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Javadirad E, Roozbahani NE, Sadafi S. Eosinophilic angiocentric fibrosis of the sinonasal tract: a case report and review of the literature. J Int Med Res 2022; 50:3000605221126039. [PMID: 36172997 PMCID: PMC9528026 DOI: 10.1177/03000605221126039] [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: 11/16/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare chronic benign disorder of unknown etiology and is characterized by submucosal thickening and fibrosis in the upper respiratory tract. In this report, we describe a case of EAF in the nasal cavity of a woman who underwent elective surgery for division of adhesions and has had no recurrence during 2 years of postoperative follow-up. A review of the literature on the clinical manifestations of EAF, sites of lesions, management, and outcomes identified 48 articles that included 72 cases. A summary of these reports is presented, including our present case. The most common anatomic site involved was the nose (77.8%), the most common manifestation was nasal obstruction (66.7%), and the most common treatment modality was surgical resection (83.3%). After surgery, 36% of patients remained free of EAF. The most common pharmacologic agent used was a corticosteroid (38.9%).
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Affiliation(s)
- Etrat Javadirad
- Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Eskandari Roozbahani
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepehr Sadafi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Farina J, Broggi G, Federico C, Zanelli M, Palicelli A, Caltabiano R. Eosinophilic Angiocentric Fibrosis of the Nasal Cavities: A Report of an Uncommon Lesion with Emphasis on the Etiology and Differential Diagnosis. Medicina (B Aires) 2022; 58:medicina58070865. [PMID: 35888584 PMCID: PMC9319830 DOI: 10.3390/medicina58070865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Background and Objectives: Eosinophilic angiocentric fibrosis (EAF) is an indolent but sometimes locally destructive lesion with a predilection for the sinonasal tract. Although it was first described in 1983, its etiology remains unknown. Some authors initially attributed EAF to trauma, hypersensitivity, and/or surgical manipulation, while it has been recently suggested to include EAF within the spectrum of IgG4-related systemic diseases. Materials and Methods: We report an uncommon case of idiopathic EAF in a 76-year-old male who developed two bilateral tumefactive masses in the nasal cavities. Results: As the histological examination showed a subepithelial proliferation of fibroblasts along with sclero-hyaline fibrosis around small-sized vessels (an “onion skin-like” pattern) and an eosinophils-rich inflammatory infiltrate, a diagnosis of EAF was rendered. The differential diagnosis included granuloma faciale, Wegener’s granulomatosis, and Churg–Strauss syndrome. Conclusions: Pathologists should be aware of the possibility that this lesion can be part of the wide spectrum of IgG4-related systemic diseases by performing IgG4 investigations to assess adherence to IgG4-related systemic disease criteria.
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Affiliation(s)
- Jessica Farina
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
- Correspondence:
| | - Carmelo Federico
- Otorhinolaryngology Unit, Casa di Cura Gibiino, 95128 Catania, Italy;
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
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Hardman J, Toon C, Nirmalananda A. An unusual presentation of eosinophilic angiocentric fibrosis. J Surg Case Rep 2017; 2017:rjx234. [PMID: 29250311 PMCID: PMC5723982 DOI: 10.1093/jscr/rjx234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition affecting the respiratory mucosa and is generally characterized by a locally destructive growth. We present a case of a lady with a saddle nose deformity that had for many years been treated as granulomatosis with polyangiitis (GPA), of which saddle nose deformity is a classic feature. At the time of surgery, she was found to have subglottic stenosis another classic feature of GPA, however, histology demonstrated EAF. We discuss the difference between the two conditions and highlight the importance of making the correct diagnosis.
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Affiliation(s)
- Joel Hardman
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Christopher Toon
- Histopath Pathology, Suite 4B, Level 4, 97 Waterloo Road, North Ryde NSW, Australia
| | - Arjuna Nirmalananda
- Department of Otolaryngology, Head and neck surgery, Royal Prince Alfred Hospital, Camperdown NSW, Australia
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Abstract
BACKGROUND Collagen is the most abundant protein in the body and the main structural component of the skin. OBJECTIVE To provide a review of the histopathology of collagen alterations and to propose a classification with the most important types of collagen anomalies in dermatopathology. The authors describe some of the main morphological clues of collagen anomalies for specific diagnosis of some cutaneous inflammatory and neoplastic conditions. METHODS The authors review histopathologic collagen anomalies, concerning both morphology and disposition in some inflammatory and neoplastic cutaneous conditions, and they review previous terminology and proposed a classification of the most important types of collagen anomalies that can be seen in dermatopathological practice. RESULTS Collagen anomalies in skin can be classified into lamellar fibrosis, sclerosis, and "balls" and "rings" of collagen. Lamellar fibrosis presents as long and thin collagen bundles forming a delicate network, which can be disposed in a parallel pattern, onion-bulb-like pattern, and storiform pattern. Sclerosis is characterized by large, thick, and eosinophilic bundles of collagen, which may present as a homogenous-diffuse pattern or as individual thick bundles of collagen with few or abundant number of fibroblasts between them. Finally, the authors propose the terms "balls" and "rings" of collagen. The term "balls" of collagen stands for thick, homogenous, eosinophilic, globular collagen bundles, with no distinguishable individual composing fibers, which include the floating sign and the free-floating sign. The term "rings" of collagen is characterized by sclerotic collagen arranged in a homogenous rimming pattern around vessels without independent fibers in its composition. CONCLUSIONS Collagen anomalies may be important clues to establish specific clues for specific diagnoses in dermatopathology.
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Heft Neal ME, Rowan NR, Willson TJ, Wang EW, Lee SE. A Case Report and Systematic Review of Eosinophilic Angiocentric Fibrosis of the Paranasal Sinuses. Ann Otol Rhinol Laryngol 2017; 126:415-423. [PMID: 28397561 DOI: 10.1177/0003489417696510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a paucity of literature discussing prognostic factors or comparing outcomes in eosinophilic angiocentric fibrosis (EAF). This review aims to analyze tumor and patient characteristics as possible prognostic markers and compare surgical approaches. METHODS Systematic literature review and case report analyzing available cases of EAF located within the paranasal sinuses. RESULTS The literature search yielded 39 articles meeting criteria for a total of 59 cases (including 1 from our institution). Median patient age was 46 years. The most common presenting symptoms were nasal obstruction (69%, n = 41) and change in external nasal appearance (39%, n = 32). The majority of cases (85%) were treated with surgical resection alone or in combination with medication. Of surgical patients, 62% underwent a complete resection with a recurrence rate of 20%. Median follow-up duration was 2 years. Endoscopic approach showed a significant positive correlation with complete resection ( P = .045). Patient sex ( P = .6), tumor location (range, P = .32-.98), lateral rhinotomy ( P = .26), septoplasty ( P = .84), and external rhinoplasty ( P = .28) were not significantly correlated with total resection. Insufficient sample size precluded calculation of predictors of recurrence following surgery. CONCLUSION This review suggests that an endoscopic approach to EAF tumor is a viable option, frequently yielding complete resection.
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Affiliation(s)
- Molly E Heft Neal
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,2 University of Michigan Department of Otolaryngology, Ann Arbor, Michigan, USA
| | - Nicholas R Rowan
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Thomas J Willson
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
| | - Stella E Lee
- 3 University of Pittsburgh Department of Otolaryngology, Pittsburgh, Pennsylvania, USA
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Jin CJ, Perez-Ordonez B, Witterick I. Eosinophilic angiocentric fibrosis of the sinonasal tract. BJR Case Rep 2016; 2:20150419. [PMID: 30363608 PMCID: PMC6180858 DOI: 10.1259/bjrcr.20150419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/09/2016] [Accepted: 01/26/2016] [Indexed: 11/05/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is an exceedingly rare and potentially disfiguring and obstructing benign lesion involving the upper airways. We report two cases of EAF originating from the nasal cavity in a 31-year-old female and a 58-year-old male exhibiting nasal obstructive symptoms, with imaging features and histopathology characteristic of EAF. Surgical excision was performed on one patient with a disfiguring nasal mass at a tertiary referral rhinology practice within a university centre. Summarized are the relevant clinical issues to increase awareness of this disease. The slow progression and rarity of the disease has previously resulted in diagnostic difficulty. We review the limited current literature surrounding the clinical features and treatment options for this progressive and potentially morbid condition. These cases reinforce that, while rare, inflammatory and fibrosing lesions in general should still be considered as part of the differential diagnosis in patients presenting with obstructive lesions in the sinonasal tract.
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Affiliation(s)
- Chunzi Jenny Jin
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Queen's University, Kingston, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, University Health Network, University of Toronto, Toronto, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
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Singh A, Selhi PK, Munjal M, Sood N. Eosinophilic Angiocentric Fibrosis of Sinonasal Region: A Rare & Under Reported Entity. J Clin Diagn Res 2015; 9:ED05-6. [PMID: 26674883 DOI: 10.7860/jcdr/2015/14958.6757] [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: 05/22/2015] [Accepted: 09/14/2015] [Indexed: 11/24/2022]
Abstract
Eosinophilic angiocentric fibrosis is a rare pathology of the sinonasal tract and the upper respiratory system characterised by fibrosis with poorly understood pathogenesis. A 47-year-old male presented with a swelling over the dorsum of the nose. The possibility of fungal granuloma was being suggested on Magnetic Resonance Imaging (MRI). Histopathology showed thick collagen bundles whorling around vessels giving an onion skin appearance with focal area of vasculitis. An inflammatory reaction rich in eosinophils along with a fibrotic stroma was seen which was highly characteristic of eosinophilic angiocentric fibrosis. Clinically & microscopically it mimics Granuloma faciale, Wegener's Granulomatosis, Churg-Strauss Syndrome, Kimura's disease and few other granulomatous conditions thus making diagnosis difficult. A probable allergic origin is being suggested because of the typical eosinophil-rich inflammatory reaction. Finally the diagnosis of Eosinophilic Angiocentric Fibrosis was given. It is a diagnosis of exclusion having characteristic histomorphological findings thus biopsy is always required to distinguish it from other lesions whose treatment differs.
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Affiliation(s)
- Aminder Singh
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Pavneet Kaur Selhi
- Associate Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Manish Munjal
- Professor, Department of Ear Nose and Throat, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Neena Sood
- Professor and Head, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
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Okamoto K, Motoishi M, Kaku R, Sawai S, Hanaoka J. A surgical case of eosinophilic angiocentric fibrosis of the lung. Surg Case Rep 2015; 1:52. [PMID: 26366349 PMCID: PMC4560143 DOI: 10.1186/s40792-015-0055-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory disease that develops from the respiratory organs and affects them. Almost all reports about EAF describe lesions affecting the upper respiratory tract. We present the first case of EAF of the lung treated by surgical excision. A 69-year-old female consulted our hospital following the detection of an abnormal chest shadow with chronic cough. Chest computed tomography showed a pulmonary growing mass in the right hilar area, which corresponded to an enhanced accumulation on positron emission tomography. We doubted a pulmonary malignant tumor and performed a right upper lobectomy. Pathological and other clinical presentations revealed EAF of the lung without coexisting systemic diseases. The patient had an uncomplicated postoperative course, and the presenting cough had improved. EAF can involve the lung and cause symptomatic airway obstruction. For a hilar region mass with imaging characteristics similar to those of lung cancer, a differential diagnosis must be considered.
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Affiliation(s)
- Keigo Okamoto
- Department of General Thoracic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatacho Fukakusa, Fushimi, Kyoto, 612-0862 Japan
| | - Makoto Motoishi
- Department of General Thoracic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatacho Fukakusa, Fushimi, Kyoto, 612-0862 Japan
| | - Ryosuke Kaku
- Department of General Thoracic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatacho Fukakusa, Fushimi, Kyoto, 612-0862 Japan
| | - Satoru Sawai
- Department of General Thoracic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatacho Fukakusa, Fushimi, Kyoto, 612-0862 Japan
| | - Jun Hanaoka
- Department of General Thoracic Surgery, Shiga University of Medical Science, Tsukinowacho Seta Otsu, Shiga, 520-2121 Japan
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10
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Kleger A, Seufferlein T, Wagner M, Tannapfel A, Hoffmann TK, Mayerle J. IgG4-related autoimmune diseases: Polymorphous presentation complicates diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:128-35. [PMID: 25759979 PMCID: PMC4361802 DOI: 10.3238/arztebl.2015.0128] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND IgG4-associated autoimmune diseases are systemic diseases affecting multiple organs of the body. Autoimmune pancreatitis, with a prevalence of 2.2 per 100,000 people, is one such disease. Because these multi-organ diseases present in highly variable ways, they were long thought just to affect individual organ systems. This only underscores the importance of familiarity with these diseases for routine clinical practice. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed, and on the published conclusions of international consensus conferences. RESULTS The current scientific understanding of this group of diseases is based largely on case reports and small case series; there have not been any randomized controlled trials (RCTs) to date. Any organ system can be affected, including (for example) the biliary pathways, salivary glands, kidneys, lymph nodes, thyroid gland, and blood vessels. Macroscopically, these diseases cause diffuse organ swelling and the formation of pseudotumorous masses. Histopathologically, they are characterized by a lymphoplasmacytic infiltrate with IgG4-positive plasma cells, which leads via an autoimmune mechanism to the typical histologic findings--storiform fibrosis ("storiform" = whorled, like a straw mat) and obliterative, i.e., vessel-occluding, phlebitis. A mixed Th1 and Th2 immune response seems to play an important role in pathogenesis, while the role of IgG4 antibodies, which are not pathogenic in themselves, is still unclear. Glucocorticoid treatment leads to remission in 98% of cases and is usually continued for 12 months as maintenance therapy. Most patients undergo remission even if untreated. Steroid-resistant disease can be treated with immune modulators. CONCLUSION IgG4-associated autoimmune diseases are becoming more common, but adequate, systematically obtained data are now available only from certain Asian countries. Interdisciplinary collaboration is a prerequisite to proper diagnosis and treatment. Treatment algorithms and RCTs are needed to point the way to organ-specific treatment in the future.
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Affiliation(s)
- Alexander Kleger
- Ulm University Medical Center, Department of Internal Medicine I
| | | | - Martin Wagner
- Ulm University Medical Center, Department of Internal Medicine I
| | | | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, Ulm University Medical Center
| | - Julia Mayerle
- University Medicine Greifswald Department of Internal Medicine A
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Eosinophilic angiocentric fibrosis of the nose and sinuses. The Journal of Laryngology & Otology 2014; 128:1071-7. [PMID: 25399547 DOI: 10.1017/s0022215114002552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis is a rare benign disorder of the upper respiratory tract. It is slow growing and progressive, with characteristic histological appearances. METHODS We report the largest single-institution case series of sinonasal eosinophilic angiocentric fibrosis to date, comprising nine patients. The current literature is reviewed, showing emerging evidence that this condition may belong to the immunoglobulin G4-related disease spectrum. RESULTS The series comprised five female and four male patients, with a mean age at presentation of 53 years. All were treated surgically. Six patients had no signs of recurrent disease after an average of 8.5 years. One patient went on to develop granulomatosis with polyangiitis (Wegener's granulomatosis), which required immunosuppressive therapy. CONCLUSION The first-line management of this rare condition is complete surgical excision. Chronic granulomatous conditions, including granulomatosis with polyangiitis, should be excluded before a diagnosis is made, and patients should be carefully followed.
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12
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Fang CH, Mady LJ, Mirani NM, Baredes S, Eloy JA. Sinonasal eosinophilic angiocentric fibrosis: a systematic review. Int Forum Allergy Rhinol 2014; 4:745-52. [PMID: 25065665 DOI: 10.1002/alr.21347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis (EAF) is a benign rare lesion of the upper respiratory mucosa. EAF most commonly presents with an obstructive nasal mass. Due to the rarity of EAF, case reports and case studies have predominated the literature. This systematic review discusses the demographics, clinical presentation, associated findings, management, and outcomes of this uncommon entity. METHODS The PubMed database was searched for all articles describing patients diagnosed with sinonasal EAF. Additional cases were examined from the bibliographies of selected articles. Demographics, clinical presentation, associated findings, radiography, management, and outcome were analyzed. RESULTS Fifty-two cases were included from 34 articles, including 1 case from our institution. The most common presenting symptom was nasal obstruction (78.8%). Fourteen patients (26.9%) had a previous history of nasal surgery or trauma. Surgical resection alone was the most commonly used primary treatment approach (50.0%), resulting in the greatest proportion of disease-free patients (55.6%) over a median follow-up period of 36 months. A combination of surgery and corticosteroids was the second-most-common treatment modality, used in 28.8% of cases. Of the 40 cases reporting patient outcomes, 100% of patients were alive at follow-up independent of treatment modality. CONCLUSION To date, this review contains the largest number of patients with sinonasal EAF. Aggressive surgical resection alone constitutes the most common treatment modality and may be most effective at eradicating disease.
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Affiliation(s)
- Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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Eosinophilic angiocentric fibrosis of the nasal septum. Case Rep Otolaryngol 2013; 2013:267285. [PMID: 23634315 PMCID: PMC3619668 DOI: 10.1155/2013/267285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Eosinophilic angiocentric fibrosis (EAF) is a rare benign condition of unknown aetiology that causes stenosis of the upper respiratory tract. It is most commonly found at the nasal septum and sinus mucosa causing mucosal thickening and nasal obstructive symptoms. The diagnosis is mainly based on characteristic histologic findings. Case Report. A 27-year-old young woman presented with a slow growing mass at her anterior nasal septum for over eight years. She complained of persistent nasal obstruction, epistaxis, sometimes diffused facial pain, and chronic headache. 3 years ago, the tumor was partially resected for ventilation and a nasal septum perforation was left. Imaging findings indicated soft-tissue thickening of the anterior part of septum and adjacent lateral nasal walls. Pathological examination showed numerous inflammatory cells infiltrates containing eosinophils, fibroinflammatory lesion with a whorled appearance fibrosis which typically surrounded vessels. A diagnosis of eosinophilic angiocentric fibrosis was made. All laboratory tests were unremarkable. Skin prick test was positive. The tumor-like lesion was totally resected. Conclusions. EAF is a rare benign and progressive disorder causing destruction. Combined with radiological imaging of EAF historical findings contribute to the diagnosis. It is important to prevent tumor from recurrence by total resection of the lesion.
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Fibrose angiocentrique à éosinophiles : une manifestation de la maladie systémique liée au IgG4 ? Ann Pathol 2012; 32:271-5. [DOI: 10.1016/j.annpat.2012.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 06/07/2012] [Accepted: 06/21/2012] [Indexed: 12/24/2022]
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15
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Fibrose angiocentrique à éosinophiles et granulome facial à forme extrafaciale, une même entité ? Ann Pathol 2011; 31:138-41. [DOI: 10.1016/j.annpat.2011.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/25/2011] [Indexed: 11/19/2022]
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Barry R, Calonje E, Hughes BR. Progressive chronic nasal enlargement with an overlying violaceous plaque. Clin Exp Dermatol 2010; 34:843-4. [PMID: 19747343 DOI: 10.1111/j.1365-2230.2008.03027.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Barry
- Portsmouth Dermatology Centre, St Mary's Hospital, Portsmouth, UK.
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Sinonasal eosinophilic angiocentric fibrosis: a report of four cases and review of literature. Head Neck Pathol 2008; 2:309-15. [PMID: 20614301 PMCID: PMC2807588 DOI: 10.1007/s12105-008-0077-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition of unknown etiology involving the sinonasal tract and the upper respiratory airways, and rarely, larynx, and orbit. We report four cases of EAF identified, in three women and one man, aged 31, 57, 27, and 51 years, respectively. The patients complained of sinonasal obstructive symptoms of long duration, nasal masses, epiphora, and/or proptosis. Histologically, all cases demonstrated a dense fibrotic stroma with a perivascular "onion-skin" whorling pattern, and a dense inflammatory infiltrate consisting of lymphocytes, plasma cells, eosinophils, and some neutrophils. In addition, one patient demonstrated modest acute neutrophilic inflammation with focal endothelial proliferation. No patient exhibited clinical or histological evidence of Wegener's granulomatosis, granuloma faciale, Kimura's disease, and malignant lymphomas. Surgical excision was performed in all cases, and to date, medical therapy has been of limited help. The clinical and histopathological features and differential diagnoses of this underreported EAF condition are discussed.
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Abstract
PURPOSE To report three cases of sclerosing Wegener's granulomatosis in the orbit and to compare the histopathological morphology with those of other types of sclerosing orbital inflammation. METHODS We analysed the clinical data along with histopathological specimens from orbital biopsies and from two enucleated eyes. RESULTS All three patients had longstanding inflammation in the orbit and involvement of the paranasal sinuses. Proptosis, impaired ocular motility and reduced visual acuity dominated the clinical picture. All histopathological specimens featured granulomatous inflammation, tissue necrosis, vasculitis and widespread dense fibrosis. In certain areas of all specimens the fibrous tissue was arranged in characteristic concentric, onionskin-like whorls of collagen around obliterated small blood vessels. CONCLUSIONS Wegener's granulomatosis may lead to orbital fibrosis and sclerosis. The stromal changes and cellular infiltrate resemble the non-specific orbital inflammation previously termed orbital pseudotumour. We present the first 'onionskin' lesions in association with Wegener's granulomatosis in the orbit. This latter morphology may represent an abnormal fibrotic reaction in inflammatory tissue.
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Affiliation(s)
- Christoffer Ostri
- Department of Neuroscience and Pharmacology, Eye Pathology Section, University of Copenhagen, Copenhagen, Denmark
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19
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Abstract
Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory fibrosing lesion of the upper respiratory tract and orbit that occurs mainly in young to middle-aged women. The etiology of EAF is unknown. To our knowledge, approximately 28 cases have been previously reported in the English literature. We report here 3 additional cases of EAF of the sinonasal tract; 2 in women aged 19 and 31 years, and 1 in a man aged 49 years. The 19-year-old woman is the youngest patient with EAF ever described. The patients presented with a nasal cavity mass, face pain, or nasal obstructive symptoms of long duration.
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Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare disease of the sinonasal tract, with histologic characteristic features like thick collagen bundles whirling around vessels in a fibrotic stroma with inflammatory cells rich in eosinophils. The Authors present a case of a 31-year-old man with bilateral nasal obstruction with no history of allergies or other systemic disease. The patient underwent a septoplasty with symptoms relieving. An EAF diagnosis was made. Differential diagnosis must rule out other lesions that may mimic EAF such as granuloma faciale, Kimura disease, Wegener granulomatosis, Churg-Strauss syndrome.
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Affiliation(s)
- Luigi Clauser
- Unit of Craniomaxillofacial Surgery, Center for Craniofacial Deformities and Orbital Surgery, S. Anna Hospital and University, Ferrara, Italy.
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Valenzuela AA, Whitehead KJ, Brown I, Sullivan TJ. Eosinophilic angiocentric fibrosis: an unusual entity producing complete lacrimal duct obstruction. Orbit 2006; 25:159-61. [PMID: 16754230 DOI: 10.1080/01676830600674544] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Eosinophilic angiocentric fibrosis is an unusual fibrotic condition of unknown aetiology that tends to affect the upper respiratory tract. Twenty-one cases have been reported in the literature and only three have had ocular adnexal involvement. Despite characteristic histopathological and clinical findings, the diagnosis remains a challenge. Furthermore, its progressive nature with potential to invade adjacent structures and the lack of response to current treatment modalities make management difficult. We describe a case of sinonasal eosinophilic angiocentric fibrosis that presented with bilateral nasolacrimal duct obstruction.
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Affiliation(s)
- Alejandra A Valenzuela
- Eyelid, Lacrimal and Orbital Clinic, Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital and the University of Queensland Medical School, Australia
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Watanabe N, Moriwaki K. Atypical eosinophilic angiocentric fibrosis on nasal septum. Auris Nasus Larynx 2006; 33:355-8. [PMID: 16529899 DOI: 10.1016/j.anl.2006.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/26/2005] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare benign condition of unknown aetiology and is most commonly found in the nasal septum and sinus mucosa. We report a case of EAF and present a review of the available literature. A 51-year-old man with progressive nasal obstruction was referred to our hospital. CT and MRI scans revealed a mass on the nasal septum; this was surgically excised. Histological analysis of the resected tumour showed an inflammatory infiltrate with a predominance of eosinophils present in fibrous matrix and absence of eosinophilic vasculitis and onion skinning. Histologically, it resembled granuloma faciale. However, our case was considered to be an EAF although eosinophilic vasculitis and onion skinning were not observed. This was because a cutaneous lesion was absent and the lesion was limited to the nasal septal mucosa.
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Affiliation(s)
- Noriko Watanabe
- Department of Otorhinolaryngology, Tondabayashi Hospital, 1-3-36, Koyodai, Tondabayashi, Osaka 584-0082, Japan.
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Leibovitch I, James CL, Wormald PJ, Selva D. Orbital Eosinophilic Angiocentric Fibrosis. Ophthalmology 2006; 113:148-52. [PMID: 16324746 DOI: 10.1016/j.ophtha.2005.09.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 09/06/2005] [Accepted: 09/30/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To report a patient with a rare case of orbital eosinophilic angiocentric fibrosis (EAF) and to review the literature. DESIGN Interventional case report. METHODS A 61-year-old man presented with a 6-week history of right periorbital edema and painless proptosis. Examination revealed a nonaxial proptosis, lateral globe displacement, and mild limitation in right eye adduction. MAIN OUTCOME MEASURES Clinical course and radiological and histological findings. RESULTS Orbital imaging revealed a right medial orbital mass with involvement of middle ethmoidal air cells. An orbital biopsy of the mass demonstrated an inflammatory infiltrate with a marked eosinophilic component, onion skinning of vessels, and surrounding fibrosis. The diagnosis of orbital EAF was made. There was no response to a 3-month treatment course with systemic steroids, but the patient did not want any further surgical interventions. CONCLUSION Although orbital EAF is rare, ophthalmologists need to be aware of this entity, as it may invade the orbit from the sinonasal tract or present as a localized orbital mass. The presence of even minimal sinus involvement and the characteristic histopathology are useful in establishing the correct diagnosis.
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Affiliation(s)
- Igal Leibovitch
- Oculoplastic and Orbital Unit, Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia.
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Yung A, Wachsmuth R, Ramnath R, Merchant W, Myatt AE, Sheehan-Dare R. Eosinophilic angiocentric fibrosis--a rare mucosal variant of granuloma faciale which may present to the dermatologist. Br J Dermatol 2005; 152:574-6. [PMID: 15787836 DOI: 10.1111/j.1365-2133.2005.06439.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Narayan J, Douglas-Jones AG. Eosinophilic angiocentric fibrosis and granuloma faciale: analysis of cellular infiltrate and review of literature. Ann Otol Rhinol Laryngol 2005; 114:35-42. [PMID: 15697160 DOI: 10.1177/000348940511400107] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare specific inflammatory condition that affects the nose and upper airways and is characterized by distinctive histopathologic features. We report the clinical, histopathologic, and radiologic features of EAF in an elderly woman who presented to us with complete stenosis of the left nostril, nasal swelling, and granuloma faciale (GF) of the overlying nasal skin. The histopathologic spectrum of the early, intermediate, and late stages of EAF in the deeper nasal tissues is illustrated along with the adjacent changes of GF in the overlying nasal skin. Quantification of immunohistochemically stained lymphocyte cell subsets in the perivascular inflammatory component was performed by using software to compare the proportions of lymphocyte subsets in the two conditions. The results showed similar proportions of perivascular CD4 T lymphocytes in EAF and GF. We believe that both EAF and GF may represent unusual tissue responses. Similar analysis in other cases will help confirm these findings. A review of the literature suggests that the condition, if localized, is amenable to surgical treatment. In progressive late stages, EAF causes fibrotic stenosis of the affected site with localized extension.
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Affiliation(s)
- Jeena Narayan
- Department of ENT, University Hospital of Wales, Cardiff, Wales
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Nguyen DB, Alex JC, Calhoun B. Eosinophilic Angiocentric Fibrosis in a Patient with Nasal Obstruction. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300314] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare clinicopathologic entity that usually affects the upper respiratory tract. We describe the case of a 45-year-old man with nasal obstruction caused by EAF. His lesion featured the distinct radiologic and histopathologic characteristics of EAF, which include an onionskin and whorled fibrosis that surrounds the blood vessels and an inflammatory infiltrate that is predominated by eosinophils. The etiology of EAF remains unknown. Given our increasing knowledge of this rare entity, reports of EAF may appear more frequently in the future.
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Affiliation(s)
- Davis B. Nguyen
- Division of Facial Plastic and Reconstructive Surgery, Section of Otolaryngology, New Haven, Conn
| | - James C. Alex
- Division of Facial Plastic and Reconstructive Surgery, Section of Otolaryngology, New Haven, Conn
| | - Benjamin Calhoun
- Department of Pathology, Yale University School of Medicine, New Haven, Conn
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Onder S, Sungur A. Eosinophilic angiocentric fibrosis: an unusual entity of the sinonasal tract. Arch Pathol Lab Med 2004; 128:90-1. [PMID: 14692804 DOI: 10.5858/2004-128-90-eaf] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of a 45-year-old man who presented with medication-resistant chronic bilateral nasal obstruction. The patient had no known history of allergy or any other disease. Nasal septoplasty was performed to relieve his symptoms. Histologically, thick collagen bundles were seen, characteristically whorling around vessels in a fibrotic stroma. Inflammatory cells, rich in eosinophils, were scattered throughout the lesion. No granulomas, necrosis, or vessel destruction were present. A diagnosis of eosinophilic angiocentric fibrosis was made. This neoplasm, which has very characteristic histologic features, is a rare entity of the sinonasal tract.
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Affiliation(s)
- Sevgen Onder
- Department of Pathology, Hacettepe University, Sihhiye, Ankara, Turkey.
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