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Zang Y, Xu L, Fan R, Cheng L, Xu Y. Extensive yellowish masses in bilateral orbit and neck. J Dermatol 2024; 51:e145-e146. [PMID: 38414144 DOI: 10.1111/1346-8138.17166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Yinshan Zang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lingxiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Fan
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lu Cheng
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Yan Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
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2
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Razlog E, Gire J, Arndt C, Denoyer A, Lassalle S, Baillif S, Martel A. Giant conjunctival inclusion cyst mimicking an orbital tumor. J Fr Ophtalmol 2023; 46:e274-e275. [PMID: 37085366 DOI: 10.1016/j.jfo.2022.12.041] [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: 11/09/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 04/23/2023]
Affiliation(s)
- E Razlog
- Service d'ophtalmologie, CHU de Robert-Debré de Reims, université Reims - Champagne-Ardenne, rue du Général Koenig, 51100 Reims, France.
| | - J Gire
- Centre de consultation ophtalmologique, 80, allée des Ormes, 06250 Mougins, France
| | - C Arndt
- Service d'ophtalmologie, CHU de Robert-Debré de Reims, université Reims - Champagne-Ardenne, rue du Général Koenig, 51100 Reims, France
| | - A Denoyer
- Service d'ophtalmologie, CHU de Robert-Debré de Reims, université Reims - Champagne-Ardenne, rue du Général Koenig, 51100 Reims, France
| | - S Lassalle
- Laboratoire d'anatomie pathologique, CHU de Nice, université Côte d'Azur, hôpital Pasteur, 30, voie Romaine, 06000 Nice, France
| | - S Baillif
- Service d'ophtalmologie, CHU de Nice, université Côte d'Azur, hôpital Pasteur, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- Service d'ophtalmologie, CHU de Nice, université Côte d'Azur, hôpital Pasteur, 30, voie Romaine, 06000 Nice, France
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3
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Eppley SE, Silkiss RZ. Bilateral primary orbital xanthogranulomas: A case report and comparison of xanthomatous conditions. J Clin Lipidol 2023; 17:587-591. [PMID: 37716832 DOI: 10.1016/j.jacl.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
This report describes an unusual and diagnostically challenging case of subcutaneous soft tissue xanthogranulomas of bilateral orbits of a 58-year-old female patient seen in a private oculoplastics practice. Accurate and timely diagnosis is crucial in xanthogranulomatous diseases so that any systemic manifestations can be identified and addressed in a multidisciplinary fashion. Periorbital xanthogranuloma is a frequent early manifestation of adult xanthogranulomatous disease, and its association with life-threatening systemic disease requires accurate diagnosis and prompt work-up. This case describes an otherwise asymptomatic patient who presented with bilateral orbital masses causing visually significant ptosis, initially diagnosed as soft tissue xanthomas, and later identified as xanthogranulomas. It is important for physicians of all fields, from primary care to surgical subspecialty, to be aware that xanthogranulomatous disease may first present as periorbital lesions and/or orbital masses, and that further work-up for vision and life-threatening systemic disease is warranted.
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Affiliation(s)
- Sarah E Eppley
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA.
| | - Rona Z Silkiss
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA
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4
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Cheng S, Roelofs KA, Pirakitikulr N, Rootman DB. Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva. Ophthalmic Plast Reconstr Surg 2023; 39:487-491. [PMID: 36972118 DOI: 10.1097/iop.0000000000002377] [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: 03/29/2023]
Abstract
PURPOSE Determining the hemodynamic characteristics of an orbital vascular malformation is a critical step in management. The purpose of this study is to assess the relationship between enophthalmos and clinically apparent distensibility of orbital vascular malformations, to optimize imaging and treatment. METHODS In this cross-sectional cohort study consecutive patients at a single institution were screened for study entry. Data extracted included age, sex, Hertel measurements, presence or absence of distensibility during the Valsalva maneuver, whether lesions were primarily venous or lymphatic based on imaging, and location of the lesion relative to the globe. Enophthalmos was defined as ≥ 2 mm difference from the opposite side. Parametric and nonparametric statistics were used, and linear regression was performed to examine factors predictive of Hertel measurement. RESULTS Twenty-nine patients met the inclusion criteria. Relative enophthalmos ≥2 mm was significantly associated with distensibility ( p = 0.03; odds ratio = 5.33). Distensibility and venous dominant morphology were the 2 most important factors associated with enophthalmos on regression analysis. The relative position of the lesion anterior or posterior to the globe did not have a significant bearing on baseline enophthalmos. CONCLUSIONS The presence of enophthalmos increases the likelihood that an orbital vascular malformation is distensible. This group of patients was also more likely to be characterized by venous dominant malformations. Baseline clinical enophthalmos may serve as a useful surrogate marker for distensibility and venous dominance, which may be useful in guiding the selection of appropriate imaging.
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Affiliation(s)
- Sarah Cheng
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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5
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Yu SN, Shteyman AR, Garcia MD, Kazim M. Congenital Orbital Fibrosis With Spontaneous Regression of Orbital Tumor. Ophthalmic Plast Reconstr Surg 2023; 39:e145-e148. [PMID: 37010054 DOI: 10.1097/iop.0000000000002398] [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: 04/04/2023]
Abstract
Congenital orbital fibrosis (COF) is a rare disorder characterized by an infiltrating orbital mass with secondary involvement of the extraocular muscles that may present with extraocular muscle dysfunction, and globe and eyelid abnormalities in infancy. This condition is thought to be a nonprogressive process and literature on longitudinal assessment of COF is limited. The authors describe a case of COF which was followed for 15 years. The patient had stable symptoms of ocular dysmotility and ptosis but was noted to have spontaneous regression of the orbital mass on serial MRI.
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Affiliation(s)
- Sarah N Yu
- Department of Ophthalmology, Columbia University, New York, U.S.A
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6
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Rana K, Juniat V, Patel S, Avey G, Lucarelli MJ, Selva D. Orbital Artifacts on MRI. Ophthalmic Plast Reconstr Surg 2023; 39:328-335. [PMID: 37290112 DOI: 10.1097/iop.0000000000002264] [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: 06/10/2023]
Abstract
PURPOSE To describe artifacts on orbital MRI, which led to an incorrect radiology report. METHODS Retrospective chart review of patients identified from the orbital databases at the Royal Adelaide Hospital and University of Wisconsin Hospital. Patients who had artifacts on orbital MRI that led to an incorrect radiology report were included. Records were evaluated for age at imaging, gender, MRI sequence, laterality, and location of artifact, radiological characteristics and misdiagnosis, and cause of artifact. RESULTS Data were collected from 7 patients (3 male) who had a median age of 61 years at the time of imaging. Five artifacts resulted from fat-suppression failure with 4 of these cases misdiagnosed as inflammatory changes and 1 misdiagnosed as neoplastic infiltration. The OD was involved in 4 cases. Six cases were in the inferior orbit region. CONCLUSIONS Fat-suppression failure artifacts may arise in the inferior orbit region and can be mistaken for inflammatory or neoplastic orbital disease. This may prompt additional investigations such as orbital biopsy. Clinicians should be aware of artifacts which can affect orbital MRI and lead to potential misdiagnosis.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology & Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, North Terrace, South Australia, Australia
| | - Valerie Juniat
- Department of Ophthalmology & Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, North Terrace, South Australia, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, South Australia, Australia
| | - Greg Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Mark J Lucarelli
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, North Terrace, South Australia, Australia
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, South Australia, Australia
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7
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Mombaerts I, Allen RC. The transconjunctival orbitotomy: A versatile approach to the orbit and beyond. Surv Ophthalmol 2023; 68:265-279. [PMID: 36372115 DOI: 10.1016/j.survophthal.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
In the management of orbital disorders and defects, minimally invasive surgical approaches have become increasingly efficient for their reduction of operative trauma and access without compromise of therapeutic benefit or diagnostic yield. Various approaches have focused on bone- and canthal-sparing techniques and concealed and small skin incisions. We review the current state of knowledge of procedures to enter the orbit via the conjunctiva. Any quadrant of the orbit can be accessed via the conjunctiva. Surgical incisions involve the orbital palpebral, forniceal, and bulbar conjunctiva. According to the location, nature, and size of the lesion, the transconjunctival orbitotomy can be used as a single procedure, in combination with a caruncular approach or as an adjunct in a multidisciplinary procedure for lesions extending deep into or outside the orbit. The working space and field of operating view can be expanded by releasing the horizontal tension of the eyelid with a lateral cantholysis, lateral paracanthal blepharotomy, or medial lid split procedure. Complications related to the conjunctival incision are reduced to dry eye disease.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.; Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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8
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Li YY, Li DM, Zhu Y. [Orbital cranial fasciitis in a child]. Zhonghua Yan Ke Za Zhi 2022; 58:298-300. [PMID: 35391517 DOI: 10.3760/cma.j.cn112142-20211019-00492] [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: 06/14/2023]
Abstract
A 4-year-old patient with a left orbital mass was admitted to the Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University. After clinical and imaging examinations, the left orbital mass lesion was removed under general anesthesia. Postoperative pathological examination confirmed orbital cranial fasciitis. The appearance and imaging result of the patient were normal at postoperative 7 months.
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Affiliation(s)
- Y Y Li
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - D M Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y Zhu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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10
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Dobbs NW, Budak MJ, White RD, Zealley IA. MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 2: Clinical Applications. AJNR Am J Neuroradiol 2021; 42:1184-1189. [PMID: 33737269 DOI: 10.3174/ajnr.a7080] [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] [Received: 07/18/2019] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
In the first part of this 2-part series, we described how to implement microscopy coil MR imaging of the orbits. Beyond being a useful anatomic educational tool, microscopy coil MR imaging has valuable applications in clinical practice. By depicting deep tissue tumor extension, which cannot be evaluated clinically, ophthalmic surgeons can minimize the surgical field, preserve normal anatomy when possible, and maximize the accuracy of resection margins. Here we demonstrate common and uncommon pathologies that may be encountered in orbital microscopy coil MR imaging practice and discuss the imaging appearance, the underlying pathologic processes, and the clinical relevance of the microscopy coil MR imaging findings.
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Affiliation(s)
- N W Dobbs
- From the Department of Clinical Neuroscience (N.W.D.), Royal Hospital for Children and Young People, Edinburgh, UK
| | - M J Budak
- Qscan Radiology Clinics (M.J.B.), Brisbane, Queensland, Australia
| | - R D White
- Department of Clinical Radiology (R.D.W.), University Hospital of Wales, Cardiff, UK
| | - I A Zealley
- Department of Clinical Radiology (I.A.Z.), Ninewells Hospital, Dundee, UK
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11
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Abstract
Invasive sino-orbital aspergillosis is a rare cause of orbital apex syndrome (OAS) in immunocompetent patients and often misdiagnosed as tumour because of its aggressive nature and invasive patterns. We report a 23-year-old immunocompetent man presenting with painful progressive loss of vision, ophthalmoplegia and proptosis of the right eye suggestive of OAS. MRI with gadolinium contrast showed an enhancing heterogeneous mass filling the paranasal sinuses, extraconal space and extending up to the right orbital apex. A functional endoscopic biopsy reported as invasive sino-orbital aspergillosis. He was started on intravenous voriconazole and maximal surgical debridement was done. He gradually regained his vision to 20/30 in the right eye. A review of literature reported several such cases which were managed medically or surgically but with poor visual recovery. This case highlights the need for awareness among clinicians for early diagnosis and treatment to prevent vision loss and better survival.
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Affiliation(s)
- Sucheta Parija
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
| | - Aparajita Banerjee
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
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12
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Dong P, Wang L, Li L. Bilateral orbital involvement of IgG4-related disease detected on 18F-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography: A Clinical Case Report. Medicine (Baltimore) 2019; 98:e18138. [PMID: 31764855 PMCID: PMC6882616 DOI: 10.1097/md.0000000000018138] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE IgG4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition, which could involve multiple structures, including the pancreas, salivary glands, and lymph nodes. However, cases of IgG4-RD involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate are rare. PATIENT CONCERNS A 51-year-old man complaining of bilateral exophthalmos, reduced vision, and weight loss of 15 kg over 2 years presented to our department for evaluation. DIAGNOSES Based on the elevated serum IgG4 level, postoperative pathology, and the features of F-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT), which revealed diffuse increased FDG uptake in many structures, he was diagnosed with IgG4-related disease involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate. INTERVENTIONS Because of the significant bilateral proptosis and exposure keratoconjunctivitis in the right eye, bilateral soft-tissue masses located in the orbits were resected, and the patient was started on oral methylprednisolone with gradual tapering. OUTCOMES The patient's symptoms gradually relieved after the operation and glucocorticoid therapy. Four months later, cranial axial CT revealed remarkable narrowing of soft-tissue masses in the bilateral orbits, and his serum IgG4 level reduced sharply. LESSONS IgG4-RD should be considered in cases of diffuse FDG uptake in the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate on PET/CT.
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Affiliation(s)
| | - Li Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lin Li
- Department of Nuclear Medicine
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13
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Abstract
Langerhans cell histiocytosis remains an enigmatic disease with a very heterogeneous presentation. We describe a rare case of orbital Langerhans cell histiocytosis in a 39-year-old female patient who presented right orbital pain and edema of the upper right eyelid. Surgery showed a friable lesion and underlying bone irregularity. Morphological aspects and immunohistochemical profile favored the diagnosis of Langerhans cell histiocytosis, which was confirmed with evidence of Langerin expression. The staging tests did not reveal any organ involvement, so we decided to follow the algorithm proposed by Euro Histio Net: in case of unifocal disease and in a single organ, clinical surveillance was preferred. This case aims to raise awareness of a manifestation of Langerhans cell histiocytosis, which should always be considered as a differential diagnosis in adults with osteolytic orbital lesions.
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Affiliation(s)
- Inês Carneiro
- Serviço de Oftalmologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - António Friande
- Serviço de Oftalmologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Maria Araújo
- Serviço de Oftalmologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
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14
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Riancho-Zarrabeitia L, Peiró Callizo E, Drake-Pérez M, García Montesinos B, Terán N, Martínez-Taboada VM. Granulomatosis with polyangiitis with isolated orbital involvement in children: a case report successfully treated with Rituximab and review of literature. Acta Reumatol Port 2019; 44:258-263. [PMID: 31484916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report the case of a 15-year old girl who presented with a non-tender right upper eyelid swelling. Magnetic resonance confirmed the presence of an enlargement of the orbicular muscle with moderate contrast enhancement. Biopsy revealed the presence of necrotizing granulomatous vasculitis. Further studies ruled out systemic involvement. Thus, she was diagnosed with isolated granulomatosis with polyangiitis (GPA). Treatment with steroids and methotrexate was started. Due to the persistence of the lesion, rituximab (RTX) was added with excellent clinical and radiological response. This is, to the best of our knowledge, the first case of isolated orbital GPA treated with RTX in a pediatric patient.
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15
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Abstract
Microphthalmos results from incomplete invagination of the optic vesicle or closure of the embryonic fissure. We present three patients with unilateral congenital microphthalmia with cyst. None of them had vision in the affected eye since birth. There was gradually increasing left eye orbital mass encroaching towards lower fornix and lower eyelid ectropion. On examination and investigations, patients had large orbital cyst with microphthalmia pushing the eyeball superiorly and posteriorly in affected orbit. Microphthalmic globe with cyst was surgically excised and histopathologically studied. Orbital cavity was big enough to occupy the conformer and the prosthetic eye after 6 weeks. Diagnosis was confirmed as large communicating orbital cyst with microphthalmia without systemic association in all the patients. None of the mothers of patients had regular antenatal check up. All the parents had consanguineous marriage. Antenatal check up with ultrasound at 14 to16 weeks of pregnancy is important for genetic counselling. Targeted abdominal ultrasound examination of pregnant women focused on the orbital region of foetus is recommended, in mothers who have children with congenital eye anomalies.
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Affiliation(s)
- Diwa Hamal
- Department of Oculoplasty, Biratnagar Eye Hospital, Biratnagar Nepal
| | | | - Priza Poudyal
- Department of Laboratory Medicine, Biratnagar Eye Hospital, Biratnagar Nepal
| | - Rohit Saiju
- Department of Oculoplasty, Tilganga Institute of Ophthalmology, Gaushala, Kathmandu, Nepal
| | - Hony Kc
- Department of Oculoplasty, Biratnagar Eye Hospital, Biratnagar Nepal
| | - Santosh Kafle
- Department of Laboratory Medicine, Biratnagar Eye Hospital, Biratnagar Nepal
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16
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Chidambaram VA, Anita CSY, Robert C, Garry C. IgG4 related orbit disease - An unusual cause of an orbital mass. Med J Malaysia 2018; 73:415-417. [PMID: 30647218] [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: 06/09/2023]
Abstract
IgG4-related disease is a newly described systemic autoimmune and allergic disease, characterized histologically by a fibroinflammatory response with IgG4 plasma cells. It was initially described as affecting the pancreas, but commonly involves the head and neck region as well. While a biopsy is essential for definitive diagnosis, cross sectional imaging may be the initial modality which may suggest this entity. We describe a case of pathologically proven IgG4 related disease which highlights some key radiologic features seen in this entity. Our case highlights some key radiological features of IgG4- related disease in the head and neck, with involvement of the lacrimal glands, pituitary gland and cranial nerves on CT.
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Affiliation(s)
- V A Chidambaram
- Singapore General Hospital, Department of Diagnostic Radiology, Singapore.
| | - C S Y Anita
- Singapore National Eye centre, Ocular inflammation and Immunology Department, Singapore
- Singapore General Hospital, Department of Diagnostic Radiology, Singapore
| | - C Robert
- Singapore General Hospital, Department of Diagnostic Radiology, Singapore.
| | - C Garry
- Massachusetts General Hospital, Harvard Medical School, Boston MA, United States of America
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17
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Secondi R, Sánchez España JC, Castellar Cerpa JJ. [Orbital fat prolapse]. J Fr Ophtalmol 2018; 41:999. [PMID: 30447957 DOI: 10.1016/j.jfo.2018.02.024] [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: 01/25/2018] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 11/18/2022]
Affiliation(s)
- R Secondi
- Sapienza University, Viale Del Policlinico, 00185 Rome, Italie.
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18
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Kitsche M, Terai N. [Orbital cavity tumor with macular folds]. Ophthalmologe 2018; 114:1031-1033. [PMID: 27933400 DOI: 10.1007/s00347-016-0416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/28/2022]
Abstract
A 40-year-old patient presented with an orbital tumor of the right eye accompanied by visual impairment and macular folds. The diagnosis of mucocele was made through clinical and radiological investigations. The excision of the mucocele was performed immediately. As early as 8 weeks after the operation, an obvious increase in visual acuity was noticed. At this time, the macular folds were no longer detectable.
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Affiliation(s)
- M Kitsche
- Augenklinik der Medizinischen Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - N Terai
- Augenklinik der Medizinischen Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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19
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Nardin C, Borot S, Beaudoin MA, Cattin F, Puzenat E, Gauthier AS, Schillo F, Borg C, Aubin F. Long-term adverse event: inflammatory orbitopathy induced by pembrolizumab in a patient with metastatic melanoma. Invest New Drugs 2018; 37:375-377. [PMID: 30145624 DOI: 10.1007/s10637-018-0659-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 07/13/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022]
Abstract
The recent advent of immune checkpoint inhibitors (ICI), including anti-programmed cell death 1 protein (anti-PD-1) agents has revolutionized the therapeutic approach of metastatic malignancies. Yet, ICI can disrupt immune tolerance resulting in enhanced immune activation in normal tissues with significant toxicity. A dysregulated activation of T-cells directed to normal tissues stands as the main mechanism of immune-related adverse events (irAE). To date, only two cases of immune-related inflammatory orbitopathy related to anti-PD-1 agents have been reported. This rare immune adverse event usually occurred early after ICI initiation. Here, we report the first case of late inflammatory orbitopathy occurring in a melanoma patient treated with pembrolizumab. Consequently, the occurrence of irAE under ICI should be monitored, even late after treatment instauration.
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Affiliation(s)
- Charlée Nardin
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France.
- EA 3181 Université de Franche Comté, Besançon cedex, France.
| | - Sophie Borot
- Service d'Endocrinologie, Centre Hospitalier Universitaire, Besançon, France
| | | | - Françoise Cattin
- Service de Radiologie, Centre Hospitalier Universitaire, Besançon, France
| | - Eve Puzenat
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France
- EA 3181 Université de Franche Comté, Besançon cedex, France
| | | | - Franck Schillo
- Service d'Endocrinologie, Centre Hospitalier Universitaire, Besançon, France
| | - Christophe Borg
- Service d'Oncologie, Centre Hospitalier Universitaire, Besançon, France
| | - François Aubin
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France
- EA 3181 Université de Franche Comté, Besançon cedex, France
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Flores Balverdi J, Baenas DF, Riscanevo NC, Sánchez AV, Figueroa Rosales R, Alvarellos A. IgG4-related orbital disease. ACTA ACUST UNITED AC 2018; 93:494-496. [PMID: 29866378 DOI: 10.1016/j.oftal.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
CASE REPORT The case is presented of a 64-year-old woman with bilateral palpebral swelling and dacryoadenitis, exophthalmos, and a history of chronic rhinitis and asthma. An increase in serum IgG4 was observed, and an incisional biopsy of lacrimal glands was performed, which showed fibrosis and a lymphoplasmacytic infiltrate with IgG4 producing cells. DISCUSSION Orbital involvement in IgG4-related disease is frequent. Bilateral dacryoadenitis is the most common manifestation. Histopathology is essential for the diagnosis and to exclude malignancy.
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Affiliation(s)
- J Flores Balverdi
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - D F Baenas
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - N C Riscanevo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - A V Sánchez
- Servicio de Anatomía Patológica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - R Figueroa Rosales
- Servicio de Oftalmología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - A Alvarellos
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Ali S, Ranney ML, Jarman AF. Transient Orbital Compartment Syndrome Caused by Spontaneous Lamina Papyracea Dehiscence. R I Med J (2013) 2018; 101:30-32. [PMID: 29393309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Orbital compartment syndrome typically occurs due to trauma or burns. Here we discuss a case of spontaneous lamina papyracea dehiscence associated with transient orbital compartment syndrome. A previously healthy woman presented to the Emergency Department complaining of unilateral eye pain after nose blowing. The patient did not have any pupillary or extra-ocular movement abnormalities; however, she did have mildly decreased visual acuity in the affected eye. Intraocular pressure was found to be elevated and a subsequent CT scan showed orbital emphysema with spontaneous dehiscence of the lamina papyracea. The intraocular pressure decreased within hours, and ultimately, she required no intervention. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].
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Affiliation(s)
- Shihab Ali
- Resident Physician, Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Megan L Ranney
- Associate Professor, Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Angela F Jarman
- Sex and Gender Fellow, Department of Emergency Medicine, Alpert Medical School of Brown University
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Abstract
RATIONALE Thyroid-associated orbitopathy (TAO) is most often seen in patients with autoimmune thyroid disease. Data about TAO occurred in patients with thyroid carcinoma are rare. We give a report of 5 patients to present the clinical characteristics, treatment, and prognosis of this type of case. PATIENT CONCERNS Five thyroid carcinoma patients presented with orbitopathy. Among them, two patients (patient 1 and 4) were hyperthyroid and TSH receptor antibody (TRAb) positive, two patients (patient 3 and 5) were euthyroid and displayed slightly elevated TRAb titres, one patient (patient 2) was euthyroid and TRAb negative. DIAGNOSES They were diagnosed as thyroid carcinoma and TAO. INTERVENTIONS Patient 1 underwent total thyroidectomy, intravenous glucocorticoids (GCs) therapy, orbital decompression surgery and oral GCs therapy. Patient 2 and 3 only received total thyroidectomy. Patient 4 received sub-total thyroidectomy and oral GCs therapy. patient 5 didn't received thyroidectomy and underwent intravenous GCs therapy for 2 courses. OUTCOMES Patient 1,2,3 showed an improvement of TAO at the final follow-up. Patient 4,5 showed no improvement of TAO at the final follow-up. LESSONS When TAO present in patients with thyroid nodules, the possibility of thyroid carcinoma should be considered, and the nature of these nodules should be carefully evaluated. In some patients with thyroid carcinoma and TAO, the remission of TAO can be seen post total thyroidectomy. But for other patients, besides thyroidectomy, an adequate dose and course of intravenous GCs treatment and even ocular surgery are also needed.
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Affiliation(s)
- Peng Yu
- Department of Internal Medicine
| | | | | | | | | | - Hong Wang
- Molecular Diagnostic Laboratory, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Ungprasert P, Crowson CS, Cartin-Ceba R, Garrity JA, Smith WM, Specks U, Matteson EL, Makol A. Clinical characteristics of inflammatory ocular disease in anti-neutrophil cytoplasmic antibody associated vasculitis: a retrospective cohort study. Rheumatology (Oxford) 2017; 56:1763-1770. [PMID: 28957561 PMCID: PMC6251565 DOI: 10.1093/rheumatology/kex261] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/06/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To characterize the clinical correlates and outcome of inflammatory ocular disease (IOD) among patients with ANCA-associated vasculitides (AAV). Methods Medical records of potential cases of AAV seen at Mayo Clinic from 2003 to 2013, inclusive, were reviewed to identify confirmed cases meeting the diagnosis of AAV using the Chapel Hill Consensus Conference 2012 descriptors. Records of confirmed cases of AAV were then further reviewed for IOD, and clinical characteristics, treatment and outcomes abstracted. Results A total of 1171 confirmed cases of AAV were identified of which 183 patients (mean age 49.0 years; 51% female; 95% Caucasian) had IOD. The most common manifestation of IOD was injection of the eye (57%) followed by eye pain (46%) and visual acuity loss (18%). Scleritis was the most common type of IOD (22%) followed by episcleritis (21%), orbital inflammation (18%), lacrimal duct stenosis (10%) and uveitis (9%). Oral glucocorticoids were used to treat IOD in the majority of patients (96%). CYC and rituximab were the most frequently used immunosuppressive agents (54 and 36%, respectively). Of those with orbital inflammation, 52% underwent therapeutic surgical intervention. Clinical remission of IOD was achieved in 91% of patients but relapses were seen in 23%. Significant visual acuity loss was observed in only six patients. Conclusion IOD is a common manifestation of AAV and seen in about 16% of patients with AAV. Scleritis, episcleritis and orbital inflammation are the most common subtypes. Most patients respond well to glucocorticoids and immunosuppression, but relapse of IOD is common.
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Affiliation(s)
| | - Cynthia S. Crowson
- Division of Rheumatology, Department of Internal Medicine
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | | | | | - Ulrich Specks
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine
| | - Eric L. Matteson
- Division of Rheumatology, Department of Internal Medicine
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ashima Makol
- Division of Rheumatology, Department of Internal Medicine
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Abstract
PURPOSE Adult xanthogranulomatous disease of the orbit and ocular adnexa is a rare disease that can cause serious morbidity and mortality. Ophthalmologists are commonly the first clinicians to come in contact with affected patients and an understanding of the clinical features is essential. DESIGN We present a retrospective case series of patients seen in the oculoplastic unit of a large tertiary referral hospital over a 20-year period. METHODS The clinical files of 7 patients with adult xanthogranulomatous disease of the orbit and ocular adnexa were reviewed. Clinical, radiological, histopathological, and immunohistochemical findings were examined. RESULTS Periocular clinical features included cutaneous xanthogranulomatous lesions, decreased visual acuity, proptosis, diplopia, skin ulceration, cicatricial ectropion, and mechanical ptosis. Systemic features included adult-onset asthma, disseminated xanthogranulomatous lesions with long bone involvement, and hematological disturbances such as monoclonal gammopathy and lymphoplasmacytic lymphoma. Lipid-laden macrophages and Touton multinucleated giant cells were histological hallmarks in all subtypes. Most lesions were strongly CD8 positive on immunohistochemistry. Radiologically, the lesions were diffuse and infiltrative in nature. Various treatments were employed with varying success including surgical excision, systemic and intralesional corticosteroids, other immunosuppressants, and systemic chemotherapy. CONCLUSIONS Adult xanthogranulomatous disease of the orbit and ocular adnexa, although rare, may be sight or life threatening. Recognition by the ophthalmologist is critical as periocular features often constitute the initial presentation.
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Affiliation(s)
- Michael J Davies
- Department of Ophthalmology, Concord Hospital, Concord, New South Wales, Australia
| | - Kevin Whitehead
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - Gary Quagliotto
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - Dominic Wood
- IQ Pathology, South Brisbane, Queensland, Australia
| | - Rajan S Patheja
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Şovrea AS, Bartoş DM, Bartoş A, Dronca E, Szabo BA. Solitary Langerhans histiocytosis of the orbit: case report and review of the literature. Rom J Morphol Embryol 2017; 58:1589-1595. [PMID: 29556661] [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: 06/08/2023]
Abstract
Langerhans cell histiocytosis (LCH), previously known as "histiocytosis X", is a clinical entity characterized by abnormal proliferation of Langerhans cells, which exert a mass effect. Orbital involvement due to LCH is rare as a unifocal disease, seldom occurring outside the pediatric population. We report a case of a 21-year-old man with solitary LCH of the orbit depicted by magnetic resonance imaging (MRI) and diagnosed by histopathological examination.
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Affiliation(s)
- Alina Simona Şovrea
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania;
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Borbolla-Pertierra AM, Guinto-Arcos E, Rodríguez-Reyes A, Graue-Moreno G, Olvera-Morales O. Brown tumour involving the orbit: case report and review of the literature. Can J Ophthalmol 2016; 51:e125-e127. [PMID: 27521680 DOI: 10.1016/j.jcjo.2016.02.020] [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: 12/19/2014] [Revised: 02/01/2016] [Accepted: 02/28/2016] [Indexed: 11/19/2022]
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Pagni F, Jaconi M, Smith AJ, Brenna A, Valente MG, Leoni S, Leni D, Vacirca F, Sozzi D. The Role of Fine Needle Aspiration of Orbital Lesions: A Case Series. Acta Cytol 2016; 60:31-8. [PMID: 26986454 DOI: 10.1159/000444385] [Citation(s) in RCA: 7] [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: 10/12/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This paper analyzes a series of ultrasound (US)-guided orbital fine needle aspirations (FNAs) which provide diagnostic information that cytopathologists approaching orbital lesions for the first time can find useful and underlines the importance of teamwork. STUDY DESIGN The investigators retrospectively obtained data from 24 consecutive orbital FNAs. For all patients, a complete clinicoradiological database was created. FNAs were performed under US guidance with 25-gauge needles and an aspiration biopsy syringe gun, and sent to the Department of Pathology for examination and data management. RESULTS The mean age of the patients was 54 years. Imaging studies included US, magnetic resonance imaging and computed tomography scans; 9 lesions involved the right orbit and 15 the left orbit. The mean lesion size was 23.6 ± 7.2 mm. After microscopic examination, 7 smears were labeled as 'nondiagnostic', while in 17 cases a definitive diagnosis was proposed, which always proved to be correct (70.8%, specificity = 100%). CONCLUSIONS The investigators believe that FNA biopsy of orbital masses is a necessary step; its weaknesses lie in the particularly delicate site of sampling and the extreme heterogeneity of lesions. Nevertheless, when orbital FNA is performed within a well-coordinated multidisciplinary team, it is a powerful tool that can be used to define the most appropriate management of these patients.
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Affiliation(s)
- Fabio Pagni
- Division of Pathology, University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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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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Karki P, Hirano H, Yamahata H, Fujio S, Yonezawa H, Iida K, Bohara M, Oyoship T, Hanaya R, Arita K. Solitary Cranial Langerhans Cell Histiocytosis: Two case reports. Hiroshima J Med Sci 2015; 64:59-63. [PMID: 26964155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells intermixed with inflammatory cells, in particular eosinophils, that may manifest as a unisystem (unifocal or multifocal) or multisystem disease. We describe the clinical and histologic spectrum of LCH of the orbit and skull in our two cases. Both cases had unifocal erosive skull lesions with a history of trauma. Typical histologic features included numerous histiocytes with varying degrees of giant cell formation and scattered eosinophilic granulocytes. The presence of Langerhans cells was confirmed by CD1a and S100 immunohistochemistry. LCH has an excellent prognosis when treated with surgical resection, steroids and radiotherapy or chemotherapy. One of our patients is disease free at 7 year follow-up and one patient had regression of lesion on follow-up.
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Bonadies A, Elia F, Solivetti FM, Vidiri A, Muscardin L, Bucher S. Electrochemotherapy of a Multirecurrent Dermatofibrosarcoma Protuberans of the Orbital Margin: A Case Report. Anticancer Res 2015; 35:6121-6126. [PMID: 26504038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous sarcoma with high recurrence rate. Radical surgery is the treatment of choice, although in cosmetically-sensitive areas such as the head and neck, this option is often not pursued. Electrochemotherapy (ECT) is a minimal invasive anti-tumor modality which is increasingly being used to treat skin metastases from different malignancies. A 31-year-old woman presented with subcutaneous local multirecurring DFSP located at the proximal end of the left eyebrow. ECT was offered as a palliative treatment to avoid radical disfiguring surgery. Two days following ECT, the patient was discharged in good general health. Partial tumor regression was appreciable at two months' follow-up by ultrasound and magnetic resonance imaging. At six months, residual fibrotic tissue was observed; at three years, no evidence of the tumour was detected. In our case, ECT achieved good local tumor control with excellent cosmetic results, preserving the patient's quality of life.
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Affiliation(s)
- Antonio Bonadies
- Department of Plastic and Reconstructive Surgery, San Gallicano, Dermatologic Institute for Research and Care, Rome, Italy
| | - Fulvia Elia
- Radiology and Diagnostic Imaging Unit, San Gallicano Dermatologic Institute for Research and Care, Rome, Italy
| | - Francesco Maria Solivetti
- Radiology and Diagnostic Imaging Unit, San Gallicano Dermatologic Institute for Research and Care, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Unit, Regina Elena Cancer Institute, Rome, Italy
| | - Luca Muscardin
- Dermatopathological Laboratory, San Gallicano, Dermatologic Institute for Research and Care, Rome, Italy
| | - Stefania Bucher
- Department of Plastic and Reconstructive Surgery, San Gallicano, Dermatologic Institute for Research and Care, Rome, Italy
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31
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Ting DSJ, Perez-Lopez M, Chew NJ, Clarke L, Dickinson AJ, Neoh C. A 10-year review of orbital biopsy: the Newcastle Eye Centre Study. Eye (Lond) 2015; 29:1162-6. [PMID: 26043705 PMCID: PMC4565955 DOI: 10.1038/eye.2015.95] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 01/22/2015] [Accepted: 04/18/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To review the histopathological diagnoses, visual outcome, and complication rate of orbital biopsy in a UK tertiary referral centre. METHODS This was a retrospective, clinical-pathological, interventional, consecutive case series. All orbital biopsies performed between July 2004 and June 2014 in Newcastle Eye Centre (Newcastle upon Tyne, UK) were included in this study. All relevant data collected from the local electronic database and medical records were analysed. RESULTS A total of 166 orbital biopsies were identified during the study period: 86 patients (53.1%) were female and the mean age was 53.7 ± 19.7 years. Of all the cases, orbital biopsies were performed unilaterally in 158 (97.5%) patients and bilaterally in 4 (2.5%) patients. The mean follow-up period was 2.2 ± 2.3 years. The two most common histopathological diagnoses were non-specific inflammatory disease (62, 38.3%) and lymphoproliferative disease (40, 24.7%). None of the patients experienced ≥ 2-Snellen line visual loss. There were 7 (4.2%) postoperative complications noted: 1 (0.6%) orbital haemorrhage with no loss of vision, 4 (2.4%) diplopia, 1 (0.6%) short-term symblepharon, and 1 (0.6%) conjunctival granuloma. Postoperative diplopia was associated with lateral orbitotomy (P = 0.044) and excisional biopsy (P = 0.015). CONCLUSIONS Orbital biopsy serves as a safe diagnostic tool in managing orbital diseases. Patient should be made aware of the risk of postoperative diplopia. Our data provides useful guidance to clinicians when counselling patients for orbital biopsy.
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Affiliation(s)
- D S J Ting
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - M Perez-Lopez
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - N J Chew
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - L Clarke
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - A J Dickinson
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - C Neoh
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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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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Affiliation(s)
- R van der Gaag
- Department of Ophthalmo-Immunology, Netherlands Ophthalmic Research Institute, University of Amsterdam
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Affiliation(s)
- R S Bahn
- Department of Internal Medicine, Mayo Clinic/Foundation, Rochester, Minn
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35
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Weetman AP, Tandon N, Metcalfe RA. T cell reactivity in endocrine ophthalmopathy. Dev Ophthalmol 2015; 25:20-8. [PMID: 8359350 DOI: 10.1159/000422420] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- A P Weetman
- Department of Medicine, University of Sheffield Clinical Sciences Centre, Northern General Hospital, UK
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de Menezes MB, Albuquerque de Andrade I, Cintra MB, Oliveira Vianna E, Cruz AAV. Pulmonary arterial hypertension and orbital involvement in a patient with eosinophilic granulomatosis with polyangiitis. Clin Exp Rheumatol 2015; 33:S-182. [PMID: 26016769] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/17/2015] [Indexed: 06/04/2023]
Affiliation(s)
- M B de Menezes
- Department of Internal Medicine, University of S. Paulo, School of Medicine of Ribeirão Preto, SP, Brazil
| | - I Albuquerque de Andrade
- Department of Internal Medicine, University of S. Paulo, School of Medicine of Ribeirão Preto, SP, Brazil
| | - M B Cintra
- Department of Internal Medicine, University of S. Paulo, School of Medicine of Ribeirão Preto, SP, Brazil
| | - E Oliveira Vianna
- Department of Internal Medicine, University of S. Paulo, School of Medicine of Ribeirão Preto, SP, Brazil
| | - A A V Cruz
- Department of Ophthalmology, University of S. Paulo, School of Medicine of Ribeirão Preto, SP, Brazil
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Podeur P, Okhremchuk I, Morvan JB, Vatin L, Rivière D, de Faria A, Joubert C, Dagain A. [Multiple intracranial epidermoid cysts: Case report]. Rev Laryngol Otol Rhinol (Bord) 2015; 136:159-162. [PMID: 29400038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Epidermoid cyst is a benign and rare tumor, that evolves slowly. We describe the case of a 55 years-old woman, who came to our consultation for atypical trigeminal neuralgia of left V1 and V2 nerves. Brain MRI found two tumors: T1W hypointense with no appreciable enhancement after gadolinium injection and T2W and diffusion hyperintense. This last feature was in favour of an epidermoid cyst, but the multiplicity of cerebral lesions was definitely not in favor of such a diagnostic. They were located behind the right eye and in the left Meckel’s cave (trigeminal cave). The surgical strategy consisted in removal the retro orbital tumor witch was the most accessible of both the diagnostic of epidermoid cyst was retaned thanks to the anatomopathology report. As these lesions had the exact same characteristics, we concluded that they were similar. The second epidermoid cyst was not removed because of surgical risk, its benign nature and low evolutionary potential.
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He X, Xing L, Liu H. [Clinicopathologic characteristics of IgG4-related disease in orbital and periorbital tissue]. Zhonghua Bing Li Xue Za Zhi 2014; 43:799-804. [PMID: 25623975] [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: 06/04/2023]
Abstract
OBJECTIVE To study the clinicopathologic characteristics of IgG4-related disease in the orbital and periorbital tissue. METHODS The clinical manifestations and pathologic features of 17 cases of IgG4-related disease affecting the orbital and periorbital tissue encountered during the period from 2012 to 2013 were studied. RESULTS There were 9 male patients and 8 female patients. The age of patients ranged from 11 to 71 years (mean = 48.5 years). The main clinical manifestation was swelling of the eyelids: bilateral in 11 patients and unilateral in 6 patients. The duration of disease ranged from 5 months to 7 years (more than 2 years in 13 cases). Six patients had history of allergic disorders. In addition to orbital/periorbital involvement, the disease also affected salivary gland, lymph node, lung and kidney. The disease relapsed in 9 patients. Amongst the 8 patients treated with steroids, 5 of them achieved complete remission and the remaining 3 patients had partial remission. The IgG4 level of the 17 cases ranged from 1.49 to 14.88 g/L. Histologic examination showed pseudolymphoma pattern in 8 cases, mixed pattern in 8 cases and sclerotic pattern in 1 case. There were various degrees of lymphoplasmacytic infiltrates (with lymphoid follicle formation) and stromal fibrosis. Classical obliterative phlebitis was absent. Tissue eosinophilia was demonstrated in the 17 cases studied. Immunohistochemical study showed the presence of more than 50 IgG4-positive plasma cells per high-power field, with IgG4/IgG plasma cells ratio more than 40%. CONCLUSION There are characteristic clinical manifestations, pathologic features and laboratory findings in orbital and periorbital IgG4-related disease. Thorough understanding is important in arriving at a correct diagnosis.
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Affiliation(s)
- Xiaojin He
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li Xing
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Honggang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China. E-mail:
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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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Peters M, Eikelberg D, Jongmans V, Pranada AB, Wohlsein P. [Rhinoorbitocerebral zygomycosis caused by Rhizopus microsporus in a roe deer (Capreolus capreolus)]. Berl Munch Tierarztl Wochenschr 2014; 127:301-304. [PMID: 25080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An one-year-old male roe deer (Capreolus capreolus) with abnormal behaviour was shot in order to exclude rabies virus infection. The 12.8 kg weighing animal was emaciated and revealed an asymmetric head with protruding left eye and expositional keratitis. There was a grey whitish soft mass within the caudal nasal cavity, which had infiltrated the frontal cerebrum through the cribriform plate and the retrobulbar tissue through the orbita. Histologically, the mass consisted of a chronic granulomatous inflammation with plentiful fungal hyphae. Fungal culture revealed mold fungi of the zygomycotic genus Rhizomucor, which were differentiated as Rhizopus microsporus by MALDI-TOF mass spectrometry and DNA-sequencing. Rhinoorbitocerebral zygomycosis has to be considered as a differential diagnosis for nasal and orbital tumour-like lesions and as a cause of abnormal behaviour of roe deer.
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Le CP, Valenzuela AA, Rosenberg M, Allen L, Palacios E. Sphenoid sinus dehiscence as a risk for visual consequences in an immunocompromised patient. J La State Med Soc 2014; 166:70-72. [PMID: 25075599] [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: 06/03/2023]
Abstract
Isolated sphenoid sinus disease is a rare entity with severe and potentially life threatening sequela. Because of the proximity of the sinus to the orbit, anatomical defects within the surrounding bony structures can facilitate communication with orbital content, predisposing the patient to substantial visual consequences. We report a case of a 51-year-old immunocompromised male who presented with headache and gradual unilateral decreases in vision. Computed tomography revealed opacification of the left sphenoid sinus accompanied by unusual bony dehiscence of the proximal optic canal. Early recognition and treatment of sphenoid sinusitis requires urgent surgical intervention with delay of treatment potentially leading to irreversible blindness or other devastating consequences. Bony dehiscence of the sphenoid sinus overlying the optic nerve has only been found in 4% of cadavers. It is associated with increased risk of orbital complications and predicts a poor prognosis. Immediate intervention is particularly important in immunocompromised individuals who are at greater risk of these severe complications.
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Affiliation(s)
| | | | | | - Laveil Allen
- Department of Radiology at Tulane University School of Medicine
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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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Braich PS, Silbert JE, Levada AJ, Schiff NR. Pseudo third cranial nerve palsy secondary to orbital ectopic lacrimal gland cyst: management with functional endoscopic sinus surgery. Ear Nose Throat J 2014; 93:77-79. [PMID: 24526481] [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: 06/03/2023] Open
Abstract
An otherwise healthy 13-month-old girl was noted by her pediatrician to have developed a left head turn. The patient was referred to a pediatric ophthalmologist, who noticed signs of incomplete third cranial nerve palsy. Magnetic resonance imaging revealed the presence of an abnormal lesion in the inferonasal orbit that was abutting the ethmoid sinus. After consultation with an ENT specialist, the decision was made to remove the lesion via functional endoscopic sinus surgery because this approach was deemed to provide adequate access while limiting morbidity. Histology of the excised lesion identified it as true ectopic lacrimal gland tissue with cysts. We recognize and comment on the fact that in many reported cases of ectopic lacrimal gland cyst, the tissue was not ectopic at all but instead represented an extension of normal lacrimal gland tissue.
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Affiliation(s)
- Puneet S Braich
- Department of Surgery, Saint Mary's Hospital, Waterbury, CT, USA
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Abstract
BACKGROUND The risks of orbital biopsy depend on the lesion's location and relationship with surrounding structures. Complications include reduced vision, although visual outcomes following orbital biopsy are not widely reported. AIMS To determine visual outcomes following orbital biopsy in Gartnavel General Hospital's Oculoplastic and Oncology Service. METHODS Case note review of 50 consecutive patients undergoing orbital incision or excision biopsy between January 2006 and December 2010. Data collected included preoperative clinical examination, radiological and histological features, preoperative and postoperative corrected distance visual acuity (CDVA) and surgical complications. The main outcome measure was change in CDVA. Mean follow-up duration was 1.32 years. RESULTS Histological diagnoses following biopsy included idiopathic orbital inflammation (n = 13) and lymphoma (n = 9). Of the radiologically defined lesions, 86.7% were extraconal (13.3% intraconal). Extraconal lesions were anterior in 59.0% (41.0% posterior). Mean preoperative LogMAR CDVA was 0.10 which was maintained at day one post-biopsy, indicating the absence of immediate sight-threatening complications such as retrobulbar haemorrhage or optic nerve compression, and there was no significant reduction at one-year follow-up (p = 0.239). Further analysis of change in CDVA showed no difference between: anterior and posterior lesions; extraconal and intraconal lesions; incision and excision biopsies; anterior and lateral surgical approaches. CONCLUSIONS CDVA is retained for one year following orbital biopsy. Significant visual loss is a very rare complication of this procedure.
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Affiliation(s)
- Aaron Jamison
- Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , Scotland and
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Prystajecky M, Rehman HU. Medical image. Raccoon eyes in amyloidosis. N Z Med J 2013; 126:102-103. [PMID: 24045358] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Michael Prystajecky
- Department of Medicine, Regina Qu'Appelle Health Region, Regina General Hospital, 1440 - 14th Avenue, Regina, SK, S4P 0W5, Canada.
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Polachek A, Caspi D, Elkayam O. Granulomatosis and polyangiitis: the rituximab option. Isr Med Assoc J 2013; 15:193-194. [PMID: 23662388] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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[Indication of endoscopic endonasal orbitotomy for orbital lesion]. Nihon Jibiinkoka Gakkai Kaiho 2013; 116:116-7. [PMID: 24163851] [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: 06/02/2023]
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Islam MN, Amin MS, Dipi RM, Khan NA. Comparison of computed tomographic and cytopathological findings in the evaluation of adult orbital mass. Mymensingh Med J 2013; 22:75-79. [PMID: 23416813] [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: 06/01/2023]
Abstract
An observational study was conducted to demonstrate the role of Computed Tomographic (CT) scan to detect clinically suspected adult orbital mass in 47 patients which could not be differentiated clinically. The CT findings were compared and correlated with the findings of fine needle aspiration cytology (FNAC) or histopathology. CT diagnosis of optic nerve sheath meningioma were 12 cases, among them only nine cases confirmed cytopathologically as meningioma and rest three as lymphoma. Among ten cases of hemangioma, eight cases were confirmed cytopathologically as cavernous hemangioma and rest two were pseudotumor and chronic inflammatory lesion. Seven cases diagnosed as pseudotumor in CT were confirmed cytopathologically. Seven cases diagnosed as paranasal sinus masses with orbital extension (nasopharyngeal angiofibroma) in CT were confirmed cytopathologically. Among three cases of thyroid ophthalmopathy diagnosed in CT, only two cases confirmed cytopathologically and rest one cytopathologic diagnosis was not possible due to inadequate tissue supply during FNAC. Two cases of chronic inflammatory lesion diagnosed in CT, also confirmed cytopathologically. Two cases of metastatic lesion diagnosed in CT, also confirmed cytopathologically. Two cases of lacrimal gland tumor diagnosed in CT, also confirmed cytopathologically i.e., pleomorphic adenoma. Two cases of melanoma diagnosed in CT, only one confirmed cytopathologically and rest one cytopathologic diagnosis was not possible due to frank blood came out during FNAC. Pseudotumors were subsequently diagnosed the non-diagnostic cases on the basis of clinical and radiological findings. It is evident from these findings that CT is a useful modality in the diagnosis of adult orbital masses.
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Affiliation(s)
- M N Islam
- Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh
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Abstract
Erdheim-Chester disease (ECD) is an exceedingly rare, disseminated non-Langerhan cell histiocytosis with multisystem involvement, having characteristic sclerotic skeletal lesions. We present an unusual case primarily manifesting as an extensive orbital disease, with low-grade systemic involvement. Owing to its rarity and therefore lack of general awareness it remains a difficult clinical and pathologic diagnosis. Immuno-histochemistry of the biopsy specimen is diagnostic.
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Affiliation(s)
- Arundeep Arora
- All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE To present a series of patients with orbital and adnexal amyloidosis and illustrate the diversity of disease and the challenges of managing such cases. METHODS Descriptive case series of ten patients with biopsy proven amyloidosis involving the orbit, conjunctiva and eyelids. The presentation, clinical findings and management are discussed for each case. RESULTS All patients had some form of eyelid abnormality or malposition. Presenting complaints included ptosis, epiphora and ocular discomfort. Other clinical findings included conjunctival lesions and proptosis. The majority of patients had localised amyloidosis and one patient had systemic disease. Conservative management included lubrication and the use of bandage contact lenses. Surgical management included debulking, ptosis or other lid surgery. CONCLUSION Amyloidosis can present to an Occuloplastic clinic in a wide variety of ways. Definitive diagnosis is based on the histopathological findings. Management is often challenging. Multi-disciplinary team involvement is critical in view of its systemic associations.
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Affiliation(s)
- Dania Al-Nuaimi
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust , Manchester, UK.
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