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Yılmaz E, Güldoğan N, Arslan A, Civan C. Pleomorphic Invasive Lobular Cancer of the Breast Presenting with Orbital Metastasis: A Case Report. Curr Med Imaging 2021; 18:432-435. [PMID: 34530716 DOI: 10.2174/1573405617666210916115321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Orbital metastasis of breast cancer is an unusual condition, especially in the absence of a previous diagnosis of primary breast cancer. The main MRI findings in patients with orbital metastasis are retroorbital soft tissue with thickening of extraocular muscles. Paradoxical enophtalmos secondary to fibrosis can be seen. CASE REPORT In this case report we present a 75-year-old female patient with left eye pain and blurred vision and retraction. Although there was no evidence of malignancy in the biopsy of the orbita; since the patient's complaints continued despite idiopathic pseudotumor treatment; mammography was recommended to rule out the possibility of breast cancer metastasis. Her mammography revealed a suspicious lesion in the left breast and proved to be pleomorphic invasive lobular cancer. CONCLUSION Breast cancer metastasis should be kept in mind in women with pseudotumor -like involvement of the orbita.
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Affiliation(s)
- Ebru Yılmaz
- Acıbadem Altunizade Hospital Breast Clinic Radiology İstanbul. Turkey
| | - Nilgün Güldoğan
- Acıbadem Altunizade Hospital Breast Clinic Radiology İstanbul. Turkey
| | - Aydan Arslan
- Zonguldak Maternity and Child Health Hospital Radiology Department, Zoguldak. Turkey
| | - Ceyda Civan
- Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul. Turkey
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Lee MJ, Planck SR, Choi D, Harrington CA, Wilson DJ, Dailey RA, Ng JD, Steele EA, Hamilton BE, Khwarg SI, Rosenbaum JT. Non-specific orbital inflammation: Current understanding and unmet needs. Prog Retin Eye Res 2020; 81:100885. [PMID: 32717379 DOI: 10.1016/j.preteyeres.2020.100885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
Non-specific orbital inflammation (NSOI) is a noninfectious inflammatory condition of the orbit. Although it is generally considered the most common diagnosis derived from an orbital biopsy, it is a diagnosis of exclusion, meaning that the diagnosis requires exclusion of a systemic process or another identifiable etiology of orbital inflammation. The clinical diagnosis of NSOI is ill-defined, but it is typically characterized by acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and less commonly visual disturbance. NSOI poses a diagnostic and therapeutic challenge: The clinical presentations and histological findings are heterogeneous, and there are no specific diagnostic criteria or treatment guidelines. The etiology and pathogenesis of NSOI are poorly understood. Here we recapitulate our current clinical understanding of NSOI, with an emphasis on the most recent findings on clinical characteristics, imaging findings, and treatment outcomes. Furthermore, gene expression profiling of NSOI and its implications are presented and discussed.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Stephen R Planck
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Dongseok Choi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SWSam Jackson Park Road, Portland, OR, 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Roger A Dailey
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - John D Ng
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Eric A Steele
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Bronwyn E Hamilton
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Devers Eye Institute, Legacy Health Systems, 1040 NW 22nd Avenue, Portland, OR, 97210, USA.
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Sarkar S. Bilateral Idiopathic Orbital Inflammation Syndrome in an adult patient: A rare case report. Saudi J Ophthalmol 2018; 32:334-337. [PMID: 30581306 PMCID: PMC6300788 DOI: 10.1016/j.sjopt.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/27/2022] Open
Abstract
Bilateral Idiopathic Orbital Inflammation Syndrome (IOIS) is rare in adults. Most commonly it affects the young adults and children. It is mostly unilateral condition. This is a case of 50 years old male coming with the complaints of painless proptosis on both the eyes for 1 year. The history of diplopia was also found. On examination, it was found that there was restriction of movements in Right eye superiorly. Any history of associated systemic illness was not found. Based on the clinical examination, laboratory reports and contrast enhanced computed tomography (CECT) the diagnosis of Bilateral IOIS was made. Patient was treated with Intravenous methyl prednisolone followed by oral Prednisolone in tapering doses for a period of 2 months. After 2 month of regular follow up the patient was found to have a favorable outcome with improved visual acuity and reduction in the size of the proptosed eye. Patient was followed up for another 6 month to observe any recurrence or relapse.
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Sripathi S, Shenoy PM, Ayachit A, Kadavigere R. Bilateral sclerosing orbital pseudotumour in an adult. BMJ Case Rep 2014; 2014:bcr-2013-203389. [PMID: 24876210 DOI: 10.1136/bcr-2013-203389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sclerosing pseudotumour of the orbit is a rare idiopathic chronic inflammatory process, which greatly mimics neoplasms both clinically and on imaging studies. It is therefore important to differentiate this entity from true neoplasms and to rule out any systemic associations. We present a rare case of sclerosing orbital pseudotumour in an adult man with no systemic illnesses who presented with painless progressive proptosis of both eyes and showed a gradual initial response to steroid therapy but relapsed after a 2-year interval.
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Affiliation(s)
- Smiti Sripathi
- Department of Radiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Poonam Mohan Shenoy
- Department of Radiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Anurag Ayachit
- Department of Radiology, Kasturba Medical College, Manipal, Karnataka, India
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Li Y, Lip G, Chong V, Yuan J, Ding Z. Idiopathic orbital inflammation syndrome with retro-orbital involvement: a retrospective study of eight patients. PLoS One 2013; 8:e57126. [PMID: 23437329 PMCID: PMC3578830 DOI: 10.1371/journal.pone.0057126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/17/2013] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this retrospective study was to document the clinical findings and radiological features of idiopathic orbital inflammation syndrome with retro-orbital involvement. Methods We searched for ophthalmological patients who received orbital imaging at Zhejiang Provincial People's Hospital between October 2003 and April 2010. Seventy-three patients were diagnosed with idiopathic orbital inflammation syndrome based on clinicoradiological features, with pathological confirmation of nonspecific inflammatory conditions in 47 patients. Eight patients (11%) had MRI or CT evidence of retro-orbital involvement. All 8 patients were diagnosed with idiopathic orbital inflammation syndrome after biopsy of the orbital lesion. MR images were obtained for all 8 patients; 3 patients also had a contrast-enhanced CT scan. Results Seven out of 8 patients with retro-orbital involvement also had orbital apex lesions. Of the 65 patients without retro-orbital involvement, 19 had orbital apex lesions. The difference in the number of patients with orbital apex lesions between the two populations was significant (Fisher exact test P = .002). In all 8 patients with retro-orbital involvement, the inflammation spread through the superior orbital fissure. The retro-orbital lesions were isointense to grey matter on T1-weighted images, hypointense on T2-weighted images, and displayed uniform contrast enhancement; on contrast-enhanced CT scans, they were hyperdense relative to the contralateral mirror area and had radiological contours that were similar to those seen on MR images. The diffuse inflammation with marked sclerosis and hyalinization that we observed in the patients with retro-orbital involvement is consistent with the diagnosis of the sclerosing subtype of idiopathic orbital inflammation syndrome. All 8 patients also complained of mild to moderate periorbital pain (headache). Conclusions In patients with idiopathic orbital inflammation syndrome, it is important to perform MRI and CT scans to identify possible retro-orbital involvement. Retro-orbital involvement is more frequent when the lesion is present in the orbital apex.
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Affiliation(s)
- Yumei Li
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P. R. China
| | - Gerald Lip
- Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vincent Chong
- Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jianhua Yuan
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P. R. China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P. R. China
- Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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Myositic type of idiopathic orbital pseudotumor in a 4-year-old child: a case report. Case Rep Med 2012; 2012:473856. [PMID: 22719772 PMCID: PMC3376481 DOI: 10.1155/2012/473856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 04/18/2012] [Indexed: 11/17/2022] Open
Abstract
Idiopathic orbital pseudotumor is a benign, noninfectious, and nonneoplastic disease with unknown cause. It is the third most common orbital disease after thyroid orbitopathy and lymphoproliferative disorder. Idiopathic orbital pseudotumor is extremely rare in pediatric age group and may cause real diagnostic problems. This paper describes a 4-year-old girl who presented with sudden ptosis in the right eye and swollen eyelid. She recovered completely with high-dose steroid therapy. We report clinical and magnetic resonance imaging findings of orbital myositis, which is a rare subtype of idiopathic orbital pseudotumor in children and needs to be differentiated from other orbital disease especially malignancy.
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Ding ZX, Lip G, Chong V. Idiopathic orbital pseudotumour. Clin Radiol 2011; 66:886-92. [PMID: 21546008 DOI: 10.1016/j.crad.2011.03.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 03/19/2011] [Accepted: 03/24/2011] [Indexed: 12/13/2022]
Abstract
Idiopathic orbital pseudotumour (IOP) is a benign inflammatory condition usually confined to the orbit. This may involve single or multiple intraorbital structures. Extraorbital extension can also occur. The imaging appearances often mimic other orbital diseases. Both computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used to investigate orbital diseases, and it is important for radiologists to be aware of the variety of imaging appearances that occur in IOP. We present the imaging appearances in histopathologically confirmed cases of IOP and discuss the clinical features, natural history, and differential diagnosis of this condition.
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Affiliation(s)
- Z X Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, China.
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Liu GT, Volpe NJ, Galetta SL. Orbital disease in neuro-ophthalmology. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Meltzer DE, Chang AHY, Shatzkes DR. Case 152: Orbital Metastatic Disease from Breast Carcinoma. Radiology 2009; 253:893-6. [DOI: 10.1148/radiol.2533081926] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Colnaghi S, Versino M, Marchioni E, Pichiecchio A, Bastianello S, Cosi V, Nappi G. ICHD-II Diagnostic Criteria for Tolosa—Hunt Syndrome in Idiopathic Inflammatory Syndromes of the Orbit and/or the Cavernous Sinus. Cephalalgia 2008; 28:577-84. [DOI: 10.1111/j.1468-2982.2008.01569.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A bibliographical search was conducted for papers published between 1999 and 2007 to verify the validity of International Classification of Headache Disorders (ICHD)-II criteria for the Tolosa-Hunt syndrome (THS) in terms of (i) the role of magnetic resonance imaging (MRI); (ii) which steroid treatment should be considered as adequate; and (iii) the response to treatment. Of 536 articles, 48, reporting on 62 patients, met the inclusion criteria. MRI was positive in 92.1% of the cases and it normalized after clinical resolution. There was no evidence of which steroid schedule should be considered as adequate; high-dose steroids are likely to be more effective both to induce resolution and to avoid recurrences. Pain subsided within the time limit required by the ICHD-II criteria, but signs did not. We conclude that THS diagnostic criteria can be improved on the basis of currently available data. MRI should play a pivotal role both to diagnose and to follow-up THS.
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Affiliation(s)
- S Colnaghi
- Department of Neurology, University of Pavia, Pavia
- Department of Neuro-Otology and Neuro-Ophthalmology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
| | - M Versino
- Department of Neurology, University of Pavia, Pavia
- Department of Neuro-Otology and Neuro-Ophthalmology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
| | - E Marchioni
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
- Department of Clinical Neurology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - A Pichiecchio
- Department of Neuroradiology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - S Bastianello
- Department of Neurology, University of Pavia, Pavia
- Department of Neuroradiology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - V Cosi
- Department of Neurology, University of Pavia, Pavia
- Department of Clinical Neurology, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
| | - G Nappi
- UCADH—University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia
- Scientific Direction, IRCCS ‘Neurological Institute C. Mondino’ Foundation, Pavia
- Department of Neurology and ENT, University ‘La Sapienza’, Roma, Italy
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El Ouafi N, Rafai MA, Fadel H, Gam I, Slassi I. [Bilateral idiopathic orbital myositis]. Rev Neurol (Paris) 2006; 162:750-2. [PMID: 16840985 DOI: 10.1016/s0035-3787(06)75074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Orbital myositis is an idiopathic inflammation of the extraoccular muscles. It is often included under the broad description of orbital pseudotumor. It is commonly a unilateral affection. CASE REPORT We report one case of bilateral orbital myositis in a 45-year-old woman. The first symptoms were diplopia and acute bilateral orbital pain exacerbated by eye movements. Physical examination especially neurological was normal. Serum creatine kinase and biological thyroid function were normal. CT scan found a bilateral enlargement of rectus oculi medialis and lateralis. Clinical improvement was obtained a few days after oral corticosteroid treatment with remission of all signs. CONCLUSION Orbital myositis is a rare entity. 90-95p.cent of cases are unilateral. Bilateral forms are exceptional and in this case require search for specific etiologies particularly thyroid ophthalmopathy. There is controversy concerning treatment options but corticosteroids are still the most common first choice therapy with good outcome.
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Affiliation(s)
- N El Ouafi
- Unité de Radiologie, Hôpital Mohammed V, Tanger, Maroc
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