphic lipoma" is in fact only age-related orbital fat prolapse.
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Affiliation(s)
- Katayoon B Ebrahimi
- Eye Pathology Laboratory, Wilmer Institute, and Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-9248, USA
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Decock CE, Breusegem CM, Van Aken EH, Leroy BP, Van Den Broecke CM, Delanghe JR. High beta-trace protein concentration in the fluid of an orbital cyst associated with bilateral colobomatous microphthalmos. Br J Ophthalmol 2007; 91:836. [PMID: 17510479 PMCID: PMC1955621 DOI: 10.1136/bjo.2006.105114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE Amyloidosis refers to a heterogeneous group of disorders associated with deposition of chemically distinct fibril proteins. Isolated orbital amyloidosis is a rare condition and requires systemic examination. The authors report a case of amyloid deposit in the orbit whose systemic investigation has been negative. METHODS A 64-year-old woman presented to the eye clinic with left-sided orbital mass, mild exophthalmos with downward ocular displacement, and ptosis. The patient presented also visual acuity loss and ocular hypertension. No systemic involvement was noted by systemic workup and it confirmed the primary orbital amyloidosis. RESULTS The patient was subject to full clinical examination, laboratory examinations, orbital echography, magnetic resonance imaging and total body computed tomography scans, rectal mucosa, and temporal artery biopsies. It was necessary to exclude systemic amyloidosis. The presence of amyloid deposits was confirmed by biopsy of orbital mass. The chemical nature of deposit was characterized using light microscopy, immunohistochemistry, and electron microscopy. CONCLUSIONS Orbital amyloidosis is a very rare disease. It should be considered in the diagnosis of patients with ptosis and exophthalmos. The treatment usually consists of surgical removal of the amyloid mass and follow-up for a likely local recurrence. In our case, mass excision determined the decrease of exophthalmos and intraocular pressure.
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Affiliation(s)
- R Di Bari
- Department of Ophthalmology and ORL, Division of Ophthalmology, University of Bari, Bari, Italy.
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Cheung N, Selva D, McNab AA. Orbital Langerhans cell histiocytosis in adults. Ophthalmology 2007; 114:1569-73. [PMID: 17337061 DOI: 10.1016/j.ophtha.2006.10.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/25/2006] [Accepted: 10/25/2006] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To report 3 patients with adult-onset orbital Langerhans cell histiocytosis (LCH). DESIGN Retrospective interventional case reports. PARTICIPANTS Three adult patients with orbital LCH. METHODS Case reports from 2 different clinics and review of the scientific literature. MAIN OUTCOME MEASURES Clinical course and radiologic and histologic findings. RESULTS Three healthy patients, aged 20 to 36 (mean, 27) years, presented with biopsy-proven unilateral orbital LCH. The initial presenting complaints were mainly orbital pain and headache with or without orbital swelling and minimal effect on ocular movements. There was radiologic evidence of disease centered on the greater wing of sphenoid bone in all cases. Biopsy via lateral canthotomy was performed with LCH confirmed based on histologic and immunohistochemical findings. There was no evidence of disease elsewhere on systemic investigations. One patient had curettage and intralesional corticosteroids, 1 patient had a craniotomy for more complete resection of the lesion, and the third patient was referred for radiotherapy. All patients achieved complete resolution of symptoms and signs. None of the patients demonstrated any evidence of distant or recurrent disease at follow-up. CONCLUSIONS Orbital LCH in adults is a rare, usually unifocal, and relatively benign disease most commonly affecting the greater wing of sphenoid bone, where there is still active bone marrow in young adults. There is no consensus on cause or therapy, but our reported cases show that several treatment modalities are effective.
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Affiliation(s)
- Ning Cheung
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Sivak-Callcott JA, Linberg JV, Rootman J, White VA, Nestor S, Williams HJ. Infiltrating orbital astrocytic proliferation associated with congenitally malformed eyes. Ophthalmic Plast Reconstr Surg 2006; 22:227-9. [PMID: 16714942 DOI: 10.1097/01.iop.0000216786.71358.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This report describes the clinical and pathologic findings in two adults with orbital infiltration by astrocytic cells associated with congenitally malformed eyes. Both cases had enlarging orbital masses and underwent complete resection. Histopathology revealed proliferation of astrocytes (fibrillary acidic protein-positive) that invaded the orbital tissues. To the best of our knowledge, there are no similar cases in the literature.
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Sivak-Callcott JA, Rootman J, Rasmussen SL, Nugent RA, White VA, Paridaens D, Currie Z, Rose G, Clark B, McNab AA, Buffam FV, Neigel JM, Kazim M. Adult xanthogranulomatous disease of the orbit and ocular adnexa: new immunohistochemical findings and clinical review. Br J Ophthalmol 2006; 90:602-8. [PMID: 16622091 PMCID: PMC1857051 DOI: 10.1136/bjo.2005.085894] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Adult xanthogranulomatous disease involving the ocular tissues is rare and poorly understood. Adult onset xanthogranuloma (AOX), adult onset asthma and periocular xanthogranuloma (AAPOX), necrobiotic xanthogranuloma (NBX), and Erdheim-Chester disease (ECD) are the four syndromes within this disorder, which is diagnosed by characteristic histopathology. Experience with eight cases prompted a multi-institutional effort to study the histopathology, immunohistochemistry, clinical findings, and systemic associations in this disorder. METHODS 22 cases, including histopathological slides, were compiled. Published reports were identified by an English language Medline search (1966-2005) and review of reference citations. Each case in this series and the literature was classified as one of four syndromes and then analysed for age onset, sex, skin xanthoma, orbital location, immune dysfunction, internal organ and bone lesions, treatment, and outcome. The histopathology in each of these cases was reviewed by two pathologists. Immunhistochemical stains (CD3, CD4, CD8, L26) were performed in 14 cases where unstained slides were available. RESULTS 137 cases were compiled. There was no sex or age difference between syndromes. AOX, AAPOX, NBX affect the anterior orbit, ECD tends to be diffuse and intraconal. Skin lesions are found in all the syndromes. Immune dysfunction was noted in all cases of AAPOX and NBX; 11% of NBX and all ECD patients had internal organ disease. Treatment included surgery, corticosteroids, other chemotherapeutic agents, radiotherapy, and combinations of these. No AOX or AAPOX deaths occurred; 66% of ECD patients died. All 22 cases had xanthoma cells; most had Touton giant cells. Lymphocytes were present in all cases and occurred as aggregates (mostly in AAPOX) or diffuse populations mixed with fibroblasts (mostly in ECD). Immunohistochemistry revealed the majority of these to be CD8+. Necrosis was most marked in NBX. CONCLUSION Adult xanthogranuloma of the orbit is rare, making prospective evaluation or meta-analysis impossible. The best treatment is unknown but seems to be with multiagent chemotherapy guided by histopathological, immunohistochemical, and systemic findings.
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Affiliation(s)
- J A Sivak-Callcott
- Department of Ophthalmology, West Virginia University Eye Institute, Morgantown, 26505, USA.
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Boschi A, Daumerie C, Spiritus M, Beguin C, Senou M, Yuksel D, Duplicy M, Costagliola S, Ludgate M, Many MC. Quantification of cells expressing the thyrotropin receptor in extraocular muscles in thyroid associated orbitopathy. Br J Ophthalmol 2005; 89:724-9. [PMID: 15923509 PMCID: PMC1772662 DOI: 10.1136/bjo.2004.050807] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Thyroid associated orbitopathy (TAO) and Graves' disease (GD) have an autoimmune pathogenesis, possibly related to the thyrotropin receptor (TSHR). The aim of this study was to determine whether TSHR immunoreactivity is correlated with disease severity or serum TSHR antibody (TRAB) levels. METHODS Orbital tissues from 30 patients with TAO were compared with those of 20 patients with strabismus and four with non-thyroid orbital inflammation. TSHR was detected by immunohistochemistry and TRAB were measured by radioreceptor assay. RESULTS No TSHR immunoreactivity was detected in the 24 control orbital tissues, whereas in all TAO biopsies elongated fibroblast-like cells, expressing TSHR, were present. These cells were located between the muscle cells, which were separated by oedema in the acute phase but fibrous tissue in the chronic phase of disease. Semi-thin sections showed numerous mast cells present in the chronic phase and in close contact with adipocytes. The number of TSHR immunostained cells was high in early disease, decreased with disease duration, and was positively correlated with TRAB levels at the onset of TAO. CONCLUSION TSHR immunoreactivity was demonstrated specifically in TAO orbits which highlights the importance of TRAB early in the pathogenesis.
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Affiliation(s)
- A Boschi
- Department of Ophthalmology, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
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Abstract
PURPOSE To present a case of inflammatory myofibroblastic tumor in the anterior orbit and to describe its clinical features, diagnosis, and management. METHODS Case report and literature review. RESULTS A 10-year-old boy presented with diplopia and limited ocular motility in his right eye secondary to a subconjunctival mass in the right supranasal side. Incisional biopsy and debulking were performed. Histopathologic examination showed the proliferation of spindle-shaped myofibroblasts that were immunoreactive for smooth muscle actin and vimentin and infiltrate of inflammatory cells. CONCLUSIONS We believe this is the first case of an inflammatory myofibroblastic tumor found localized in the orbit.
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Affiliation(s)
- Ho-Seok Sa
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Kangnam-ku, Seoul, Korea
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Kaplan B, Martin BM, Cohen HI, Manaster J, Kassif Y, Rehany U, Livneh A. Primary local orbital amyloidosis: biochemical identification of the immunoglobulin light chain kappaIII subtype in a small formalin fixed, paraffin wax embedded tissue sample. J Clin Pathol 2005; 58:539-42. [PMID: 15858128 PMCID: PMC1770653 DOI: 10.1136/jcp.2004.022517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2004] [Indexed: 11/04/2022]
Abstract
BACKGROUND Amyloidosis refers to a heterogeneous group of disorders associated with the deposition of chemically distinct amyloid fibril proteins. Precise determination of chemical amyloid type has diagnostic, therapeutic, and prognostic relevance. Although immunohistochemical techniques are used routinely to determine the amyloid type, the results can be negative or inconclusive, so that biochemical characterisation is often required. The development and application of new biochemical microtechniques suitable for examination of extremely small tissue samples is essential for precise identification of the deposited amyloid proteins. AIMS To investigate biochemically the amyloid proteins present in a formalin fixed paraffin wax embedded orbital tissue from a patient with localised orbital amyloidosis in whom immunohistochemistry was not helpful in the determination of amyloid type. METHODS Extraction of amyloid proteins from fixed tissue and their identification was carried out by a recently developed microtechnique. An extremely small tissue sample was dewaxed and extracted with formic acid. The extracted material was analysed using electrophoresis, western blotting, and amino acid sequencing. RESULTS Biochemical examination of the extracted proteins showed the presence of immunoglobulin (Ig) derived amyloid proteins, which were composed of the N-terminal fragments of the Ig light chain kappaIII subtype (AL-kappaIII) (16, 8, and 3 kDa). CONCLUSIONS This is the first chemically proved AL case reported in association with primary localised orbital amyloidosis. The biochemical microtechnique used was useful in achieving a precise diagnosis of amyloid disease, in a case where the results of routine immunohistochemical examination of amyloid were inconclusive.
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Affiliation(s)
- B Kaplan
- Heller Institute of Medical Research, Sheba Medical Centre, Tel-Hashomer, 52621, Israel.
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20
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Li YC, Lu DH. [Heterotopic brain tissue in the orbit]. Zhonghua Bing Li Xue Za Zhi 2005; 34:190-1. [PMID: 15938839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Ghose S, Balasubramaniam ST, Mahindrakar A, Sharma V, Sen S, Sarkar C, Chhabra MS. Orbital ectopic glial tissue in relation to medial rectus: a rare entity. Clin Exp Ophthalmol 2005; 33:67-9. [PMID: 15670082 DOI: 10.1111/j.1442-9071.2004.00945.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Heterotopic brain tissue is a rare entity and it is rarer still in the orbit. There have been very few case reports of orbital ectopic glial tissue. The case is described herein of a 3-month-old baby presenting with an orbital glial hamartoma inseparable from the medial rectus muscle. The diagnosis was based on the histopathological features and a positive GFAP stain. The features of this case and the previously reported cases are discussed.
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Affiliation(s)
- Supriyo Ghose
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
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Abstract
PURPOSE To report an interesting case of adult onset Langerhans cell histiocytosis in a 41-year-old male with clinicopathological correlation. DESIGN Interventional case report. MATERIALS AND METHODS A 41-year-old male presented with an ill-defined mass occupying the temporal quadrant of the left orbit. Computerized tomography revealed an ill-defined extraconal mass involving the superolateral aspect of the left orbit with areas of osteolysis involving the lateral and superior orbital walls. The mass excised at orbitotomy showed microscopic features consistent with Langerhans cell histiocytosis. Immunohistochemistry with CD-68 macrophage marker and S-100 was positive, confirming the diagnosis. Treatment included oral steroids and radiotherapy. At 6 months follow-up, he developed a punched-out lytic lesion in the left parietal calvarium. He again received external beam radiotherapy. At 14 months follow-up, he is doing well with no recurrences. CONCLUSIONS Adult onset Langerhans cell histiocytosis, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient.
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MESH Headings
- Adult
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Combined Modality Therapy
- Diagnosis, Differential
- Glucocorticoids/therapeutic use
- Histiocytosis, Langerhans-Cell/diagnostic imaging
- Histiocytosis, Langerhans-Cell/metabolism
- Histiocytosis, Langerhans-Cell/pathology
- Histiocytosis, Langerhans-Cell/therapy
- Humans
- Immunohistochemistry
- Male
- Orbital Diseases/diagnostic imaging
- Orbital Diseases/metabolism
- Orbital Diseases/pathology
- Orbital Diseases/therapy
- Radiotherapy, Adjuvant
- S100 Proteins/metabolism
- Tomography, X-Ray Computed
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Affiliation(s)
- Mehryar Taban
- Doheny Eye Institute, USC School of Medicine, Los Angeles, California 90033, USA
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Abstract
PURPOSE To report a case of Langerhans cell histiocytosis presenting as periorbital cellulitis. DESIGN Interventional case report. METHODS A 3-year-old girl presented with periorbital swelling of the right upper lid laterally of two days' duration. A history of recent eye trauma was reported. RESULTS Computed tomography showed a soft tissue mass that eroded the frontozygomatic suture. The lesion was debulked through a lateral orbitotomy. Electron microscopy disclosed Birbeck granules. Immunohistochemistry stained positively for CD68 and CD1a antigenic determinants. CONCLUSIONS Although rare, Langerhans cell histiocytosis can cause acute periorbital cellulitis in children. Trauma can induce an inflammatory response, allowing for earlier diagnosis of the orbital lesion.
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Affiliation(s)
- Jaime Levy
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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25
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Crisp M, Starkey KJ, Lane C, Ham J, Ludgate M. Adipogenesis in thyroid eye disease. Invest Ophthalmol Vis Sci 2000; 41:3249-55. [PMID: 11006210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
PURPOSE Adipogenesis contributes to the pathogenesis of thyroid eye disease (TED). Thyrotropin receptor (TSHR) transcripts are present in orbital fat. This study was conducted to determine whether they are expressed as functional protein, and if so, whether this is restricted to TED orbits or to a particular stage in adipocyte differentiation. METHODS Samples of fat were obtained from 18 TED-affected orbits and 4 normal orbits, and 9 were obtained from nonorbital locations. Frozen sections were examined by immunocytochemistry using monoclonal antibodies specific for the human TSHR. Samples were disaggregated and the preadipocytes separated from the mature by differential centrifugation and cultured in serum-free or DM and examined for morphologic changes, oil red O and TSHR staining, and TSH-induced cyclic adenosine monophosphate (cAMP) production. RESULTS Marked immunoreactivity was observed in frozen sections from all three TED samples and faint staining in both normal orbital fat samples. In vitro, 1% to 5% of preadipocytes displayed TSHR immunoreactivity in five of six TED and two of three normal orbital samples and in three of five nonorbital samples. Differentiation, was induced in all 14 orbital samples. Three of four nonorbital samples contained occasional differentiated cells. Fifty percent to 70% of differentiating cells demonstrated receptor immunoreactivity. Two of three TED and four of four nonorbital preadipocytes in DM and/or mature adipocytes displayed a TSH-mediated increase in cAMP. CONCLUSIONS The results indicate that orbital fat TSHR transcripts are expressed as protein, which can be functional. This is not aberrant in TED orbits, although expression may be upregulated. The majority of preadipocytes undergoing differentiation express the receptor, indicating a key role for this population in one mechanism for increasing orbital volume.
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Affiliation(s)
- M Crisp
- Endocrine Section, Department of Medicine, and the. Department of Ophthalmology University of Wales College of Medicine, Cardiff, United Kingdom
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Read RW, Maguluri S, Zhang J, Rao NA. Peroxynitrite formation in the orbit of diabetics with rhinocerebral mucormycosis. Ocul Immunol Inflamm 2000; 8:169-75. [PMID: 11120578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To evaluate whether an intact respiratory burst exists within the orbit of diabetics with rhinocerebral mucormycosis. METHODS Immunohistochemical detection of nitrotyrosine in the orbital tissue of diabetics requiring exenteration due to rhinocerebral mucormycosis. Nitrotyrosine is the stable product of the nitration of tyrosine residues by peroxynitrite. Peroxynitrite is a potent oxidant produced by the combination of superoxide and nitric oxide during the respiratory burst. RESULTS Four specimens were analyzed. All showed focal areas of specific staining against nitrotyrosine of the walls and internal structures of fungal organisms. CONCLUSIONS An intact respiratory burst is present in the orbit of diabetics during infection with rhinocerebral mucormycosis. Possible mechanisms of peroxynitrite's microbicidal effects and reasons for a deficiency in diabetics are discussed.
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Affiliation(s)
- R W Read
- Doheny Eye Institute, University of Southern California, Los Angeles, California, USA
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Karim MM, Inoue M, Hayashi Y, Nishizaki M, Hanioka K, Imai Y, Ito H, Yamamoto M. Orbital cholesterol granuloma with destruction of the lateral orbital roof. Jpn J Ophthalmol 2000; 44:179-82. [PMID: 10715389 DOI: 10.1016/s0021-5155(99)00180-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Orbital cholesterol granuloma in a 51-year-old man is described. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) were done. RESULTS Both studies showed a mass in the left orbit, with evidence of orbital roof destruction in the CT scan. On the basis of clinical and imaging findings, a diagnosis was made of malignant orbital tumor with destruction of the lateral orbital roof. Surgical exploration revealed a thickly encapsulated mass densely adherent to the left superior orbital bone and periosteum. Although the dura mater was intact, bone destruction in the lateral orbital roof was seen. The entire mass was successfully excised and histopathological evaluation was performed. Histopathology showed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of cholesterol granuloma. CONCLUSIONS Care must be taken to differentiate cholesterol granuloma from malignant orbital tumor. CT scan and MRI imaging seem well-suited to detecting the characteristic findings of cholesterol granuloma.
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Affiliation(s)
- M M Karim
- Department of Ophthalmology, Kobe University School of Medicine, Chuo-Ku, Kobe, Japan
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Abstract
PURPOSE Phakomatous choristoma is a rare congenital tumour of lenticular origin. The exact location at clinical presentation is controversial, but herein we provide evidence that phakomatous choristoma may be located in the lower eyelid or orbit or both. METHODS Case report of an infant presenting with a mass in the lower eyelid at birth, a systematic review of previous cases of phakomatous choristoma and an outline of the histopathological features in normal mid-facial embryonic development at different gestational ages. RESULTS The histopathological features of the present case were consistent with those of a phakomatous choristoma. The preoperative imaging studies and clinical findings at surgery suggested that the tumour occupied parts of both the lower eyelid and anterior orbit. Histopathological sections of a normal human embryo showed that at the 26-mm stage of development the embryonic lens is formed but the bony walls defining the orbit are not yet present. CONCLUSION Phakomatous choristoma arises in a setting of undifferentiated mesenchymal tissue which later may develop into the lower eyelid or orbit depending on the choristomatous elements being deposited superficial or deep to the embryonic surface.
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Affiliation(s)
- S Seregard
- St. Erik's Eye Hospital and Karolinska Institute, Stockholm, Sweden
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Abstract
BACKGROUND Cholesterol granuloma of the orbit is a rare entity, and its pathogenesis is still poorly understood. We report on 6 cases including one patient who had been examined by X-ray prior to the tumor's clinical manifestation. PATIENT DATA All tumors were located in the superior temporal orbit. Histologically, they revealed the typical features of a cholesterol granuloma without any epithelial elements. They infiltrated the bone but left the soft tissues largely intact. Complete surgical removal of the granulomatous mass was attempted in each case, and particular attention was given to thorough abrasion of the bone. Only 2 patients reported a previous trauma. In one of them, retrospective evaluation of the X-ray scan taken a few hours after his accident revealed no definite changes in the orbital bone at the site of the future tumor. The only recurrence developed in a patient in whom the bony base of the tumor had not been drilled out completely. CONCLUSIONS The origin of orbital cholesterol granuloma remains unknown. According to our data and those available in the literature, trauma is not a precondition but may accelerate growth. Some non-epithelial malformation in the bone, with a predelection in the temporal upper quadrant, might be the origin. To prevent a recurrence it appears essential to totally erase the tumor from its bony bed.
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Affiliation(s)
- J W Harbour
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63110, USA
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Boylan CB, Davis K, Bennett-Clarke CA, Rhoades RW. Neonatal damage to the rat's infraorbital nerve upregulates both galanin and neuropeptide Y in individual vibrissae-related primary afferent axons. Exp Brain Res 1996; 112:475-84. [PMID: 9007549 DOI: 10.1007/bf00227953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Previous studies in adult animals have suggested that the peptides galanin and neuropeptide Y (NPY) may be upregulated in the same primary afferent neurons after peripheral axotomy. The present study was undertaken to determine whether such upregulation occurred in vibrissae-related primary afferent neurons and their axons after damage to the infraorbital nerve [ION; the trigeminal (V) branch that innervates the vibrissae follicles]. Double-labelling experiments demonstrated that approximately 75% of axotomized V ganglion cells and the central arbors of vibrissae-related primary afferents expressed both galanin and NPY after perinatal, but not adult, nerve damage. However, additional experiments demonstrated that the sensitive periods for lesion-induced upregulation of the two peptides and the period over which they were expressed after neonatal ION transection differed substantially. Staining for both peptides was increased after ION damage on P-0 through P-14, but only galanin staining was increased in vibrissae-related primary afferents after lesions on P-21. Galanin expression was elevated in vibrissae-related primary afferents in rats killed 3, 8, and 15 days after neonatal ION transection, while increased NPY was observed at only the middle time point. The lesion-induced increases in galanin and NPY in vibrissae-related ION primary afferents suggest that these peptides may modulate central V reorganization after such damage.
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Affiliation(s)
- C B Boylan
- Department of Anatomy and Neurobiology, Medical College of Ohio, Toledo 43699, USA
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Otto E, Förster G, Kuhlemann K, Hansen C, Kahaly GJ. TSH receptor in endocrine autoimmunity. Clin Exp Rheumatol 1996; 14 Suppl 15:S77-84. [PMID: 8828952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The human thyrotropin receptor (hTSHR) is a potential common antigen in endocrine autoimmunity. Recently, some studies demonstrated transcripts for hTSHR or its components in the extrathyroidal tissue of patients with autoimmune thyroid disease (ATD), although others were unable to confirm these findings. In the present study we investigated orbital adipose/connective and muscle tissue as well as primary cell cultures of orbital fibroblasts and myoblasts from patients with thyroid and eye disease. METHODS The messenger ribonucleic acid (mRNA) of hTSHR was reverse transcribed and amplified by polymerase chain reaction (PCR). To evaluate the existence of a functional hTSHR in cultured orbital fibroblasts and muscle cells, the TSH-mediated metabolic activity of the cells was measured by tetrazolium assay. RESULTS We were unable to amplify the extracellular domain of hTSHR regardless of the material used. In contrast, transcripts of the transmembrane and intracellular domain of hTSHR were detectable in both crude retrobulbar tissue and primary cells cultures. The results of fibroblast amplification experiments were more successful than those with myoblasts. Furthermore, we were able to confirm that these transcripts of hTSHR can also be detected in the retro-ocular tissue of healthy persons. Independently of the TSH activity employed, no stimulation of fibroblasts or myoblasts was detected, even at higher TSH levels. CONCLUSION These data do not suggest that hTSHR is expressed in a functional form in orbital tissue. However, a part of the receptor could play a role in the pathogenesis of autoimmune eye disease as a non-functional but antigenic protein. Whether a common antigen in the thyroid and orbit is related to hTSHR has not been clarified yet.
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Affiliation(s)
- E Otto
- Department of Medicine III, Johannes Gutenberg, University Hospital, Mainz, Germany
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McCarthy JM, White VA, Harris G, Simons KB, Kennerdell J, Rootman J. Idiopathic sclerosing inflammation of the orbit: immunohistologic analysis and comparison with retroperitoneal fibrosis. Mod Pathol 1993; 6:581-7. [PMID: 7504259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Idiopathic sclerosing inflammation of the orbit is clinically characterized by an insidious, chronic and progressive fibrosing process damaging orbital structures through entrapment and mass effect. Histologically, desmoplasia and a sparse infiltrate of lymphocytes, histiocytes, plasma cells, and occasional neutrophils and eosinophils are seen. An immune pathogenesis is suspected but presently poorly understood. To characterize the inflammatory infiltrate and to compare orbital and other inflammatory fibrosing lesions, immunoperoxidase studies using the streptavidin method were performed on 16 formalin or Bouins' fixed, paraffin-embedded orbital biopsy specimens and six specimens of retroperitoneal fibrosis. Positive staining of orbital tissue occurred as follows: T-cells (UCHL-1) 94% of cases, B-cells (L26) 40%, tissue macrophages (KP-1) 56%, HLA Dr positive antigen presenting cells and activated T-cells (LN3) 44%, and immunoglobulins (kappa, 80%; lambda, 63%, IgG, 73%, IgA, 44% and IgM, 31%). Results were strikingly similar for retroperitoneal fibrosis. These findings imply a cell mediated pathogenesis in idiopathic sclerosing inflammation of the orbit that is similar to retroperitoneal fibrosis and suggest therapeutic potential for agents modifying this facet of the immune system.
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Affiliation(s)
- J M McCarthy
- Department of Pathology, Vancouver General Hospital, British Columbia, Canada
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Trocme SD, Bartley GB, Campbell RJ, Gleich GJ, Leiferman KM. Eosinophil and neutrophil degranulation in ophthalmic lesions of Wegener's granulomatosis. Arch Ophthalmol 1991; 109:1585-9. [PMID: 1755742 DOI: 10.1001/archopht.1991.01080110121049] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although eosinophils and neutrophils have been identified in orbital and corneoscleral tissues in some patients with Wegener's granulomatosis, their role in the pathogenesis of the disorder is not completely understood. Nine specimens from six patients with Wegener's granulomatosis and autopsy controls from patients without ophthalmic disease were evaluated with indirect immunofluorescence for eosinophil granule major basic protein and neutrophil elastase. Extracellular deposition of both major basic protein and elastase was identified in orbital tissues from all the patients with Wegener's granulomatosis. Two of the specimens were from enucleated eyes with corneoscleral disease; extracellular deposition of eosinophil major basic protein was identified in one eye, and extracellular neutrophil elastase was deposited in both eyes in lesional areas. None of the control tissues showed major basic protein or elastase deposition. These findings suggest that both eosinophils and neutrophils participate in the pathogenesis of the orbital and corneoscleral manifestations of Wegener's granulomatosis.
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Affiliation(s)
- S D Trocme
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905
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Abstract
We report the case of a 7-year-old Japanese girl with nodular fasciitis which was investigated by immunohistological and electron microscopical methods. An excised nodular lesion in her right orbit showed characteristic histological features of the disease. The fibroblastic cells showed myofibroblastic characteristics, such as immunohistochemically positive reactions against muscle specific actin and vimentin and characteristic electron microscopical appearances. The multinuclear giant cells did not react against any histiocytic markers, including HLA-DR, antimacrophage antigen, lysozyme, and S-100 protein, but the myofibroblastic markers and the electron microscopical study did reveal myofibroblastic characters.
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Affiliation(s)
- T Sakamoto
- Department of Ophthalmology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Winguth S, Kurhanewicz J, Wang ML, Quivey JM, James TL, Char DH. 31P magnetic resonance spectroscopy (MRS) of experimental orbital myositis. Invest Ophthalmol Vis Sci 1991; 32:2417-22. [PMID: 2071353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We described a model of orbital myositis that was induced by 12-0-tetradecanoyl-phorbol-13-acetate (TPA) injection into the superior rectus muscle of New Zealand white rabbits. In this study, in vivo 31P magnetic resonance spectroscopy (MRS) was performed with a 4.7 Tesla Oxford (Oxford Instruments, Oxford, England) magnet to monitor the evolution of muscle inflammation in control animals and the response of this model to external beam radiation. 31P MRS showed a dramatic increase in high-energy phosphorus and phospholipid metabolites 48 hr after TPA injection. These spectra were similar to those from implanted allogenic fibroblasts. Within 18-48 hr after a single dose (400 cGy) or sequential doses (3 days at 400 cGy) of orbital irradiation, reduced extraocular muscle swelling and a significant decrease of all 31P metabolites occurred. A decrease (63 +/- 6%) in the signal-to-noise (S/N) ratio of the control inflamed muscle 31P MR spectra increased by 28 days after inflammation. Two days after single-dose radiation, 31P MR metabolites were significantly lower (58 +/- 5%, P less than 0.012) than control spectra. These postradiation spectra mirror the 28-day control spectra and are consistent with previous histologic data that show decreased fibroblastic activity. Change in 31P MRS was a sensitive indicator of treatment response latency.
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Affiliation(s)
- S Winguth
- Department of Ophthalmology, University of California, San Francisco
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Abstract
Although eosinophils are prominent in orbital lesions of patients with histiocytosis X (Langerhans' cell histiocytosis), little is known of their pathogenic significance in the disease. To determine whether eosinophils degranulate and deposit toxic proteins in orbital histiocytosis X, the authors examined lesions by indirect immunofluorescence for localization of the core granule protein (major basic protein) outside of eosinophils. Four patients with histiocytosis X were studied: three with eosinophilic granuloma and one with Hand-Schüller-Christian disease. Tissue eosinophilia was prominent in all specimens; striking extracellular deposition of eosinophil major basic protein was noted in three patients, and focal deposition was present in the fourth patient. Orbital specimens obtained at autopsy from patients without orbital disease were studied as control specimens; no tissue eosinophilia or deposition of eosinophil major basic protein was observed. These findings indicate that eosinophils likely degranulate in lesions of orbital histiocytosis X and may participate in the pathogenesis of the disease.
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Affiliation(s)
- S D Trocme
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905
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Abstract
Hematic cyst of the orbit has been described in association with various diseases, but its pathogenetic mechanism remains unclear. We treated two patients (two men, 38 and 35 years old) who had growing cysts suspected of being malignant tumors. Surgical exploration of the orbits disclosed birefringent crystals (hematodin) either in the cyst wall or in the cyst's contents. The crystals imitated foreign bodies in their appearance and in the reactions they induced.
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