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Azzi L, Magnoli F, Krepysheva D, Fontana F, Coppola A, Cappelli A, Dani M, Battaglia P, Rabbiosi D. The "great imitator": IgG4-related disease of the oral cavity. Two case reports and scoping review. Head Neck 2024; 46:1510-1525. [PMID: 38566594 DOI: 10.1002/hed.27763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to review the lesser-known intraoral manifestations of immunoglobulin G4-related disease (IgG4-RD). In this paper we report an unprecedented case of oral IgG4-RD mimicking angiolymphoid hyperplasia with eosinophilia (ALHE), and another case presenting as plasma cell gingivitis. We then performed a scoping review of published cases of IgG4-RD involving the oral cavity. The following data were collected for each case: age, sex, intraoral site(s) involved, clinical appearance, imaging features, serum IgG4 values, histopathology, treatment, and follow-up duration. Fifty-one cases of oral IgG4-RD were published in literature. The hard palate and jaw bones were the two main locations reported, while the histological identification of a IgG4/IgG plasma cells ratio ≥40% was fundamental for diagnosis. Conversely, the pathological features of storiform fibrosis and obliterative phlebitis were not common. Future reports regarding oral IgG4-RD should report clear adherence to the recognized international diagnostic criteria of the disease.
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Affiliation(s)
- Lorenzo Azzi
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
- Unit of Oral Medicine and Pathology, Dental Clinic, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Francesca Magnoli
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Diana Krepysheva
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Federico Fontana
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
- Unit of Radiology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Andrea Coppola
- Unit of Radiology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Antonella Cappelli
- Unit of Rheumatology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Marta Dani
- Unit of Oral Medicine and Pathology, Dental Clinic, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
- Unit of Otolaryngology and Head and Neck Surgery, Azienda Socio-Sanitaria Territoriale Lariana, San Fermo della Battaglia (CO), Italy
| | - Dimitri Rabbiosi
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
- Unit of Maxillofacial Surgery, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
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2
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Ruffer N, Krusche M, Holl-Ulrich K, Kötter I, Lötscher F. [Cocaine-induced vasculitis and mimics of vasculitis]. Z Rheumatol 2023; 82:606-614. [PMID: 35612660 PMCID: PMC10495486 DOI: 10.1007/s00393-022-01217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Cocaine is a psychotropic tropane alkaloid and stimulant drug. Nasal insufflation of cocaine powder is a common route of administration. In Germany, cocaine is frequently adulterated with levamisole, an anthelminthic drug with immunomodulatory effects. Both substances are linked to various autoimmune conditions. Cocaine-induced midline destructive lesions cause a progressive destruction of osteocartilaginous structures within the upper respiratory tract and can mimic localized granulomatosis with polyangiitis. In addition, systemic vasculitis due to cocaine and levamisole has been reported. Differentiation of these conditions from primary vasculitis can be challenging because antineutrophil cytoplasmic antibodies (ANCA) are commonly detected. Early diagnosis of these conditions is crucial as clinical improvement is closely related to drug cessation.
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Affiliation(s)
- Nikolas Ruffer
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland.
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Pathologie-Hamburg, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
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3
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Senevirathna K, Jayawickrama SM, Jayasinghe YA, Prabani KIP, Akshala K, Pradeep RGGR, Damayanthi HDWT, Hettiarachchi K, Dorji T, Lucero‐Prisno DE, Rajapakse RMG, Kanmodi KK, Jayasinghe RD. Nanoplatforms: The future of oral cancer treatment. Health Sci Rep 2023; 6:e1471. [PMID: 37547360 PMCID: PMC10397482 DOI: 10.1002/hsr2.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background and Aims Cytotoxicity is a key disadvantage of using chemotherapeutic drugs to treat cancer. This can be overcome by encapsulating chemotherapeutic drugs in suitable carriers for targeted delivery, allowing them to be released only at the cancerous sites. Herein, we aim to review the recent scientific developments in the utilization of nanotechnology-based drug delivery systems for treating oral malignancies that can lead to further improvements in clinical practice. Methods A comprehensive literature search was conducted on PubMed, Google Scholar, ScienceDirect, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to nanoplatforms and their applications in oral cancer treatment. Results Nanoplatforms offer a revolutionary strategy to overcome the challenges associated with conventional oral cancer treatments, such as poor drug solubility, non-specific targeting, and systemic toxicity. These nanoscale drug delivery systems encompass various formulations, including liposomes, polymeric nanoparticles, dendrimers, and hydrogels, which facilitate controlled release and targeted delivery of therapeutic agents to oral cancer sites. By exploiting the enhanced permeability and retention effect, Nanoplatforms accumulate preferentially in the tumor microenvironment, increasing drug concentration and minimizing damage to healthy tissues. Additionally, nanoplatforms can be engineered to carry multiple drugs or a combination of drugs and diagnostic agents, enabling personalized and precise treatment approaches. Conclusion The utilization of nanoplatforms in oral cancer treatment holds significant promise in revolutionizing therapeutic strategies. Despite the promising results in preclinical studies, further research is required to evaluate the safety, efficacy, and long-term effects of nanoformulations in clinical settings. If successfully translated into clinical practice, nanoplatform-based therapies have the potential to improve patient outcomes, reduce side effects, and pave the way for more personalized and effective oral cancer treatments.
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Affiliation(s)
- Kalpani Senevirathna
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Shalindu M. Jayawickrama
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Yovanthi A. Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Karunakalage I. P. Prabani
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Kushani Akshala
- Department of Agricultural Biology, Faculty of AgricultureUniversity of PeradeniyaPeradeniyaSri Lanka
| | | | | | - Kalani Hettiarachchi
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Thinley Dorji
- Department of Internal MedicineCentral Regional Referral HospitalGelegphuBhutan
| | - Don E. Lucero‐Prisno
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Kehinde K. Kanmodi
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of DentistryUniversity of RwandaKigaliRwanda
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Cephas Health Research Initiative IncIbadanNigeria
| | - Ruwan D. Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
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4
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Schirmer JH, Both M, Müller O. Vaskulitis mimics. AKTUEL RHEUMATOL 2023. [DOI: 10.1055/a-1949-8509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
ZusammenfassungIdiopathische Vaskulitiden sind seltene entzündliche Systemerkrankungen,
die nach der Chapel-Hill Konsensus-Nomenklatur nach der Größe
der prädominant betroffenen Gebiete von Blutgefäßen
(große, mittelgroße, kleine Gefäße und
Gefäße variabler Größe) eingeteilt werden.
Vaskulitis mimics sind Syndrome, die ein ähnliches klinisches Bild
hervorrufen oder leicht mit einer idiopathischen Vaskulitis verwechselt werden
und teils sogar ein Krankheitsbild, das klinisch und histologisch einer
Vaskulitis gleicht, auslösen können. Die Zahl der Vaskulitis
mimics ist groß, je nach betroffenem Gefäßgebiet kommen
hereditäre Erkrankungen des Bindegewebes, genetisch bedingte
Immundefekt- und Autoinflammationssyndrome, infektiöse Erkrankungen,
seltene entzündliche Systemerkrankungen, Tumorerkrankungen,
medikamenteninduzierte Syndrome und zahlreiche weitere infrage. In diesem Review
wird eine Auswahl klassischer Imitatoren von Vaskulitiden, orientiert an der
Größe der betroffenen Blutgefäße
präsentiert und Konstellationen, die typische
„Fallstricke“ in der klinischen Abklärung darstellen
können, diskutiert.
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Affiliation(s)
- Jan Henrik Schirmer
- Klinik für Innere Medizin I, Sektion Rheumatologie,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel,
Germany
| | - Marcus Both
- Klinik für Radiologie und Neuroradiologie,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel,
Germany
| | - OliverJ Müller
- Klinik für Innere Medizin III (Kardiologie, Angiologie und
internistische Intensivmedizin), Universitätsklinikum Schleswig-Holstein
Campus Kiel, Kiel, Germany
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5
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Awadelkarim B, Vila J, Nayar MK, Leeds JS, Griffiths B, Oppong KW. Pancreaticobiliary versus head and neck presentation of immunoglobulin G4-related disease: different sides of the same coin? BMJ Open Gastroenterol 2023; 10:bmjgast-2022-000961. [PMID: 36707105 PMCID: PMC9884923 DOI: 10.1136/bmjgast-2022-000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/07/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND STUDY AIM Immunoglobulin G4-related disease (IgG4-RD) is a rare immune mediated fibroinflammatory condition. Pancreaticobiliary (PB) and head and neck (HN) are two of the most commonly involved anatomical sites. It has been postulated that PB IgG4-RD and HN IgG4-RD have distinct clinical phenotypes. Whether the optimum treatment regimen or response to therapy differs between them is unknown. We aimed to assess differences between PB and HN IgG4-RD in a cohort of IgG4 disease managed by an IgG4-RD multispecialty team. METHODS We performed a retrospective study of a prospectively maintained multidisciplinary IgG4-RD database to identify patients diagnosed with PB and HN IgG4-RD (based on initial presentation) between 2005 and 2019. The electronic patient records were reviewed. Use of immunosuppressive agents and clinical course was analysed. RESULTS 60 patients with PB IgG4-RD and 14 with HN IgG4-RD were included in the study. PB IgG4-RD was associated with older age at diagnosis 64 versus 51 years (p<0.001), higher serum IgG4 level as a multiple of upper limit of normal median (IQR) 2 (1-3.75) vs 1 (1-2), (p=0.04) and greater proportion with more than one organ involved 68% vs 33% (p=0.03). HN IgG4-RD was more likely to receive second-line therapy 71% versus 36% (p=0.03). Persistent elevation of serum IgG4 after therapy was more common in PB IgG4-RD 84% versus 43% (p=0.03). CONCLUSION These findings support the contention that PB IgG4-RD and HN IgG4-RD have different clinical profiles and represent distinct subtypes of IgG4-RD.
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Affiliation(s)
- Bidour Awadelkarim
- HPB Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Josephine Vila
- Rheumatology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Manu K Nayar
- HPB Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John S Leeds
- HPB Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bridget Griffiths
- Rheumatology Department, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Kofi W Oppong
- HPB Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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6
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Nitro L, Pipolo C, Fadda GL, Allevi F, Borgione M, Cavallo G, Felisati G, Saibene AM. Distribution of cocaine-induced midline destructive lesions: systematic review and classification. Eur Arch Otorhinolaryngol 2022; 279:3257-3267. [PMID: 35138441 PMCID: PMC9130192 DOI: 10.1007/s00405-022-07290-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
Purpose Intranasal cocaine is known to potentially lead to midline destructive lesions. The present systematic review was undertaken to systematically define the localization of cocaine-induced midline destructive lesions and their prevalence and to propose a practical classification of these lesions. Methods A PRISMA-compliant systematic review was performed in multiple databases with criteria designed to include all studies published until March 2021 providing a precise definition of cocaine-induced midline lesions in humans. We selected all original studies except case reports. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for lesion localization, patients’ demographics, exposure to cocaine, and relationship with external nose destruction. Results Among 2593 unique citations, 17 studies were deemed eligible (127 patients). All studies were retrospective case series. The destructive process determined a septal perforation in 99.2% of patients. The distribution prevalence decreased from the inferior third of the sinonasal complex (nasal floor and inferolateral nasal wall, respectively, 59% and 29.9% of patients) to the middle third (middle turbinate and ethmoid, 22.8% of patients), and ultimately to neurocranial structures (7.9% of patients). Nasal deformities were inconsistently reported across reviewed studies. Cocaine use duration, frequency, and status were reported only occasionally. Conclusion Based on the distribution prevalence observed, we propose a four-grade destruction location-based classification. Future prospective studies following the evolution of cocaine-induced lesions are needed to validate our classification, its relationship with lesion evolution, and whether it represents a reliable tool for homogeneous research results reporting.
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Affiliation(s)
- Letizia Nitro
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Fabiana Allevi
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mario Borgione
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy. .,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.
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7
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Ji Y, Liu R, Zhao C. Response to "IgG4-Related Midline Destructive Disease" by Akiyama M. J Clin Rheumatol 2021; 27:S886. [PMID: 32833910 DOI: 10.1097/rhu.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yongjin Ji
- Department of Otolaryngology Head and Neck Surgery Shanxi Medical University Second Affiliated Hospital Taiyuan, Shanxi, China
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8
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Trimarchi M, Vinciguerra A, Resti AG, Giordano L, Bussi M. Multidisciplinary approach to lacrimal system diseases. ACTA ACUST UNITED AC 2021; 41:S102-S107. [PMID: 34060525 PMCID: PMC8172105 DOI: 10.14639/0392-100x-suppl.1-41-2021-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022]
Abstract
Pathologies of the lacrimal drainage system range from benign to malignant lesions. However, independently of the etiological origin, the most common presenting symptom is represented by epiphora due to the dysfunction of the lacrimal system. Different diagnostic tools are now available, but for the most the first diagnostic approach is characterized by an ophthalmological visit, associated with nasal endoscopy, usually performed by an otolaryngologist. Frequently the diagnostic work-up is completed with a radiological exam (e.g. maxilla-facial CT or dacryocystography), whose role is still to be determined. Once a diagnosis has been made, different treatments are available in relation to the type of the disease, and commonly need close cooperation between an ENT and ophthalmic surgeon given the close anatomical structures involved. Taking into account all these aspects, the aim of this review is to highlight how a multidisciplinary approach to lacrimal pathologies is mandatory from diagnosis to treatment in order to offer the best clinical approach.
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Affiliation(s)
- Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Ophthalmologic Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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9
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Transcranial extradural subtemporal repair for sphenoid sinus lateral recess meningoencephalocele: technical note. Neurosurg Rev 2021; 45:903-909. [PMID: 34143324 DOI: 10.1007/s10143-021-01581-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 06/07/2021] [Indexed: 12/31/2022]
Abstract
Cranial meningoencephalocele is a rare condition consisting of the herniation of meninges, CSF, and brain tissue through a cranial or skull base defect. Sphenoid sinus lateral recess meningoencephalocele is of particular interest due to the complex anatomy surrounding the bone defect and their demanding surgical management. In this technical note, we reported a step-by-step description of a rare case of sphenoid sinus lateral recess meningoencephalocele causing headache due to recurrent cerebrospinal fluid leak treated with a subtemporal craniotomy with extradural middle cranial fossa drilling and meningoencephalocele removal with multilayer reconstruction. The transcranial route is a safe and effective treatment for sphenoid sinus lateral recess meningoencephalocele repair. The subtemporal extradural approach allows for an optimal exposure of the relevant anatomy minimizing risks and improving the possibility to perform an effective multilayer skull base reconstruction.
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10
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Skillington SA, Ogden MA. IgG4-Related Disease and the Salivary Glands: A Review of Pathophysiology, Diagnosis, and Management. Otolaryngol Clin North Am 2021; 54:497-508. [PMID: 34024478 DOI: 10.1016/j.otc.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
IgG4-related disease is a rare, immune-mediated, systemic disease that is characterized by soft tissue lymphocyte infiltration and resultant fibrosis. The salivary glands are among the most commonly affected organs. Patients present with subacute submandibular and/or parotid swelling and sialadenitis. Diagnosis incorporates clinical, serologic, radiologic, and pathologic findings. Most cases respond quickly to systemic glucocorticoids. IgG4-related disease mimics many infectious, inflammatory, and neoplastic diseases. Therefore, IgG4-related disease is frequently misdiagnosed. A knowledge of the pathophysiology, diagnosis, and management of IgG4-related disease is important for providers who treat salivary gland diseases.
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Affiliation(s)
- S Andrew Skillington
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, PO Box 8115, St Louis, MO 63110, USA
| | - M Allison Ogden
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, PO Box 8115, St Louis, MO 63110, USA.
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11
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Solitary Extramedullary Plasmacytoma Presenting as Asymptomatic Palatal Erythroplakia: Report of a Case. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073762. [PMID: 33916539 PMCID: PMC8038516 DOI: 10.3390/ijerph18073762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
Solitary plasmacytoma (SP) is a rare malignant tumor of plasma cells with no systemic spread; however, when it disseminates and affects multiple skeletal sites, it is called multiple myeloma (MM). The etiology of solitary plasmacytoma is unknown, with two possible subtypes: solitary extramedullary plasmacytoma (EMP) and solitary bone plasmacytoma (SBP). We present a case of EMP arising as asymptomatic erythroplakia of the palate, which is rarely described in the literature. The definitive diagnosis was obtained with immunohistochemical studies, after which the lesion was subjected to excisional biopsy. At present, after two years of close follow-up, the patient has shown no signs of relapse or conversion to MM. The uniqueness of the case highlights the possibility of an atypical EMP lesion in the head and neck, thus posing a diagnostic and therapeutic challenge for physicians.
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12
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Lanzillotta M, Fernàndez-Codina A, Culver E, Ebbo M, Martinez-Valle F, Schleinitz N, Della-Torre E. Emerging therapy options for IgG4-related disease. Expert Rev Clin Immunol 2021; 17:471-483. [PMID: 33689549 DOI: 10.1080/1744666x.2021.1902310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Awareness of IgG4-related disease (IgG4-RD) is increasing worldwide and specialists are now familiar with most of its clinical manifestations and mimickers. IgG4-RD promptly responds to glucocorticoids and repeated courses are typically used to induce and maintain remission because the disease relapses in most patients. If left untreated, it can lead to organ dysfunction, organ failure and death. Advancement in our understanding of IgG4-RD pathogenesis is leading to the identification of novel therapeutic targets and emerging treatments are now setting the stage for personalized therapies for the future. AREAS COVERED This review focuses on emerging treatment options for IgG4-RD based on our advancing understanding of disease pathophysiology. Research was performed in the English literature on Pubmed and clinicaltrials.gov databases. EXPERT OPINION Glucocorticoids remain the first-line induction treatment for the multi-organ manifestations of IgG4-RD. Alternative immunosuppressive agents for maintaining remission are warranted in order to avoid long-term steroid toxicity, and to offer a more mechanistic and personalized therapeutic strategy. Targeting B and T-lymphocyte activation represents the most promising approach, but randomized controlled trials are eagerly awaited to confirm positive preliminary experiences reported in case series and small cohort studies.
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Affiliation(s)
- Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Scientific Institute, ss Milan, Italy
| | - Andreu Fernàndez-Codina
- Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Rheumatology Division and General Internal Medicine division-Windsor Campus, Western University, 268 Grosvenor St, D2-191, Rheumatology Centre, St. Joseph´s Health Care, London, Ontario, Canada
| | - Emma Culver
- Translational Gastroenterology Unit, University of Oxford, Oxford,UK.,Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mikael Ebbo
- Département De Médecine Interne, Centre De Référence Constitutif Des Cytopénies Auto-immunes De L'adulte (CERECAI), Hôpital De La Timone, Aix-Marseille Université, Assistance publique-Hôpitaux De Marseille, Marseille, France
| | | | - Nicolas Schleinitz
- Département De Médecine Interne, Centre De Référence Constitutif Des Cytopénies Auto-immunes De L'adulte (CERECAI), Hôpital De La Timone, Aix-Marseille Université, Assistance publique-Hôpitaux De Marseille, Marseille, France
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (Unirar), IRCCS San Raffaele Scientific Institute, ss Milan, Italy
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13
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Bondi S, Vinciguerra A, Lissoni A, Rizzo N, Barbieri D, Indelicato P, Abati S. Mucosal Melanoma of the Hard Palate: Surgical Treatment and Reconstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3341. [PMID: 33804881 PMCID: PMC8036556 DOI: 10.3390/ijerph18073341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Mucosal melanomas of the head and neck region are uncommon pathologies that can affect the oral cavity, and are characterized by a high rate of mortality. Considering the lack of knowledge regarding risk and prognostic factors, current best clinical practice is represented by a large surgical excision with disease-free margins, eventually associated with a reconstructive flap. Indeed, given the frequent necessity of postoperative radiotherapy and fast healing process, a reconstruction of the surgical gap is advisable. Even if several flaps have been most commonly used, the submental island flap represents a valid alternative thanks to local advantages and similar oncologic outcomes compared to free flaps.
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Affiliation(s)
- Stefano Bondi
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
| | - Alessandro Vinciguerra
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Alessandra Lissoni
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
| | - Nathalie Rizzo
- Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, 20100 Milano, Italy;
| | - Diego Barbieri
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Pietro Indelicato
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Silvio Abati
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
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14
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Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063219. [PMID: 33804629 PMCID: PMC8003646 DOI: 10.3390/ijerph18063219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/05/2022]
Abstract
Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.
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15
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Trimarchi M, Indelicato P, Vinciguerra A, Bussi M. Clinical efficacy of dupilumab in the treatment of severe chronic rhinosinusitis: The first case outside of a clinical trial. Clin Case Rep 2021; 9:1428-1432. [PMID: 33768860 PMCID: PMC7981721 DOI: 10.1002/ccr3.3792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Treatment options for severe CRSwNP are limited. Dupilumab is a safe, well-tolerated, and effective alternative in patients with poor control of symptoms, corticosteroid-dependent disease, and high rates of recurrence of nasal polyps after surgery.
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Affiliation(s)
- Matteo Trimarchi
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Pietro Indelicato
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Alessandro Vinciguerra
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Mario Bussi
- Otorhinolaryngology UnitDivision of Head and Neck DepartmentIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
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16
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Dragan AD, Weller A, Lingam RK. Imaging of IgG4-related disease in the extracranial head and neck. Eur J Radiol 2021; 136:109560. [PMID: 33524920 DOI: 10.1016/j.ejrad.2021.109560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Immunoglobulin G4-related disease (IgG4-RD) is a newly defined fibro-inflammatory multisystemic condition defined by a triad of diagnostic criteria based on clinical presentation, biochemical and histopathological findings. Whereas some subsites of this disease have been well described in the literature so far (e.g. pancreas, kidneys, retroperitoneum, salivary glands), more recently identified anatomical sites of involvement in the head and neck are less well understood (e.g. nose, paranasal sinuses). METHOD This pictorial review details the imaging appearances of extracranial IgG4-RD in the Head & Neck. Multimodality imaging appearance and features are presented, with reference to the published literature to date. RESULTS Following a subsite-based approach, we present both the most common and the more rarely encountered imaging patterns of IgG4-RD in the extracranial head and neck, along with the relevant differential diagnoses to consider. Our institutional experience not only cements what is already known in the existing literature on this topic, but also reveals new imaging features of IgG4-RD, notably in the sinonasal tract. CONCLUSIONS This pictorial review of extracranial head & neck IgG4-RD will enable radiologists to recognise the features of this condition and propose it as a differential diagnosis to include alongside other probable entities. It establishes the place of the radiologist in the diagnosis and management of IgG4-RD.
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Affiliation(s)
- Alina Denisa Dragan
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom
| | - Alexander Weller
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom
| | - Ravi Kumar Lingam
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom.
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17
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Abati S, Bramati C, Bondi S, Lissoni A, Trimarchi M. Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249160. [PMID: 33302498 PMCID: PMC7764090 DOI: 10.3390/ijerph17249160] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023]
Abstract
Oral cancer (OC) is an uncommon malignancy in Western countries, being one of the most common cancers in some high-risk areas of the world. It is a largely preventable cancer, since most of the different risk factors identified, such as tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. Given its high mortality, early diagnosis is of utmost importance. Prevention and the anticipation of diagnosis begin with identification of potentially malignant lesions of the oral mucosa and with local conditions promoting chronic inflammation. Therefore, every lesion must be recognized promptly and treated adequately. The clinical recognition and evaluation of oral mucosal lesions can detect up to 99% of oral cancers/premalignancies. As stated by the World Health Organization, any suspicious lesion that does not subside within two weeks from detection and removal of local causes of irritation must be biopsied. Surgical biopsy remains the gold standard for diagnosis of oral cancer. Adjunctive tools have been developed and studied to help clinicians in the diagnostic pathway, such as toluidine blue vital staining and autofluorescence imaging. In the near future other methods, i.e., identification of salivary markers of progression may help in reducing mortality due to oral cancer.
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Affiliation(s)
- Silvio Abati
- Dentistry and Stomatology-IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milano, Italy;
- School of Medicine, University Vita-Salute, 20132 Milano, Italy; (C.B.); (M.T.)
- Correspondence: ; Tel.: +39-02-26433410
| | - Chiara Bramati
- School of Medicine, University Vita-Salute, 20132 Milano, Italy; (C.B.); (M.T.)
- Otorhinolaryngology-Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20132 Milano, Italy;
| | - Stefano Bondi
- Otorhinolaryngology-Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20132 Milano, Italy;
| | - Alessandra Lissoni
- Dentistry and Stomatology-IRCCS San Raffaele Hospital, University Vita-Salute, 20132 Milano, Italy;
| | - Matteo Trimarchi
- School of Medicine, University Vita-Salute, 20132 Milano, Italy; (C.B.); (M.T.)
- Otorhinolaryngology-Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20132 Milano, Italy;
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18
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Rampi A, Lanzillotta M, Mancuso G, Vinciguerra A, Dagna L. IgG4-Related Disease of the Oral Cavity. Case Series from a Large Single-Center Cohort of Italian Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218179. [PMID: 33167472 PMCID: PMC7663930 DOI: 10.3390/ijerph17218179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022]
Abstract
A series of destructive and tumefactive lesions of the oral cavity are increasingly recognized as part of the IgG4-related disease (IgG4-RD) spectrum. We herein examined the clinical, serological, radiological, and histological features of a series of patients referred to our clinic because of oral cavity lesions ultimately attributed to IgG4-RD. In particular, we studied 6 consecutive patients out of 200 patients referred to the immunology outpatient unit who presented with erosive and/or tumefactive lesions of the oral cavity. All patients underwent serum IgG4 measurement, nasal endoscopy, radiological studies, and histological evaluation of tissue specimens. The histological studies included immunostaining studies to assess the number of IgG4+ plasma cells/High-Power Field (HPF) for calculation of the IgG4+/IgG+ plasma cell ratio. Six patients (3% of the entire cohort) were diagnosed with IgG4-RD of the oral cavity based on histological evaluation. A major complaint at presentation was oral discomfort due to bulging mass. A mild to no increase in serum IgG4 was observed. Different patterns of organ involvement were associated with oral lesions. Five patients were treated with immunosuppressive therapy and two patients promptly responded to B-cell depletion with rituximab. Watchful waiting was decided in one patient with no major clinical symptoms. Involvement of the oral cavity is an infrequent manifestation of IgG4-RD but should be taken into consideration as a possible differential diagnosis of tumefactive or erosive lesions once neoplastic conditions are excluded. A histological examination of biopsy samples from the oral cavity represents the mainstay for diagnosis of IgG4-RD.
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Affiliation(s)
- Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.V.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.); (L.D.)
| | - Marco Lanzillotta
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.); (L.D.)
- Division of Immunology, Rheumatology, Allergy and Rare Disease (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence:
| | - Gaia Mancuso
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.); (L.D.)
- Division of Immunology, Rheumatology, Allergy and Rare Disease (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Vinciguerra
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.V.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.); (L.D.)
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.); (L.D.)
- Division of Immunology, Rheumatology, Allergy and Rare Disease (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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19
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Indelicato P, Vinciguerra A, Giordano Resti A, Trimarchi M. A case of endonasal balloon-assisted dacryoplasty after failure of endonasal dacryocystorhinostomy. Clin Case Rep 2020; 8:1605-1609. [PMID: 32983459 PMCID: PMC7495747 DOI: 10.1002/ccr3.2956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Endonasal balloon-assisted dacryoplasty is a minimally invasive technique that uses a high-pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Alessandro Vinciguerra
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Antonio Giordano Resti
- Division of Head and Neck DepartmentOphthalmologic unitIRCCS San Raffaele Scientific InstituteMilanoItaly
| | - Matteo Trimarchi
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
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20
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Della-Torre E, Mancuso G, Lanzillotta M, Ramirez GA, Arcidiacono PG, Capurso G, Falconi M, Dagna L. Urgent manifestations of immunoglobulin G 4-related disease. Scand J Rheumatol 2020; 50:48-51. [PMID: 32692264 DOI: 10.1080/03009742.2020.1771763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Immunoglobulin G4-related disease (IgG4-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG4-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG4-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG4-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG4-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG4-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.
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Affiliation(s)
- E Della-Torre
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G Mancuso
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - M Lanzillotta
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G A Ramirez
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - M Falconi
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - L Dagna
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
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21
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Indelicato P, Vinciguerra A, Giordano Resti A, Bussi M, Trimarchi M. Endoscopic endonasal balloon-dacryoplasty in failed dacryocystorhinostomy. Eur J Ophthalmol 2020; 31:2076-2081. [PMID: 32664743 DOI: 10.1177/1120672120942692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endoscopic endonasal balloon-assisted dacryoplasty is a minimally-invasive surgical procedure that can be used in recurrent epiphora, a common pathology in both adulthood and childhood. STUDY DESIGN/SETTINGS We present a retrospective case series of eight patients who underwent trans-nasal balloon-assisted dacryoplasty after a failed external or endoscopic dacryocystorhinostomy, from March 2019 to January 2020, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. SUBJECTS AND METHODS All patients underwent routine preoperative work-up including fluorescein test (Jones test I-II), probing and irrigation of the lacrimal pathway and nasal endoscopy. Because of the recurrent nature of the pathology, pre-operatory computed tomography scan or dacryocystography was not performed. The surgical procedure was based on enlargement of the stenotic neorhinostomy created by primary dacryocystorhinostomy through the use of a high-pressure balloon catheter. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. RESULTS Anatomic and functional success was achieved in 100% of patients. Operative time ranged from 9 to 22 min (mean 16 min). No significant complications were reported. CONCLUSION Our results indicate that trans-nasal balloon-assisted dacryoplasty can be considered as a safe and reliable surgical approach after a failed primary dacryocystorhinostomy. The shorter surgical time and reduced post-operative complication rates are the main advantages of this procedure.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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22
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Blaison F, Faganello D, Goigoux C, Mercié P, Baulier G, Contin-Bordes C, Duffau P. Cocaïne et lésions destructrices centro-faciales : à propos d'un cas. Rev Med Interne 2020; 41:622-627. [PMID: 32660858 DOI: 10.1016/j.revmed.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed. CASE REPORT A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made. CONCLUSION CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.
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Affiliation(s)
- Félix Blaison
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France.
| | - Déborah Faganello
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Camille Goigoux
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Patrick Mercié
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Gildas Baulier
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Cécile Contin-Bordes
- Laboratoire d'immunologie et immunogénétique, hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, France
| | - Pierre Duffau
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
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23
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Abstract
IgG4 related disease was recognized as a unified disease entity only 15 years ago. Awareness of IgG4 related disease has increased worldwide since then, and specialists are now familiar with most of its clinical manifestations. Involvement of the pancreato-biliary tract, retroperitoneum/aorta, head and neck, and salivary glands are the most frequently observed disease phenotypes, differing in epidemiological features, serological findings, and prognostic outcomes. In view of this multifaceted presentation, IgG4 related disease represents a great mimicker of many neoplastic, inflammatory, and infectious conditions. Histopathology remains key to diagnosis because reliable biomarkers are lacking. Recently released classification criteria will be invaluable in improving early recognition of the disease. IgG4 related disease is highly treatable and responds promptly to glucocorticoids, but it can lead to end stage organ failure and even death if unrecognized. Prolonged courses of corticosteroids are often needed to maintain remission because the disease relapses in most patients. Rapid advancement in our understanding of the pathophysiology of IgG4 related disease is leading to the identification of novel therapeutic targets and possible personalized approaches to treatment.
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Affiliation(s)
- Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Mancuso
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Berti A, Bond M, Volpe A, Felicetti M, Bortolotti R, Paolazzi G. Practical approach to vasculitides in adults: an overview of clinical conditions that can mimic vasculitides closely. ACTA ACUST UNITED AC 2020. [DOI: 10.4081/br.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary systemic vasculitides are rare diseases affecting blood vessel walls. The type and patterns of distribution of the organs affected usually reflect the size of the vessels predominantly involved, and the patterns of clinical manifestations are generally useful to reach a specific diagnosis. However, presenting symptoms may lack adequate specificity for a prompt diagnosis, leading to a diagnostic (and therapeutic) delay, often causing irreversible damage to the affected organs. Due to their rarity and variable clinical presentation, the diagnosis of primary vasculitides could be challenging for physicians. Vasculitis mimickers, i.e. the clinical conditions that could be likely mistaken for vasculitides, need to be carefully ruled out, especially before starting the immunosuppressive therapy. We present here a practical approach to the diagnosis of primary systemic vasculitides involving large, medium and small size vessels, and reviewed most of the conditions that could mimic primary systemic vasculitides.
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García-Curdi F, Lois-Ortega Y, Gonzales-Sejas AG, Alfonso-Collado JI, Fumanal-Senz L, Vallés-Varela H. [IgG4 related disease with exclusive sinonasal involvement: A case report and literature review]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2019; 52:125-129. [PMID: 30902377 DOI: 10.1016/j.patol.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/03/2018] [Accepted: 05/11/2018] [Indexed: 06/09/2023]
Abstract
IgG4 related disease (igG4-RD) is a pathological process which integrates a large number of diseases of unknown pathogenesis, considered as being exclusive to many different organs. Diagnosis is established through histological, radiological and serological criteria. Treatment is based on long term corticosteroids; rituximab being used only in refractory cases. It is unusual for this entity to be found exclusively in the head and neck, without systemic involvement; there are only a few reported cases to date. We present a case of a nasosinusal IgG4-RD orbital tumor with paranasal sinus involvement. The accurate diagnosis made early onset corticosteroid treatment possible and the patient is currently asymptomatic.
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Affiliation(s)
- Fernando García-Curdi
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - Yolanda Lois-Ortega
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | | | | | - Luis Fumanal-Senz
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Héctor Vallés-Varela
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Trimarchi M, Bondi S, Della Torre E, Terreni MR, Bussi M. Palate perforation differentiates cocaine-induced midline destructive lesions from granulomatosis with polyangiitis. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:281-285. [PMID: 28663599 PMCID: PMC5584099 DOI: 10.14639/0392-100x-1586] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/11/2017] [Indexed: 12/24/2022]
Abstract
Cocaine abuse occasionally causes extensive destruction of the osteocartilaginous structures of the nose, sinuses and palate, which mimics the clinical picture of other diseases associated with necrotising midfacial lesions. The differentiation of cocaine-induced midline destructive lesions (CIMDL) and limited granulomatosis with polyangiitis (GPA) may be difficult, particularly if patients do not readily admit substance abuse. We studied 10 patients with CIMDL and palate perforation referred to our Unit between 2002 and 2015. All cases underwent nasal endoscopy, sinus CT or MRI and ANCA test. In 8 patients, a nasal biopsy was performed. The PubMed database was searched to review all cases of palate perforation described in patients affected by CIMDL or GPA. All 10 cases presented with septal perforation and inferior turbinate destruction. We found hard palate perforation in 7 patients, soft palate perforation in 2 patients, and perforation of both in one patient. ANCA testing was negative in 8 patients and positive in 2, with C-ANCA and P-ANCA specificity, respectively. A review of the English literature identified palate perforation in 5 patients with GPA and in 73 patients with CIMDL. The presence of palate perforation in patients with MDL may represent a clinical marker that strongly favors CIMDL over GPA.
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Affiliation(s)
| | - S Bondi
- Department of Otorhinolaryngology
| | | | - M R Terreni
- Departments of Pathology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milan, Italy
| | - M Bussi
- Department of Otorhinolaryngology
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Della-Torre E, Lanzillotta M, Campochiaro C, Bozzalla E, Bozzolo E, Bandiera A, Bazzigaluppi E, Canevari C, Modorati G, Stone JH, Manfredi A, Doglioni C. Antineutrophil cytoplasmic antibody positivity in IgG4-related disease: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e4633. [PMID: 27559962 PMCID: PMC5400329 DOI: 10.1097/md.0000000000004633] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a fibroinflammatory condition characterized by serum IgG4 elevation and tissue infiltration of IgG4-positive plasma cells. Substantial overlap between IgG4-RD and antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) exists in terms of organ involvement and histopathological features. A positive ANCA assay is regarded as a highly specific finding in favor of an AAV, and generally influences away from a diagnosis of IgG4-RD. Recent reports, however, have raised the possibility that some patients with IgG4-RD are ANCA positive, thus suggesting reconsideration of the role of ANCA in the diagnostic workup. In the present work, we describe the first case of concomitant biopsy-proven IgG4-RD and granulomatosis with polyangiitis (GPA), demonstrating antiproteinase 3 (PR3) ANCA of the IgG4 subclass in the patient's serum. We also review the literature in order to provide clinicians with tools for interpreting ANCA positivity in IgG4-RD patients. CASE SUMMARY A 51-year-old woman was referred for left exopthalmos due to lacrimal gland enlargement and increased serum IgG4 concentration. IgG4-RD was suspected and further imaging studies disclosed multiple pulmonary masses in the right lung. Histological analysis of the left lacrimal gland was diagnostic for IgG4-RD, but lung biopsy showed typical features of GPA. ANCA assay was positive for anti-PR3 antibodies. Further immunofluorescence studies demonstrated anti-PR3 antibodies of IgG1 and IgG4 subclass. Treatment with rituximab induced swift remission of both IgG4-RD and GPA manifestations. We identified 9 other reports of patients with IgG4-RD and positive ANCA in the English literature, 5 cases with biopsy-proven IgG4-RD and 4 cases in whom IgG4-RD was diagnosed presumptively. Four patients had also histological evidence of concomitant AAV. CONCLUSION The present work demonstrates that ANCA positivity in patients with biopsy-proven IgG4-RD should prompt the exclusion of a concomitant vasculitic process; a positive ANCA does not exclude the diagnosis of IgG4-RD; confirmation through immunoenzymatic assays of the ANCA specificity, clinical-pathological correlation, and histopathological evaluation remain crucial steps for the differential diagnosis between AAV and IgG4-RD.
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Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
- Correspondence: Emanuel Della-Torre, Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy (e-mail: )
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
| | - Corrado Campochiaro
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | - Emanuele Bozzalla
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
| | - Enrica Bozzolo
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | | | | | - Carla Canevari
- Division of Nuclear Medicine, IRCCS-San Raffaele Scientific Institute
| | - Giulio Modorati
- Department of Ophthalmology, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - John H. Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Angelo Manfredi
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | - Claudio Doglioni
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Pathology Unit, IRCCS-San Raffaele Scientific Institute, Milan, Italy
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