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Benson T, Kovarik C, Berry C, Sobanko J, Rosenbach M. Treatment of periorbital xanthogranuloma with fractional carbon dioxide laser. JAAD Case Rep 2024; 48:42-45. [PMID: 38774666 PMCID: PMC11107071 DOI: 10.1016/j.jdcr.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Affiliation(s)
- Travis Benson
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Corbett Berry
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Alkatan HM, Fatani DR, Maktabi AMY, Alzahem TA. Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions. BMC Ophthalmol 2024; 24:124. [PMID: 38504269 PMCID: PMC10949701 DOI: 10.1186/s12886-024-03388-8] [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: 09/21/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The "C group" of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). METHODS This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). RESULTS Twenty patients were diagnosed as "Group C" disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans' histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). CONCLUSION Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.
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Affiliation(s)
- Hind Manaa Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box 266, Riyadh, 11362, Saudi Arabia.
- Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Dalal R Fatani
- Oculoplasty and Orbit Surgery, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Tariq A Alzahem
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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3
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Lai KKH, Wong ACC, Ng JKM, Choi PCL, Cheuk W, Yip WWK, Tham CCY, Chong KKL. Immunoglobulin G4-related orbital xanthogranulomatous disease: A case series and literature review. J Fr Ophtalmol 2024; 47:103914. [PMID: 37648548 DOI: 10.1016/j.jfo.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Affiliation(s)
- K K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - A C C Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - J K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - P C L Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - W Cheuk
- Department of Anatomical and Cellular Pathology, Queen Elizabeth Hospital, Hong Kong
| | - W W K Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - C C Y Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - K K L Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Eye Hospital, Hong Kong.
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4
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Chen Y, Gao A, Tian X. Bilateral Adult-Onset Orbital Xanthogranuloma: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:3575-3580. [PMID: 38111909 PMCID: PMC10725833 DOI: 10.2147/ccid.s437616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
Adult-onset xanthogranuloma (AOX) is one of the four rare syndromes collectively referred to as adult xanthogranulomatous disease (AXD). It primarily occurs in the orbit and ocular adnexa and displays distinctive histopathological features, characterized by the infiltration of non-Langerhans-derived foam-like histiocytes and Touton giant cells. The presence of diffuse yellow plaques on the eyelids serves as a highly indicative feature. In this report, we present a compelling case of bilateral periorbital AOX. Initially, the patient received a diagnosis of necrotizing xanthogranuloma (NBX) and underwent treatment with dapsone, which yielded a poor response. Subsequently, through repeated biopsy, immunoprotein electrophoresis, and high-throughput sequencing, the diagnosis was revised to AOX. Subsequently, the patient's treatment was modified to include oral hormone therapy, and no further progression of the periorbital plaque was observed. Notably, the patient's sister was diagnosed with xanthelasma palpebrarum (XP), suggesting a potential genetic association between AOX and XP. Unfortunately, the sister declined further histologic examination and genetic sequencing of her skin lesions, impeding the acquisition of additional evidence regarding the genetic link between these two disorders. Despite the divergent pathological features, pathogenesis, and clinical presentation of AOX and xanthelasma palbrarum, clinicians should remain cognizant of the plausible genetic correlation between these two conditions and pursue further investigations when feasible.
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Affiliation(s)
- Yue Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Aili Gao
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
| | - Xin Tian
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People’s Republic of China
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5
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Eppley SE, Silkiss RZ. Bilateral primary orbital xanthogranulomas: A case report and comparison of xanthomatous conditions. J Clin Lipidol 2023; 17:587-591. [PMID: 37716832 DOI: 10.1016/j.jacl.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
This report describes an unusual and diagnostically challenging case of subcutaneous soft tissue xanthogranulomas of bilateral orbits of a 58-year-old female patient seen in a private oculoplastics practice. Accurate and timely diagnosis is crucial in xanthogranulomatous diseases so that any systemic manifestations can be identified and addressed in a multidisciplinary fashion. Periorbital xanthogranuloma is a frequent early manifestation of adult xanthogranulomatous disease, and its association with life-threatening systemic disease requires accurate diagnosis and prompt work-up. This case describes an otherwise asymptomatic patient who presented with bilateral orbital masses causing visually significant ptosis, initially diagnosed as soft tissue xanthomas, and later identified as xanthogranulomas. It is important for physicians of all fields, from primary care to surgical subspecialty, to be aware that xanthogranulomatous disease may first present as periorbital lesions and/or orbital masses, and that further work-up for vision and life-threatening systemic disease is warranted.
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Affiliation(s)
- Sarah E Eppley
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA.
| | - Rona Z Silkiss
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA
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6
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Detiger SE, Hötte GJ, Verdijk RM, de Keizer ROB, van Hagen PM, van Laar JAM, Paridaens D. Adult orbital xanthogranuloma: long-term follow-up of treated cases. Eye (Lond) 2023; 37:2475-2481. [PMID: 36526862 PMCID: PMC10397269 DOI: 10.1038/s41433-022-02357-z] [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: 08/20/2022] [Revised: 11/04/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adult orbital xanthogranulomatous disease (AOXGD) is a group of rare disorders. Four subtypes are identified: adult-onset xanthogranuloma (AOX), adult-onset asthma and periocular xanthogranuloma (AAPOX), necrobiotic xanthogranuloma (NBX), and Erdheim-Chester disease (ECD). Therapy options vary and little is known about the long-term effect of the treatment. In this study, we will describe the clinical behaviour, effect of treatment, and long-term outcome in a consecutive series of patients with AOXGD. METHODS This is a descriptive, retrospective study with a long follow-up term of 21 patients with histologically proven AOXGD, treated between 1989 and 2021 in the Rotterdam Eye Hospital and Erasmus MC University Medical Center. RESULTS Twenty-one patients with histologically proven AOXGD were included. The follow-up ranged from 2-260 months (median of 67 months). Six of the nine patients with AOX were treated with surgery alone, with recurrence in two. Three received systemic therapy, with recurrence in one. All four patients with AAPOX received systemic treatment, the disease recurred in two. Two patients with NBX were treated with surgery alone, with recurrence in one. Four required additional therapy with recurrence in two. Both patients with ECD required systemic therapy. CONCLUSIONS Recognition of AOXGD is important, in particular, because of the potential severe systemic locations in the different subtypes. Surgical excision might be a sufficient therapy for patients with AOX. Patients with AAPOX, NBX, and ECD warrant systemic therapy. Currently, there is no conclusive evidence for a superior treatment strategy, but further studies are necessary to investigate treatment options.
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Affiliation(s)
- S E Detiger
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
| | - G J Hötte
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
| | - R M Verdijk
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Department of Pathology, Section of Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R O B de Keizer
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P M van Hagen
- Departments of Internal Medicine and Immunology, section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J A M van Laar
- Departments of Internal Medicine and Immunology, section Clinical Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Paridaens
- The Rotterdam Eye Hospital, Department of Oculoplastic, Orbital and Lacrimal Surgery, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Park JK, Huang LC, Kossler AL. Erdheim-Chester disease and vemurafenib: a review of ophthalmic presentations and clinical outcomes. Orbit 2023; 42:233-244. [PMID: 35702885 DOI: 10.1080/01676830.2022.2087232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE To provide a comprehensive review of ocular and orbital manifestations of Erdheim-Chester Disease (ECD) and compare clinical outcomes with vemurafenib (INN) to historical treatments (HT). Primary outcomes are ophthalmic findings on presentation, changes in visual acuity, and mortality rate. Secondary outcomes include the progression of ocular findings, systemic involvements, and treatment modalities. METHODS All published literature from January 1983 to March 2021 was searched for ophthalmic manifestations of ECD. Clinical outcomes following HT were collected and compared with INN. RESULTS Forty-seven patients with ECD and ophthalmic presentations were identified. The mean age was 49.6 years (SD = 15.0). Proptosis (65.6%) and extraocular muscle restrictions (42.5%) were the most common presenting signs. Of 41 (87.2%) patients with orbital masses on radiologic examination, 90.2% were bilateral, and 53.7% were located in the intraconal space. Ophthalmic examination was significant for xanthelasma (27.2%), optic disc edema (34.0%), and subretinal changes (21.3%). Common treatments were systemic steroids (76.6%), interferon-α (17.0%), and cyclophosphamide (14.9%). INN was less commonly used (12.8%). The mean change in logMAR visual acuity declined with HT (29.9%) but improved with INN (79.1%) (p > 0.05). The proportion of eyes with complete vision loss increased after HT (p < 0.05). The overall mortality rate was 27.7% and notably higher in the HT group (29.3%) when compared to the INN group (16.7%) (p > 0.05). CONCLUSION ECD presents with many ophthalmic manifestations. Although the intraocular treatments remain controversial, INN should be highly considered in treating orbital ECD patients with BRAF-V600E mutations to prevent and reverse vision loss.
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Affiliation(s)
- Ji Kwan Park
- Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana, USA
| | - Laura C Huang
- Pediatric Ophthalmology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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8
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Kaplan TM, Salomao DR, Dalvin LA. An Amelanotic Choroidal Lesion in a 68-Year-Old Man. JAMA Ophthalmol 2023; 141:206-207. [PMID: 36520450 DOI: 10.1001/jamaophthalmol.2022.5336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 68-year-old man with a history of keratoconus was referred for evaluation of a choroidal lesion in his left eye. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern. What would you do next?
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Affiliation(s)
- Tyler M Kaplan
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Diva R Salomao
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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9
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Danesh K, Cohen LM, Liu Y, Karlin JN, Rootman DB. Systemic eosinophilic disease presenting as dacryoadenitis. Orbit 2023; 42:107-111. [PMID: 34514933 DOI: 10.1080/01676830.2021.1973514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eosinophilic disease with orbital involvement is rare. We present two patients with dacryoadenitis associated with local and systemic eosinophilia. A 32-year-old man presented with episodic dacryoadenitis, lower respiratory inflammation and peripheral eosinophilia. Lung and lacrimal gland biopsies demonstrated eosinophilic infiltrate without granuloma, necrosis, or vasculitis. He improved with oral corticosteroids and Mepolizumab, an IL-5 inhibitor. The second case involved a 33-year-old man who similarly presented with episodic dacryoadenitis, pulmonary inflammation and pain/swelling in the hands and feet. Lacrimal gland biopsy demonstrated a predominantly eosinophilic infiltrate without granuloma or vasculitis. Symptoms improved with oral corticosteroids. Although neither patient was provided a definitive diagnosis, both were determined to have an eosinophilic condition on the spectrum of eosinophilic asthma or eosinophilic granulomatosis with polyangiitis.
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Affiliation(s)
- Kayla Danesh
- University of California Los Angeles, Los Angeles, California, USA
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Yan Liu
- Department of Pathology and Human Anatomy, Loma Linda University Health, Loma Linda, California, USA
| | - Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
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10
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Huang S, Juniat V, Satchi K, Cohen LM, Davis G, Rootman DB, McNab A, Selva D. Bilateral lacrimal gland disease: clinical features and outcomes. Eye (Lond) 2022; 36:2163-2171. [PMID: 34725471 PMCID: PMC9582005 DOI: 10.1038/s41433-021-01819-0] [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: 07/11/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with bilateral lacrimal gland disease are a unique subset of patients where there is a paucity of literature. This presentation often represents systemic disease or malignancy and can cause diagnostic difficulties. We aim to describe the diagnoses and features of bilateral lacrimal gland disease. METHOD Retrospective multi-centre case series involving 115 patients with bilateral lacrimal gland disease from 1995 to 2020. RESULTS 115 patients were included. Their ages ranged from 9 to 85 (mean 47.3 years) with a female predominance (73, 63.5%). The most common category of diagnosis was inflammatory (69, 60%) followed by lymphoproliferative (23, 20%), structural (17, 14.8%) and other conditions (6, 5.2%). The five most common specific diagnoses were IgG4 related disease (20, 17.4%) and idiopathic orbital inflammatory disease (20, 17.4%), lymphoma (16, 13.9%), lacrimal gland prolapse (13, 11.3%), and sarcoidosis (11, 9.6%). Corticosteroid treatment was used most commonly (29, 25.2%) followed by observation (25, 21.7%). At last follow up, the majority of patients had complete resolution, significant improvement with mild residual disease or stable disease without further progression (104, 90.4%). CONCLUSION Bilateral lacrimal disease may be due to a range of aetiologies, most of which are systemic. The most common are inflammatory and lymphoproliferative conditions. Due to the wide range of aetiologies of bilateral lacrimal gland disease, it is extremely difficult to accurately determine a cause based on clinical findings alone, highlighting the vital role of lacrimal gland biopsy in patients presenting with bilateral lacrimal gland disease.
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Affiliation(s)
- Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Khami Satchi
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, Los Angeles, CA, USA
| | - Garry Davis
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, Los Angeles, CA, USA
| | - Alan McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
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Chhabra N, Cebak JE, Schmitt A, Lal D, Rosenthal AC, Taylor CM, Thorwarth RM, Shah AA, Rodriguez-Pla A. Concomitant presentation of eosinophilic or oncocytic mucoepidermoid carcinoma, immunoglobulin G4-related disease, and adult-onset asthma and periocular xanthogranuloma: Case report of 3 uncommon clinical entities. Medicine (Baltimore) 2022; 101:e30067. [PMID: 35960078 PMCID: PMC9371478 DOI: 10.1097/md.0000000000030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Immunoglobulin (Ig) G4-related disease (IgG4-RD) reportedly has a strong relationship with adult-onset asthma and periocular xanthogranuloma (AAPOX) and may be linked to sclerosing mucoepidermoid carcinoma (MEC). We present a rare case of IgG4-RD and AAPOX occurring in a patient with resected eosinophilic or oncocytic MEC. PATIENT CONCERNS A 52-year-old woman was referred to our rheumatology clinic in 2020 to be evaluated for suspected IgG4-RD. DIAGNOSES The patient had diagnoses of periorbital xanthelasmas, worsening glucocorticoid-dependent chronic rhinosinusitis and adult-onset asthma, and cervical lymphadenopathy persisting 2 years after resection of a low-grade MEC of a minor salivary gland. INTERVENTIONS Because the patient's symptomatic relief was glucocorticoid dependent, IgG4-RD was suspected, and she was referred to our medical center. Her amylase and lipase levels were elevated. Serum IgG4 levels were initially within normal limits, but IgG4-RD was diagnosed because of the presence of lymphadenopathy and evidence of pancreatitis, which was shown on positron emission tomography/computed tomography. Furthermore, the IgG4 levels later increased without explanation. After the patient began combination therapy with a glucocorticoid (prednisone) and methotrexate, her symptoms improved but recurred when the daily oral glucocorticoid dosage decreased below 10 mg. An excisional biopsy of her right submandibular gland in 2021 yielded results consistent with IgG4-RD. In addition, AAPOX was diagnosed, given the presence of periocular edema and plaques, adult-onset asthma, and rhinosinusitis. OUTCOME The patient was carcinoma free at last follow-up and was receiving medication to treat the other conditions. LESSONS The diagnosis of these 3 concomitant, uncommon entities required approximately 7 years of medical investigations. Clinicians should know that IgG4-RD, AAPOX, and MEC may occur together.
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Affiliation(s)
- Nikita Chhabra
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | - John E. Cebak
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | | | - Devyani Lal
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - Cullen M. Taylor
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ryan M. Thorwarth
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ami A. Shah
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
| | - Alicia Rodriguez-Pla
- Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona
- *Correspondence: Alicia Rodriguez-Pla, Division of Rheumatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (e-mail: )
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12
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Milman T, Eiger-Moscovich M, Henry RK, Ida CM, Ruben M, Shields CL, Lally SE, Penne RB, Stefanyszyn MA, Bilyk JR, Rapuano CJ, Rabinowitz M, Eagle RC. Cyclin D1 expression and molecular genetic findings in periocular histiocytoses and neoplasms of macrophage-dendritic cell lineage. Am J Ophthalmol 2022; 242:36-51. [PMID: 35594918 DOI: 10.1016/j.ajo.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Frequent activating mutations in the mitogen-activated protein kinase (MAPK) pathway genes have been identified in histiocytoses. MAPK signaling consistently upregulates Cyclin D1. The goal of this study was to determine whether Cyclin D1 expression by immunohistochemistry is a useful diagnostic marker for periocular histiocytoses and to further characterize their genetic basis. DESIGN Retrospective observational case series. METHODS Pathology records were searched for all patients with histiocytoses diagnosed between 1995-2020. Eleven histiocyte-rich inflammatory lesions and 10 xanthelasma served as controls. Cyclin D1 immunohistochemistry was performed on all tissues. A subset of histiocytoses was evaluated by next-generation sequencing (NGS) and droplet digital PCR (ddPCR). RESULTS There were 36 patients, 15 (42%) males and 21 (58%) females, with histiocytoses: 9 (25%) juvenile xanthogranuloma, 8 (22%) adult-onset asthma and periocular xanthogranuloma, 7 (19%) Langerhans cell histiocytosis, 5 (14%) Rosai-Dorfman disease, 5 (14%) xanthogranuloma not otherwise specified, 1 (3%) Erdheim-Chester disease, and 1 (3%) histiocytic sarcoma. Moderate-to-strong nuclear Cyclin D1 expression was present in ≥50% of lesional cells in histiocytoses (23/36, 64%), significantly more when compared to histiocyte-rich inflammatory lesions (0/11, 0%, P<.001) and xanthelasma (0/10, 0%, P<.001). Cyclin D1 was expressed in <10% of lesional cells in all 11 histiocyte-rich inflammatory lesions (P<.001) and all 10 xanthelasma lesions (P<.001). MAPK pathway gene mutations were detected in 12 of 14 (86%) histiocytoses successfully assayed by NGS and/or ddPCR. CONCLUSIONS Our study confirms that the Cyclin D1 immunohistochemical stain is a useful diagnostic marker for periocular histiocytoses, correlating with underlying mutations in MAPK pathway genes.
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Affiliation(s)
- Tatyana Milman
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Maya Eiger-Moscovich
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Maya Eiger-Moscovich is currently practicing at Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel. Meghan Ruben is currently practicing at Department of Ophthalmology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Roger K Henry
- Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School at Rutgers University (R.K.H.), Newark, New Jersey
| | - Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Mayo Clinic College of Medicine and Science (C.M.I.), Rochester, Minnesota; USA
| | - Megan Ruben
- Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sara E Lally
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert B Penne
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service (M.Ru., C.L.S., S.E.L., R.B.P.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mary A Stefanyszyn
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jurij R Bilyk
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher J Rapuano
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Cornea Service (C.J.R.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rabinowitz
- Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Oculoplastic and Orbital Surgery (M.A.S., J.R.B., M.Ra.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- From the Department of Pathology (T.M., M.E.-M., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology (T.M., C.L.S., S.E.L., R.B.P., M.A.S., J.R.B., C.J.R., M.Ra., R.C.E.), Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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13
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Andron AA, Nair AG, Della Rocca D, Della Rocca RC, Reddy HS. Concomitant adult onset xanthogranuloma and IgG4-related orbital disease: a rare occurrence. Orbit 2022; 41:108-111. [PMID: 32847452 DOI: 10.1080/01676830.2020.1814353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Adult onset xanthogranulomatous disease is a rare orbital disease. IgG4-related disease is a systemic disease that can often manifest in the orbit. In this communication, we present the case of a patient with a xanthelasma-like lesion on the upper eyelid, and an enlarged lacrimal gland, which on biopsy was diagnosed as an orbital xanthogranuloma. Detailed serological workup showed that the patient was found to have elevated serum IgG4 levels. The orbital specimen was re-stained and found to be positive for IgG4. The patient was treated with oral steroids with partial resolution of the lesion. This is an interesting case of both histopathological adult onset xanthogranuloma (AOX) and IgG4-related orbital disease (IgG4-ROD). The early evidence suggests that the diagnosis of one of these disorders should point the physician to investigate for the presence of the other, especially if xanthogranulomatous disease is diagnosed first.
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Affiliation(s)
- Aleza A Andron
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
- Department of Ophthalmology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India
| | - David Della Rocca
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Robert C Della Rocca
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Harsha S Reddy
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
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14
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Cozzani E, Muracchioli A, Orcioni GF, Parodi A. Symmetrical Periorbital Yellow Plaques in a Patient with Haematological Dyscrasia: A Quiz. Acta Derm Venereol 2021; 101:adv00612. [PMID: 34708246 PMCID: PMC9472095 DOI: 10.2340/actadv.v101.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Andrea Muracchioli
- Di.S.SAL Section of Dermatology, University of Genoa, Section of Dermatology, University of Genoa DiSSal, IRCCS Policlinic Hospital San Martino-IST, IT-16132 Genoa, Italy.
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15
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Jois B, Ananthasivan R, Rawat PRVS, Rakshit S. Role of 18 F-FDG PET/CT in Erdheim-Chester Disease in the Era of Multimodality Imaging. Indian J Radiol Imaging 2021; 31:729-734. [PMID: 34790325 PMCID: PMC8590557 DOI: 10.1055/s-0041-1736164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Erdheim–Chester disease is a rare disease with systemic non-Langerhans cell histiocytosis, the diagnosis of which with conventional imaging modalities is challenging. We describe a case of a 73-year-old woman who was referred with a progressive history of bilateral proptosis. The magnetic resonance imaging (MRI) orbit demonstrated bilateral orbital masses with optic nerve encasement. A subsequent 18F-FDG PET/CT scan showed multi-organ disease with involvement of the orbits, pericardium, aorta, pararenal fascia, and appendicular bones. Metabolically active, easily accessible areas were selected for CT-guided biopsy. The biopsy showed sheets of foamy histiocytes with the expression of CD 68 and CD 163 consistent with a diagnosis of Erdheim–Chester disease. The FDG PET/CT played a pivotal role in establishing the diagnosis with the assessment of disease extent and further guided in the targeted biopsy.
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Affiliation(s)
- Bhargavi Jois
- Department of Nuclear Medicine, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospitals, Bengaluru, Karnataka, India
| | | | - Susmita Rakshit
- Department of Pathology, Manipal Hospitals, Bengaluru, Karnataka, India
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16
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Alkatan HM, Alzahem TA, Maktabi AMY. Ophthalmic histiocytic lesions: a baseline demographic and clinicopathological study of 28 cases from two eye centers. Int Ophthalmol 2021; 42:1221-1232. [PMID: 34727265 DOI: 10.1007/s10792-021-02108-1] [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: 02/14/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ophthalmic histiocytic lesions comprise a heterogeneous rare group of disorders that are characterized by an abnormal proliferation of histiocytes and may affect all age groups of both sexes. The aim of this study was to highlight the basic demographic, clinical, and histopathological characteristics of this rare group of diseases in ophthalmic practice, which has not been previously studied in this area. Only individual cases have been previously reported. METHODS This was a retrospective study of all biopsied ocular and periocular histiocytic lesions from two centers, King Khaled Eye Specialist Hospital (KKESH) and King Abdulaziz University Hospital (KAUH) in Riyadh, Saudi Arabia, from January 1993 to December 2018. The histopathological diagnosis was confirmed, and the cases were re-classified by reviewing all histopathological slides. The corresponding demographic and clinical data were analyzed. A relevant literature review was also carried out for comparison of our collected analyzed data to published data and to draw our own conclusions. RESULTS A total of 34 ocular/periocular histiocytic lesions in 28 patients who were mostly Saudis (92.9%) were included. The male-to-female ratio was 4:3. The median age at presentation was 6.4 years (range: 2.8-35 years). Twenty-two patients had unilateral involvement, and six patients had bilateral lesions. In patients with Langerhans cell histiocytosis (LCH; L group), the most common presenting findings were eyelid swelling (75%), periocular tenderness (37.5%), proptosis/globe displacement (37.5%) eyelid erythema (25%), and orbital pain (12.5%). In patients with Rosai Dorfman disease (RDD; R group), proptosis/globe displacement occurred in all patients and 80% had decreased vision. Patients in the C group (Cutaneous non-LCH histiocytoses) had variable clinical features because of the different locations of the histiocytic lesions, with the majority involving the eyelids (66.7%). Diagnosis was accurately reached clinically in 38.8%, 33.7%, and 46.7% of patients in the L, C, and R groups, respectively. Overall, the clinical diagnosis was in concordance with the histopathologic diagnosis in 14 out of 34 lesions (41.2%). CONCLUSIONS Histiocytic disease is more likely to be overlooked clinically owing to its rarity. In the C group, juvenile xanthogranuloma (JXG) was the most commonly encountered histiocytic lesion and had a tendency to present at a later age with extremely rare intraocular involvement in contrast to previously published reports. The median age at presentation was higher in group R. All patients in group L had strictly unilateral disease, while RDD (group R) was most commonly bilateral. Future research on genetic aspects, management, and prognosis is necessary.
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Affiliation(s)
- Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia. .,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. .,Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Tariq A Alzahem
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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17
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Guo B, Juniat V, Gilhotra A, Selva D. Corneal limbal xanthogranuloma in Erdheim-Chester disease. Can J Ophthalmol 2021; 57:e87-e89. [PMID: 34715037 DOI: 10.1016/j.jcjo.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Brad Guo
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
| | - Valerie Juniat
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
| | | | - Dinesh Selva
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
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18
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Kim J, Steeples LR, Jones NP. Ocular Involvement in the Histiocytoses: A Literature Review with an Illustrative Case Series. Ocul Immunol Inflamm 2021; 30:600-614. [PMID: 34637661 DOI: 10.1080/09273948.2021.1936566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexaePatients and methods: Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre.Results: Skin lesions with signs including eyelid mass, orbital bone destruction, bizarre keratic precipitates, limbal or iris mass, haemorrhagic anterior uveitis, subretinal lesions of uncertain etiology, ischaemic retinopathy, optic neuropathy, and apparent steroid-resistant inflammations should be comprehensively investigated.Conclusions: Ophthalmic involvement in histiocytosis is rare. Clinical manifestations vary from limited single-organ disease to lethal systemic infiltration or malignancy. Radiology may identify lesions for biopsy. Histology with appropriate markers is essential. Oncology advice may be required.
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Affiliation(s)
- Jennifer Kim
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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19
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Shapira Y, Juniat V, Smith C, Selva D. Adult-Onset Xanthogranuloma With Frontal Nerve and Intracranial Involvement. Ophthalmic Plast Reconstr Surg 2021; 37:e167-e170. [PMID: 33710041 DOI: 10.1097/iop.0000000000001964] [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: 11/25/2022]
Abstract
Adult-onset xanthogranuloma (AOX) typically affects the preseptal and anterior orbital regions. The authors report a 49-year-old man with a 6-month history of unilateral AOX, demonstrating diffuse extraconal and intraconal orbital involvement, including the lacrimal gland and extraocular muscles. There was frontal nerve enlargement, intracranial and pterygopalatine fossa involvement. Investigations excluded IgG4 disease and Erdheim-Chester disease. This case illustrates that AOX may be added to the causes of orbital nerve enlargement and may demonstrate intracranial extension.
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Affiliation(s)
- Yinon Shapira
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | | | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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20
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Green MB, Daly MK, Laver NMV, Lefebvre DR. Adult-onset asthma and periocular xanthogranuloma - A rare infiltrative disease of the orbit and eyelid. Am J Ophthalmol Case Rep 2021; 22:101043. [PMID: 33869889 PMCID: PMC8044650 DOI: 10.1016/j.ajoc.2021.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/25/2021] [Accepted: 02/22/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To present a case of adult onset asthma with periocular xanthogranuloma (AAPOX), and discuss existing literature on adult orbital xanthogranulomatous diseases (AOXGDs) and their treatment. Observations A 63 year old male presented with progressive bilateral eyelid swelling with overlying yellow plaques associated with asthma. CT scan showed periorbital swelling with enlargement of the superior and lateral rectus muscles bilaterally. Biopsy demonstrated orbital xanthogranulomatous disease with increased IgG4 plasma cells. The patient was treated with intralesional triamcinolone, oral prednisone, and cyclophosphamide without significant improvement. Surgical debulking was eventually performed which improved his external symptoms until he was lost to follow up 15 months later. Conclusions and Importance AOXGDs are a group of rare infiltrative diseases of the eyelids and orbit that can be associated with significant systemic morbidities. While they all have similar underlying histopathologic features, appreciating the clinical difference between these diseases is important in understanding patient prognosis and ensuring appropriate clinical monitoring. There is also growing research demonstrating that AAPOX, along with other AOXGDs, may represent part of a continuum of IgG4 related disease, similar to what is seen in this case. There is currently no reliably effective treatment for AOXGDs, and additional research into the management of these diseases is necessary.
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Affiliation(s)
- Michael B Green
- Veterans Affairs Boston Healthcare System, Department of Ophthalmology, 150 South Huntington Avenue, Boston, MA, 02130, USA.,Boston University School of Medicine, Department of Ophthalmology, 72 East Concord Street, Boston, MA, 02118, USA
| | - Mary K Daly
- Veterans Affairs Boston Healthcare System, Department of Ophthalmology, 150 South Huntington Avenue, Boston, MA, 02130, USA.,Boston University School of Medicine, Department of Ophthalmology, 72 East Concord Street, Boston, MA, 02118, USA.,Harvard Medical School, Department of Ophthalmology, 243 Charles Street, Boston, MA, 02114, USA
| | - Nora M V Laver
- Tufts University School of Medicine, Department of Ophthalmology and Department of Pathology and Laboratory Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Daniel R Lefebvre
- Veterans Affairs Boston Healthcare System, Department of Ophthalmology, 150 South Huntington Avenue, Boston, MA, 02130, USA.,Harvard Medical School, Department of Ophthalmology, 243 Charles Street, Boston, MA, 02114, USA
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21
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Paul N, Farah E, Zmuda M, Galatoire O. [Secondary eyelid pockets: Pitfalls in blepharoplasty surgery]. J Fr Ophtalmol 2021; 44:331-339. [PMID: 33516573 DOI: 10.1016/j.jfo.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Requests for cosmetic eyelid surgery are frequent. The surgeon must carry out a complete clinical examination in order to rule out any orbital pathologies responsible for eyelid pockets. METHODS Study of ten patients who have consulted in the oculopalpebral surgery department of La Fondation Ophtalmologique de Rothschild for cosmetic surgery of the eyelid pockets and in whom an underlying pathology was diagnosed. RESULTS The clinical examination allows to look for signs of alarms, such as medical history, unilateral involvement, pain and the presence of exophthalmos. These should lead to perform orbital imaging and surgical biopsy if an orbital mass has been identified for histological analysis which will make the diagnosis. We identified four cases of orbital lymphoma, one foreign body granuloma, chronic bilateral dacryoadenitis, sarcoidosis involvement, AAPOX syndrom, cavernous hemangioma, and simple fatty hernia. CONCLUSION These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.
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Affiliation(s)
- N Paul
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France.
| | - E Farah
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
| | - M Zmuda
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
| | - O Galatoire
- Service de chirurgie orbito-palpébrale, Fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
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22
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Brodie J, Zhou S, Makkuni D, Beadsmoore C, Mukhtyar C, Saada J, Bowles KM, Beigi B, Burton BJL. Erdheim-Chester Disease: Two cases from an ophthalmic perspective. Am J Ophthalmol Case Rep 2020; 20:100984. [PMID: 33204897 PMCID: PMC7649437 DOI: 10.1016/j.ajoc.2020.100984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose We report two patients who presented initially to ophthalmology clinics with symptoms and signs of orbital inflammation that led to a diagnosis of Erdheim-Chester Disease (ECD). Observations ECD is a rare form of non-Langerhans cell histiocytosis (LCH) which is characterised by multi-system organ involvement and poor prognosis with standard therapies. Both patients were positive for the BRAF V600E mutation on genetic testing and were treated with the BRAF inhibitors Vemurafenib and Dabrafenib respectively. These cases highlight the variable clinical presentation and course of ECD, the classical radiological and histopathological findings, and the high degree of clinical suspicion necessary to reach this diagnosis. Conclusions and importance The combination of xanthelasma and bilateral, diffuse intraconal orbital masses must suggest to the clinician the possibility of ECD; and consideration to arrange further investigation with a full body CT or FDG PET/CT scan should be given, even in the absence of wider systemic symptoms or signs. With the advent of targeted therapies such as BRAF inhibitors, it is of even more importance that a diagnosis of ECD is established in a timely manner in order to give these patients the best chance of reduced morbidity and increased survival.
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Affiliation(s)
- James Brodie
- Department of Ophthalmology, James Paget University Hospitals NHS Trust, Great Yarmouth, Norfolk, United Kingdom.,Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Sean Zhou
- Department of Ophthalmology, James Paget University Hospitals NHS Trust, Great Yarmouth, Norfolk, United Kingdom
| | - Damodar Makkuni
- Department of Rheumatology, James Paget University Hospitals NHS Trust, Great Yarmouth, Norfolk, United Kingdom
| | - Clare Beadsmoore
- Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Janak Saada
- Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Kristian M Bowles
- Department of Medicine - Haematology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Bijan Beigi
- Department of Ophthalmology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, United Kingdom
| | - Ben J L Burton
- Department of Ophthalmology, James Paget University Hospitals NHS Trust, Great Yarmouth, Norfolk, United Kingdom
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23
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Gu JH, Lee GH. Xanthogranuloma formation after endoscopic sinus surgery: A case report. Int J Surg Case Rep 2020; 76:263-265. [PMID: 33053486 PMCID: PMC7566200 DOI: 10.1016/j.ijscr.2020.09.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Although xanthogranuloma is known to be related to trauma or mucosa, possibly developing around a periorbital or oral lesion, xanthogranuloma related to sinusitis urgery has not been reported. We present a case of xanthogranuloma formation after endoscopic sinus surgery (ESS). Presentaion of case A 54-year-old man with pain and swelling in the right periorbital area presented to our clinic. He had had a blowout fracture treated by ESS 2 years prior. Physical examination and computed tomography revealed an ∼1-cm × 0.7-cm cystic mass on the right lower eyelid. Subciliary exploration found a fat-like mass that we completely excised. A histological examination revealed xanthogranuloma. No recurrence was observed for 1 year. Discussion If the wall between the sinuses and the orbit and the mucosa of the maxillary sinus are injured during ESS, infectious material and hematoma could develop into chronic granulomatous inflammation. In addition, a large antrostomy and/or a damaged nasolacrimal duct are risk factors for xanthogranuloma. Antibiotics can treat the disease and prevent infection. Progressive growth of the lesion and its infiltration into surrounding tissues may result in surgical resection. Conclusion Because many masses are idiopathic, the development of xanthogranuloma after simple ESS or a nondisplaced blowout fracture is possible. Although xanthogranuloma progression usually is benign and without specific complications, it may be sight- or life-threatening. Antibiotics and surgical resection are the treatments of choice and the latter can be a diagnostic tool. Physicians should be aware of the possibility of granuloma formation in patients who have undergone ESS.
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Affiliation(s)
- Ja Hea Gu
- Department of Plastic Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea.
| | - Gyu Hyeong Lee
- Department of Plastic Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
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24
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Sahu K, Sethy M, Sirka CS, Rout AN. Adult-Onset Asthma with Periocular Xanthogranuloma (AAPOX), a Variant of Periorbital Xanthogranulomatous Disease: An Uncommon Entity. Indian Dermatol Online J 2020; 11:792-795. [PMID: 33235848 PMCID: PMC7678554 DOI: 10.4103/idoj.idoj_541_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/20/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
Adult orbital xanthogranulomatous disease (AOXGD) is a rare granulomatous disorder. Adult-onset asthma with periocular xanthogranuloma (AAPOX) which is a subtype of AOXGD is very rare and a realtively unknown entity among dermatologists. Very few cases had been reported in literature. Clinically recurrent periorbital swelling and its location may mimic other dermatological conditions like sarcoidosis, necrobiotic xanthogranuloma, dermatomyositis, and rarely amyloidosis. Herein we report a female with recurrent periorbital swelling with brownish yellow papulonodular lesions on periorbital area with adult-onset asthma. Histopathology and immunohistochemistry proved the diagnosis. She was started with systemic methylprednisolone and methotrexate and improved significantly after 4 months. We report this case because of its rarity and to create awareness among dermatologists about this uncommon entity.
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Affiliation(s)
- Kananbala Sahu
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhusmita Sethy
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra Sekhar Sirka
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arpita Nibedita Rout
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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25
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Leung KCP, Lam NKY, Chan E, Ko TCS. Primary recurrent orbital schwannoma treated with surgical excision and Mitomycin-C. Am J Ophthalmol Case Rep 2020; 19:100784. [PMID: 32613139 PMCID: PMC7315101 DOI: 10.1016/j.ajoc.2020.100784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Primary orbital schwannoma (POS) is a slow growing, benign encapsulated peripheral nerve sheath tumor that occurs infrequently within the orbit. Recurrence of POS is extremely rare. Previous speculations for reasons of recurrence include incomplete excision and tumor seeding. Observations We present the fifth case reported in the literature to date of POS that had 2 episodes of recurrences within 8 years after diagnosis, in which rapid and insidious relapses were observed after initial surgical resection. This is also the first reported recurrent POS in which topical Mitomycin-C (MMC) has been employed during surgical excision with an aim to prevent further recurrences. Conclusions AND IMPORTANCE: Whilst complete surgical excision remained the standard for management for most POS, when there are multiple recurrences and in cases where total excision is not possible, addition of topical MMC may be an option that may bring about tumour regression as demonstrated in our case.
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Affiliation(s)
| | - Nerissa Kei Yen Lam
- Department of Ophthalmology, Tuen Mun Eye Centre, Tuen Mun Hospital, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hosptial, Causewaybay, Hong Kong
| | - Tak Chuen Simon Ko
- Department of Ophthalmology, Tung Wah Eastern Hosptial, Causewaybay, Hong Kong
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26
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Sönmez Ergün S, Kirazoğlu A, Yildiz P. Surgical treatment of adult-onset xanthogranuloma. Dermatol Ther 2020; 33:e13577. [PMID: 32410364 DOI: 10.1111/dth.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/24/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Selma Sönmez Ergün
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Medical School, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Kirazoğlu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Medical School, Bezmialem Vakif University, Istanbul, Turkey
| | - Pelin Yildiz
- Department of Pathology, Bezmialem Medical School, Bezmialem Vakıf University, İstanbul, Turkey
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27
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Wollina U, Schönlebe J, Abdel-Naser MB, Goldman A. Adult-onset xanthogranuloma on earlobe-A very rare condition. Dermatol Ther 2020; 33:e13495. [PMID: 32356574 DOI: 10.1111/dth.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching, Hospital Dresden-Friedrichstrasse in Dresden, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Mohamed B Abdel-Naser
- Department of Dermatology and Venereology, Ain Shams University Hospital, Cairo, Egypt
| | - Alberto Goldman
- Clinica Goldman and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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28
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White VA. Understanding and Classification of Ocular Lymphomas. Ocul Oncol Pathol 2019; 5:379-386. [PMID: 31768360 PMCID: PMC6872993 DOI: 10.1159/000499845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lymphomas that involve the tissues of the ocular adnexae and the eye itself can be confusing for both the new and seasoned learner alike. In this review, I present a simple way of classifying these disorders that will help to facilitate understanding of these myriad entities. SUMMARY Classifications of lymphomas have changed significantly over the last 40 years, but in recent decades, the basic structure of the WHO classification has remained the same, facilitating understanding. KEY MESSAGES The ocular lymphomas can be divided into those that are external to the eye (ocular adnexae) and those that are internal (vitreoretinal and uveal). At each of these sites specific subtypes of lymphoma are common. Focusing on these common subtypes can aid the learner to create a scaffold that enables current understanding and upon which they can build for the future.
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Affiliation(s)
- Valerie A. White
- WHO/IARC Classification of Tumours Group, International Agency for Research on Cancer, Lyon, France
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29
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Asproudis I, Kanari M, Ntountas I, Ragos V, Goussia A, Batistatou A, Voulgari PV. Successful treatment with rituximab of IgG4-related disease coexisting with adult-onset asthma and periocular xanthogranuloma. Rheumatol Int 2019; 40:671-677. [PMID: 31392499 DOI: 10.1007/s00296-019-04409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
Immunoglobulin G4-related disease (IgG4RD) is a systemic fibro-inflammatory disease of unknown aetiology, which is characterized by tumefactive lymphoplasmatocytic infiltrative lesions, with a predominance of IgG4 positive plasma cells, fibrosis and obliterative phlebitis. Adult-onset asthma and periocular xanthogranuloma (AAPOX) is a rare disease of unknown aetiology characterized by violaceous or yellow cutaneous papules and nodules usually accompanied with adult-onset asthma. We report a case of IgG4RD associated with AAPOX. We also conducted a literature search with keywords including IgG4RD and AAPOX. A 36-year-old woman presented with bilateral exophthalmos and periorbital oedema. Keratoconjunctivitis sicca, painless left parotid gland and submandibular left lymph node enlargement were also noted. Two and half years ago biopsy of yellow plaques of her right lower eyelid confirmed periorbital xanthogranuloma. She underwent parotid gland biopsy which showed IgG4RD. She was treated with steroids and two cycles of rituximab with complete remission. The literature review revealed 8 articles describing 14 cases with IgG4RD and AAPOX, 9 men and 5 women (ratio M:F = 1.8:1) were affected. The age at diagnosis was greater in men compared to women. In the majority of patients, ophthalmic presentation included bilateral upper and lower eyelid swelling while systemic features were asthma, lacrimal and parotid involvement, lymphadenopathy, sclerosing pancreatitis and sclerosing cholangitis. Prednisone and rituximab were effective treatments. It has to be clarified whether the association between IgG4RD and AAPOX represents shared pathophysiology, a common underlying cause or coincidence. Rituximab added to steroids resulted in complete remission of the two entities.
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Affiliation(s)
- Ioannis Asproudis
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Maria Kanari
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Ntountas
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Ragos
- Department of Oral and Maxillofacial Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Paraskevi Vasileios Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.
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30
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Gallo J, Piermattei N, Albertengo A, Stone JH, Paira S. A 26-Year-Old Woman With Asthma and Bilateral Ocular Swelling. Arthritis Care Res (Hoboken) 2019; 69:587-591. [PMID: 27273870 DOI: 10.1002/acr.22947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/27/2016] [Accepted: 05/31/2016] [Indexed: 01/31/2023]
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31
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Maeng MM, Godfrey KJ, Jalaj S, Kazim M. Adult xanthogranulomatous disease of the orbit: case report of spontaneous regression and review of treatment modalities. Orbit 2019; 39:31-37. [PMID: 31021176 DOI: 10.1080/01676830.2019.1590421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult xanthogranulomatous disease of the orbit is a rare and incompletely understood entity. It can be limited to the orbit or be associated with systemic disease. While routine systemic surveillance is the standard of care for patients with orbital xanthogranulomatous disease, there is no universally accepted protocol for managing periorbital and orbital involvement. The authors report a case of adult orbital xanthogranuloma, without systemic disease, who, after 10 years of observation, demonstrated sustained radiographic regression of the lesions. To the authors' knowledge, this represents one of the first reports of spontaneous regression of untreated orbital xanthogranuloma, and supports observation of lesions that do not compromise ocular function. We present our case in the context of a major review of various treatment strategies described in the literature, including surgical resection, radiotherapy, plasmapheresis, corticosteroids, multiple immunomodulatory medications.
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Affiliation(s)
- Michelle M Maeng
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Kyle J Godfrey
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Sanjai Jalaj
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael Kazim
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
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Ding X, Cao Y, Xing Y, Ge S, Lin M, Li J. TIMP-1 Mediates Inflammatory and Immune Response to IL-6 in Adult Orbital Xanthogranulomatous Disease. Ocul Immunol Inflamm 2019; 28:288-297. [PMID: 30973282 DOI: 10.1080/09273948.2019.1581227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore the pathogenesis that TIMP-1 mediated in adult orbital xanthogranulomatous disease (AOXGD), a rare type of non-Langerhans histiocytosis that damages the appearance and quality of life of patientsMethods: We reviewed 22 patients diagnosed with AOXGD based on clinical manifestations and histological analysis, and then investigated the expression of TIMP-1 and IL-6 with q-PCR and IHC in AOXGD tissues and the possible mechanism involved in the induction of TIMP-1 by IL-6.Results: IL-6 and TIMP-1 were significantly increased in AOXGD tissues. IL-6 promoted TIMP-1 production by M1 macrophages by stimulating the phosphorylation of JAK2 and STAT3. Moreover, IL-17 and IFN-γ, the classical markers of Th1 and Th17 cells, were increased in AOXGD.Conclusion: These data implied that the IL6~JAK2/STAT3-TIMP-1 signalling pathway is activated in AOXGD and that adaptive Th1 and Th17 responses are involved in the development of AOXGD.
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Affiliation(s)
- Xia Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuan Cao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Xing
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ming Lin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Navarro-Hernández E, Hernández-Pons A, Montolío-Marzo S, Pérez-López M. Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling. ACTA ACUST UNITED AC 2019; 94:248-251. [PMID: 30712950 DOI: 10.1016/j.oftal.2018.12.004] [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: 10/23/2018] [Revised: 12/02/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas.
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Affiliation(s)
- E Navarro-Hernández
- Servicio de Oftalmología, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - A Hernández-Pons
- Servicio de Oftalmología, Hospital Universitario Dr. Peset, Valencia, España
| | - S Montolío-Marzo
- Servicio de Oftalmología, Unidad de Órbita, Párpados y Vía Lagrimal, FISABIO Oftalmología Médica, Valencia, España.
| | - M Pérez-López
- Servicio de Oftalmología, Unidad de Órbita, Párpados y Vía Lagrimal, FISABIO Oftalmología Médica, Valencia, España
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34
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Miola AC, Marques MEA, Miot HA. Necrobiotic xanthogranuloma (without paraproteinemia) in a patient with Pelger-Huët anomaly. Int J Dermatol 2018; 58:E93-E94. [PMID: 30588610 DOI: 10.1111/ijd.14365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anna C Miola
- Department of Dermatology and Radiotherapy, FMB-UNESP, Botucatu, São Paulo, Brazil
| | | | - Helio A Miot
- Department of Dermatology and Radiotherapy, FMB-UNESP, Botucatu, São Paulo, Brazil
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35
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Jakobiec FA, Ma L, Wolkow N, Sutula FC, Freitag SK. The Significance of Extracellular Cholesterol Crystals or a Cholesterol Granuloma in Xanthelasma. Ocul Oncol Pathol 2018; 4:345-354. [PMID: 30574485 DOI: 10.1159/000486532] [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: 12/06/2017] [Revised: 12/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Xanthelasma is an unreliable indicator of systemic hyperlipidemia. A review in search of unusual histopathologic features of cellular composition that might correlate with systemic hyperlipidemia was conducted. Methods An observational case series of 3 cases was performed. Slides were stained and analyzed with hematoxylin and eosin, Masson trichrome, and periodic acid-Schiff as well as for iron. Three lesions displayed an atypical morphologic finding and were subjected to immunohistochemical analysis for CD3, CD20, CD68, CD163, S100, and adipophilin. Results The three lesions comprised in this study had classical xanthoma cells with densely packed fine vacuoles. The xanthoma cells were CD68, CD163, and adipophilin positive and S100 negative. In case 1, extracellular, nonpolarizing cholesterol crystalloids displayed totally negative staining for all biomarkers. In cases 2 and 3, the cholesterol granulomas were surrounded and permeated by CD68- or CD163-positive epithelioid and giant cells and by CD3-positive T lymphocytes. The 3 cases each harbored squamous cysts. Conclusion In case 1, the uninflamed extracellular cholesterol crystalloids were associated with severely dysregulated systemic hyperlipidemia. In cases 2 and 3, the cholesterol granulomas were interpreted as a local manifestation of a cyst that might have partially ruptured and did not portend serious hyperlipidemia.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lina Ma
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis C Sutula
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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36
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Hellman JB, Kim E, Lin LK. Recurrent Bilateral Periorbital Swelling. JAMA Ophthalmol 2018; 136:1406-1407. [PMID: 30242331 DOI: 10.1001/jamaophthalmol.2018.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Esther Kim
- University of California, Davis, Eye Center, Sacramento
| | - Lily Koo Lin
- University of California, Davis, Eye Center, Sacramento
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37
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Singh M, Gautam N, Kaur M, Yadav D, Gupta P. Intravenous rituximab for the treatment of relapsing adult-onset asthma with periocular xanthogranuloma. Can J Ophthalmol 2018; 54:e115-e118. [PMID: 31109495 DOI: 10.1016/j.jcjo.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Natasha Gautam
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Yadav
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chen TP, Yi WL, Liu CS, Lin YH. Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus: A case report and literature review. Medicine (Baltimore) 2018; 97:e12615. [PMID: 30290633 PMCID: PMC6200551 DOI: 10.1097/md.0000000000012615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues. PATIENT CONCERNS A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only. DIAGNOSES Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma. INTERVENTIONS Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside. OUTCOMES The patient recovered from the disease without posttreatment comorbidities. LESSONS This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.
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Affiliation(s)
- Tzu-Pai Chen
- Medical College of National Cheng Kung University
| | - Wan-Ling Yi
- Medical College of National Cheng Kung University
| | | | - Yu-Hsuan Lin
- Department of Otolaryngology, Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Otolaryngology, Head and Neck Surgery, National Defense, Medical Center, Taipei, Taiwan, Republic of China
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39
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Dunkley L, Mudhar HS. IgG4-related disease presenting with raised serum IgG2-real timeline of IgG4-RD? Rheumatology (Oxford) 2018; 57:197-199. [PMID: 29155962 DOI: 10.1093/rheumatology/kex371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
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40
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Abad S, Héran F, Terrada C, Bielefeld P, Sène D, Trad S, Saadoun D, Sève P. [Management of orbital inflammation in internal medicine. Proposal for a diagnostic work-up]. Rev Med Interne 2018; 39:746-754. [PMID: 29398045 DOI: 10.1016/j.revmed.2017.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 12/17/2022]
Abstract
Inflammatory orbitopathies relate to an inflammatory state originating within the orbit and its adnexes, except the inner ocular globe. Orbital inflammation (OI) may be either localized manifestation of a proven or like autoimmune disease, or local response from immune system against infectious, structural or tumoral antigens. We review the clinical manifestations of OI, which provide helpful clues to the diagnosis and describe the inflammatory, infectious and neoplastic conditions classically associated with OI. Autoimmune diseases are probably the most common causes of OI associated with a bilateral dacryoadenitis (e.g., sarcoidosis, granulomatosis with polyangiitis, IgG4-related disease). We focused on a major part of the IgG4-RD spectrum, the IgG4-related orbital disease which has been recently described and the idiopathic orbital inflammation syndrome that one should consider in patients 40 years of age or older with non specific inflammation OI on biopsy but without underlying local or systemic disease. An algorithm for the diagnostic approach of OI was proposed. If systemic explorations fail to diagnose an underlying disease, histopathologic control is required for distinguishing non-specific OI from other differential diagnosis, especially lymphoma. In the cases of pure myositic locations and posteriorly located tumours where biopsy could damage to the optic nerve, analysis of orbital lesions in T2W IRM sequence may be helpful to distinguish idiopathic OI (IOI) from lymphoma. When the diagnostic work-up fails, a corticosteroid trial could be used, but its beneficial effect has to be cautiously interpretated before definitively diagnosing IOI. Finally, treatments used in main infllammatory orbitopathies were also reviewed.
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Affiliation(s)
- S Abad
- UMR1125, LI2P, service de médecine interne, hôpital Avicenne, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny cedex 09, France.
| | - F Héran
- Service d'imagerie, Fondation Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France.
| | - C Terrada
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, groupe hospitalier (GH) Pitié-Salpêtrière, université Paris 6, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France; Centre Roule-Péretti, 169, avenue Achille-Péretti, 92200 Neuilly-sur-Seine, France.
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, hôpital du Bocage, 2, boulevard Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - D Sène
- Service de médecine interne B, hôpital Lariboisière, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, université Sorbonne Paris Cité- Paris Diderot, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 9, avenue du Général-de-Gaulle, 92100 Boulogne-Billancourt, France; Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), 55, avenue de Paris, 78000 Versailles, France.
| | - D Saadoun
- Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, université Pierre-et-Marie Curie, AP-HP, Paris 6, 75013 Paris, France; DHU I2B, inflammation, immunopathology, biotherapy, UPMC, Paris 6, 75013 Paris, France; Centre national de référence des maladies auto-immunes et systémiques rares, 75013 Paris, France.
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, hospices Civils de Lyon, université de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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MRI Findings of Adult-Onset Orbital Xanthogranulomatous Disease : A Case Report. Clin Neuroradiol 2018; 28:601-604. [PMID: 29427029 DOI: 10.1007/s00062-018-0673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
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Unlu B, Ayhan Z, Lebe B, Men S, Durak I, Saatci AO. Unilateral Adult Xanthogranulomatous Infiltration of the Conjunctiva, Limbus and Sclera Leading to a Combined Ophthalmic Artery and Central Retinal Vein Occlusion. Open Ophthalmol J 2018; 11:362-367. [PMID: 29299083 PMCID: PMC5725586 DOI: 10.2174/1874364101711010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/28/2017] [Accepted: 11/10/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the features of a female patient with a biopsy-proven xanthogranulomatous infiltration of the conjunctiva, limbus and sclera who had an exudative retinal detachment, combined ophthalmic artery and central retinal vein occlusion unilaterally. Method A-53-year old otherwise healthy woman presenting with a painful visual loss in her right eye underwent an ophthalmic examination, meticulous systemic work-up and histopathologic assessment. Results Ophthalmic examination revealed multiple subconjunctival masses, upper limbal infiltrations, trace cells in the anterior chamber, pale looking posterior fundus, 360 degree scattered retinal hemorrhages and marked exudative retinal detachment in her right eye. Left eye was completely normal.A biopsy taken from one of the subconjunctival masses demonstrated a diffuse infiltration of the histiocytes and this was interpreted as a xanthogranulomatous infiltration with the help of immunohistochemical staining techniques. Conclusion Present case is the only reported adult case with xanthogranulomatous-like infiltration of the eyeball featuring both anterior and posterior segment involvement without any concomitant major systemic disturbances.
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Affiliation(s)
- Burak Unlu
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Banu Lebe
- Department of Pathology, Dokuz Eylul University, İzmir, Turkey
| | - Suleyman Men
- Department of Radiology, Dokuz Eylul University, İzmir, Turkey
| | - Ismet Durak
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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Lee S, Chung S, Heo J, Lew H. IgG4-related Ophthalmic Disease Associated with Adult Xanthogranulomatous Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.11.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seunghyun Lee
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sokjoong Chung
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea
| | - Jinhyung Heo
- Department of Pathology, CHA Bundang Medical Center, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea
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Keorochana N, Klanarongran K, Satayasoontorn K, Chaiamnuay S. Necrobiotic xanthogranuloma scleritis in a case of granulomatosis with polyangiitis (Wegener's granulomatosis). Int Med Case Rep J 2017; 10:323-328. [PMID: 29042820 PMCID: PMC5633293 DOI: 10.2147/imcrj.s145943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to describe a case of necrobiotic xanthogranuloma scleritis in a 53-year-old male with unilateral progressive visual loss, scleritis, prolonged fever, and multiple mononeuropathy. Scleral biopsy showed necrosis with small abscess, and the pathological tissues revealed submucosal infiltration of mononucleated foamy histiocytes (xanthoma cells), hemosiderin-laden macrophages, neutrophils, lymphocytes, plasma cells, and erythrocytes without Touton giant cells or cholesterol clefts. Serum protein electrophoresis showed polyclonal gammopathy. All infectious investigations were negative. Afterward, this patient was diagnosed with granulomatosis with polyangiitis based on granuloma found in scleral tissue, vasculitis seen in sural nerve biopsy and positive serologies (C-ANCA and anti-PR3 antibody). He was treated with high-dose corticosteroid and later with intravenous cyclophosphamide monthly. He responded well to treatment, both eye and systemic conditions. Necrobiotic xanthogranuloma scleritis could be an early presentation of granulomatosis with polyangiitis.
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Affiliation(s)
| | | | | | - Sumapa Chaiamnuay
- Department of Medicine, Rheumatology Division, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Luemsamran P, Rootman J, White VA, Nassiri N, Heran MKS. The role of biopsy in lacrimal gland inflammation: A clinicopathologic study. Orbit 2017; 36:411-418. [PMID: 28816552 DOI: 10.1080/01676830.2017.1352608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the causes of lacrimal gland inflammation based on histopathology and systemic evaluation. METHODS This is a retrospective case series study. From the University of British Columbia Orbit Clinic between January 1976 and December 2008, we reviewed the medical records of 60 patients who presented with inflammatory features of the lacrimal gland (i.e., erythema, edema, or tenderness) in which the diagnoses were not possible clinically and on imaging alone. As was our routine practice, all these patients underwent lacrimal gland biopsy before starting any treatment. RESULTS The histopathologic findings of the 60 patients showed that 37 (61.7%) had identifiable types of lacrimal inflammation including 10 with Sjogren's syndrome, seven with sarcoidal reaction, six with feature of granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), five with lymphoma, two with sclerosing inflammation, two with IgG4-related dacryoadenitis, and one patient each with infectious dacryoadenitis, myoepithelial carcinoma, xanthogranuloma, eosinophilic angiocentric fibrosis, and eosinophilic allergic granulomatous nodule. The histopathologic findings of the remaining 23 (38.3%) patients showed nonspecific inflammation of the lacrimal gland. 23 patients (38.3%) had associated systemic diseases. 48 patients (80%) were treated successfully and 10 (16.7%) had recurrence of inflammation. CONCLUSIONS We recommend that in patients presenting with lacrimal gland inflammation (i.e., erythema, edema, tenderness) in which the specific diagnosis cannot be made clinically and on imaging, biopsy is warranted for accurate diagnosis and appropriate treatment. We found that the majority of these patients (61.7%) had specific histopathology, and 38% had systemic diseases.
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Affiliation(s)
- Panitee Luemsamran
- a Department of Ophthalmology, Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Jack Rootman
- b Department of Ophthalmology and Visual Sciences , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada.,c Department of Pathology and Laboratory Medicine , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada.,d Jules Stein Eye Institute , University of California at Los Angeles , USA
| | - Valerie A White
- c Department of Pathology and Laboratory Medicine , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada
| | - Nariman Nassiri
- d Jules Stein Eye Institute , University of California at Los Angeles , USA
| | - Manraj K S Heran
- e Department of Radiology , University of British Columbia and the Vancouver General Hospital , Vancouver , BC , Canada
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Lakdawala N, Ferenczi K, Grant-Kels JM. Granulomatous diseases: Kids are not just little people. Clin Dermatol 2017; 35:555-565. [PMID: 29191347 DOI: 10.1016/j.clindermatol.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous diseases represent a heterogeneous group of conditions characterized by histiocytic inflammation that affect patients of any age. These diseases differ widely in their pathogenesis and include infectious and noninfectious conditions. This review focuses on noninfectious granulomatous conditions, with particular emphasis on age-related differences in the onset, epidemiology, clinical manifestations, prognosis, and age-specific management of specific granulomatous disorders. Knowledge of age-specific aspects of granulomatous conditions in adults and children improves both the extent of the diagnostic workup and the management of these patients.
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Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwuakee, WI.
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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Brosa Morros H, Subirà O, Gomà Gàllego M, Paúles Villar MJ, Mascaró Zamora F, Abia Serrano M. Ulcerative granuloma of the eyelid as the initial manifestation of granulomatosis with polyangiitis (Wegener's granulomatosis): A case report. Orbit 2017; 36:243-246. [PMID: 28306365 DOI: 10.1080/01676830.2017.1287740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 56-year-old-man presented a 2-month history of chalazion in the eyelids without response to treatment and with an inconclusive biopsy. Laboratory results confirmed the presence of Enterobacter cloacae and Streptococcus gordonii infection. Despite appropriate intravenous antibiotic treatment, clinical worsening was observed. Radical surgical excision and total tarsorrhaphy were performed. Following treatment, the patient was asymptomatic for 6 weeks until he developed acute renal failure, generalised arthralgia, acute hypertensive anterior uveitis, and dacryoadenitis. Lacrimal gland biopsy revealed a perivascular granulomatous inflammation with necrotic foci. Renal biopsy showed a necrotizing extracapillary glomerulonephritis. Blood tests showed elevated levels of C-reactive protein, positive rheumatoid factor, and proteinase 3-anti-neutrophil cytoplasmic antibody. The patients was therefore diagnosed with granulomatosis with polyangiitis and treated with cyclophosphamide and corticosteroids, with good systemic and orbital response. Surgical reconstruction of the eyelid was subsequently performed. This case describes, for the first time in the literature, an eyelid granuloma as the presenting sign in GPA, highlighting the importance of differential diagnosis of eyelid lesions with unusual characteristics.
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Affiliation(s)
- Helena Brosa Morros
- a Department of Ophthalmology, Oculoplastics & Orbit , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Olaia Subirà
- a Department of Ophthalmology, Oculoplastics & Orbit , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Montse Gomà Gàllego
- b Department of Pathology , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Maria José Paúles Villar
- b Department of Pathology , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Ferran Mascaró Zamora
- a Department of Ophthalmology, Oculoplastics & Orbit , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Maravillas Abia Serrano
- a Department of Ophthalmology, Oculoplastics & Orbit , Bellvitge University Hospital, L'Hospitalet de Llobregat , Barcelona , Spain
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Devi Nivean P, Nivean M. Monomorphic xanthomatous type of xanthogranuloma: a rare entity. GMS OPHTHALMOLOGY CASES 2017; 7:Doc19. [PMID: 28875110 PMCID: PMC5514191 DOI: 10.3205/oc000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Xanthogranuloma is an uncommon tumor in the ocular adnexa. It usually presents as diffuse lid swelling with or without orbital involvement. Xanthogranulomas can be associated with systemic comorbidities. They are diagnosed by their characteristic pathological finding. They are further subclassified based on immunohistochemistry. We present two cases with lid swelling which were diagnosed to be xanthogranuloma. Our cases were special because of the unique presentation as localized monomorphic lesions.
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Affiliation(s)
- Pratheeba Devi Nivean
- M.N. Eye Hospital, Chennai, India,*To whom correspondence should be addressed: Pratheeba Devi Nivean, M.N. Eye Hospital, Chennai, India, E-mail:
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Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Baykal C, Polat Ekinci A, Yazganoglu KD, Buyukbabani N. The clinical spectrum of xanthomatous lesions of the eyelids. Int J Dermatol 2017; 56:981-992. [PMID: 28500693 DOI: 10.1111/ijd.13637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 03/10/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
Yellowish papules, nodules, or plaques, namely "xanthomatous" lesions, may be seen on the eyelids in the course of various disorders. The prototype is "xanthelasma palpebrarum" (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non-Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult-onset xanthogranuloma, adult-onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease, Rosai-Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.
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Affiliation(s)
- Can Baykal
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Algun Polat Ekinci
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kurtulus D Yazganoglu
- Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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