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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alkatan HM, Alrashed SH, Maktabi AM. Ophthalmic manifestations of nasopharyngeal carcinoma (NPC): A systematic review of reported cases with and without prior history of nasopharyngeal carcinoma. Arq Bras Oftalmol 2024; 87:e20220241. [PMID: 38451680 DOI: 10.5935/0004-2749.2022-0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/03/2023] [Indexed: 03/08/2024] Open
Abstract
PURPOSE We aimed to study reported cases of nasopharyngeal carcinoma presenting with ophthalmic manifestations with and without a prior diagnosis of nasopharyngeal carcinoma. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was conducted using the MEDLINE database in PubMed and Google Scholar. We included patients with a previous diagnosis of nasopharyngeal carcinoma in Group I and those without a prior diagnosis of nasopharyngeal carcinoma in Group II. Data included demographics, clinical presentation, history of nasopharyngeal carcinoma, treatment, histopathological description, World Health Organization classification, and outcome. RESULTS Fifty-eight patients (26 in Group I and 32 in Group II) were included. The male-to-female ratio was 3:1. The mean age of the patients (53.3 ± 11.7 years and 54.8 ± 16.2 years, respectively) and gender did not differ significantly between the two groups. The most common ocular presentations were diplopia and proptosis in the first group (each in 34.6%), whereas visual disturbance was most common in the second group (46.9%). Treatment options and World Health Organization grading were comparable. The outcome in 38 patients (after a comparable follow-up period) was significantly better in group II (p=0.003). There was no statistically significant difference in the outcome of 23 patients in correlation with World Health Organization grades II versus III irrespective of group (p=0.094). CONCLUSIONS The demographics of patients with nasopharyngeal carcinoma presenting with ophthalmic manifestations were similar between the two study groups, with a wide age range and male predominance. Patients presenting initially to ophthalmologists with no history of nasopharyngeal carcinoma have a more favorable outcome. World Health Organization grading may have less value as a prognostic indicator.
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Affiliation(s)
- Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Hamad Alrashed
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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3
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Al-Faky YH, Alkatan HM. Histopathological changes of lymphatic malformation after bleomycin injection. Arq Bras Oftalmol 2022:S0004-27492022005005214. [PMID: 35319659 DOI: 10.5935/0004-2749.20230048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/17/2021] [Indexed: 11/20/2022] Open
Abstract
Lymphatic malformation is a rare orbital tumor that used to be treated surgically, with high complication rates, or recently with intralesional bleomycin injection. We report for the first time the histopathological changes of eyelid lymphatic malformation after water-soluble intralesional bleomycin injection in a 20-year-old woman who had unsuccessful orbital surgical debulking during childhood. The changes confirmed the assumption of fibrosis induced by intralesional bleomycin injection. The minimal bleeding during surgical intervention made it much easier than the usual lymphatic malformation bloody procedure, without postoperative recurrences and with favorable aesthetic outcomes.
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Affiliation(s)
- Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Patient: Male, 11-month-old Final Diagnosis: Microphthalmos with massive retinal gliosis Symptoms: Microphthalmos with no useful vision, left eye Medication: — Clinical Procedure: Enucleation, left eye Specialty: Ophthalmology • Pathology
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Affiliation(s)
- Rakan S Al-Essa
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Maria A Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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5
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Helmi HA, Alsarhani W, Alkatan HM, Al-Rikabi AC, Al-Faky YH. Sebaceous Gland Carcinoma with Misleading Clinical Appearance: A Case Report of an Eyelid Lesion. Am J Case Rep 2020; 21:e925134. [PMID: 32788569 PMCID: PMC7447290 DOI: 10.12659/ajcr.925134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patient: Female, 53-year-old Final Diagnosis: Sebaceous gland carcinoma Symptoms: Mass in right lower lid Medication: — Clinical Procedure: Full-thickness wedge resection with frozen section control Specialty: Oncology • Ophthalmology • Pathology
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Affiliation(s)
- Hala A Helmi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar C Al-Rikabi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alrashed SH, Alkatan HM, Alsuhaibani AH. Granulomatous reaction to migrating silicone oil clinically mimicking a xanthelasma: A case report. Int J Surg Case Rep 2020; 70:182-184. [PMID: 32417735 PMCID: PMC7229421 DOI: 10.1016/j.ijscr.2020.04.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 11/29/2022] Open
Abstract
Distant silicone oil migration may occur following retina surgery. Silicone oil in periocular tissue results in granulomatous reaction. It may resemble a periocular xanthelasma-like skin lesion. Tissue diagnosis is essential for confirmation in such cases.
Introduction Silicone oil has been used for many years in retinal surgeries for retinal detachment. One of its reported complications is oil migration to the periorbital area, resulting in granulomatous reaction. Presentation of case A 56-year-old lady, with history of retinal detachment that was repaired by vitrectomy, silicone oil removal and epi-retinal membrane peeling, presented to us with unilateral ptosis and a skin lesion that resembled xanthelasma. Discussion Histopathology of this lesion showed silicone oil infiltrating the surrounding connective tissue and fat with absence of foamy histiocytes. Conclusion We are reporting a case of silicone oil migration with pseudo-xanthelasma lesion. This has been reported only twice to the best of our knowledge in the English-written literature.
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Affiliation(s)
- Saleh Hamad Alrashed
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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7
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Alkatan HM, Alsalamah AK, Almizel A, Alshomar KM, Maktabi AM, ElKhamary SM, Eberhart CG, Iuliano A, Lanni V, Strianese D. Orbital solitary fibrous tumors: a multi-centered histopathological and immunohistochemical analysis with radiological description. Ann Saudi Med 2020; 40:227-233. [PMID: 32493043 PMCID: PMC7270616 DOI: 10.5144/0256-4947.2020.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Solitary fibrous tumors (SFT), formerly called hemangiopericytoma, are rare tumors derived from mesenchymal cells originally described in the pleura, but these tumors may affect extraserosal tissues including the lacrimal gland and orbit. OBJECTIVE Conduct a multi-centered clinical, radiological and histopathological analysis of 17 orbital SFT cases. DESIGN A retrospective case series. SETTING Three eye centers in two countries. PATIENTS AND METHODS The data collected from the charts of 17 adult patients presenting with tissue diagnosis of orbital hemangiopericytoma or SFT from January 2003 to December 2018 included demographics, clinical imaging and histopathological information including immunohistochemical (IHC) characteristics. MAIN OUTCOME MEASURES The demographic characteristics, clinical presentation, and histopathological patterns or variants of SFT were analyzed. SAMPLE SIZE 17 adult patients. RESULTS Mean age was 45 years (range 23-80 years). Male to female ratio was 3:1. The right eye was affected in 12 (70.5%) patients. Commonest presentation was proptosis in 13/17 (76% of patients). Other symptoms were impaired motility (29%) and ptosis (11%). Lesions mostly affected the medial orbit (35%), then orbital apex in 11%. The histopathological classic pattern-less variant was the commonest. One case with aggressive behavior, multiple recurrences and atypical features was encountered. Immunohistochemical (IHC) markers used included CD34 expression in all cases, Bcl-2 expression in 10/11, CD99 in 9/9 and Vimentin in 4/4. STAT6 was used in 2 cases. CONCLUSIONS SFTs are rare tumors affecting the orbit in both genders equally in their mid-forties, but showed male predominance in our analysis with a predominant classic histopathological pattern. Tissue diagnosis is essential and requires IHC studies for confirmation. LIMITATIONS Sample size is relatively small owing to the rarity of this tumor in the orbit. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hind Manaa Alkatan
- From the Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Abrar K Alsalamah
- From the Division of Vitreoretinal and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Khalid M Alshomar
- From the Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- From the Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sahar M ElKhamary
- From the Department of Radiology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Charles G Eberhart
- From the Department of Pathology, Ophthalmology and Oncology, John Hopkins University, School of Medicine, Baltimore, United States
| | - Adriana Iuliano
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Vittoria Lanni
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy
| | - Diego Strianese
- From the Department of Neuroscience, School of Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.,From the Orbital Unit, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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8
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Alkatan HM, AlQahtani FS, Maktabi AM. Enucleated globes with advanced retinoblastoma: correlation of histopathological features and reclassification of tumors according to the 8th edition of the American Joint Committee on Cancer (AJCC). Int Ophthalmol 2020; 40:1739-1747. [PMID: 32193778 DOI: 10.1007/s10792-020-01342-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We aim to study certain histopathological characteristics of the retinoblastoma (RB) tumors in globes with clinically advanced RB, which can be correlated with the high-risk features including: tumor differentiation, growth pattern and focality. We also aim to reclassify the tumor pathologically in the analyzed cases according to the American Joint Committee on Cancer (AJCC) 8th edition in an attempt to compare the validity of this newest classification. METHODS Retrospective study of patients diagnosed with clinical RB of groups D and E during the period: January 2013 to December 2017 at King Khaled Eye Specialist Hospital (KKESH) and King Abdulaziz University Hospital (KAUH). Charts were reviewed for demographic and basic clinical data. Histopathological features (tumor differentiation, growth pattern, focality, seeding, and presence of choroidal invasion (focal versus massive), level of optic nerve (ON) invasion, anterior chamber invasion, scleral and extra-scleral extension, and finally the documented pathological tumors (pT) classification based on the AJCC 7th edition were collected. RESULTS We included 146 eyes with advanced retinoblastoma (groups D and E) from 104 patients. Gender distribution was almost equal with 54 males. Median age was 12 months (range 1-96 months), and a mean age was 17.1 ± 15.1 months. No family history was found in the majority (94.2%). Clinically, the most common presenting symptoms: leukocoria (73.3%), squint (33.6%) and least commonly proptosis (2.7%). A total of 106 enucleation specimens were reviewed. Degree of RB differentiation was: well differentiated (18%), moderate (30%), poor (35%), and undifferentiated (17%). The most common high-risk features were ON invasion (68%) with the majority being prelaminar in nature, choroidal invasion (45%) with more than half being massive, iris/trabecular meshwork (TM)/Schlemm's canal invasion (8.5%), and then intra-scleral/extra-scleral extension (5%). Less tumor differentiation doubles the relative risk of massive choroidal invasion (with 95% CI) with a statistically significant P value (P = 0.030). Endophytic RB was associated with vitreous seeding, while exophytic tumors were associated with subretinal seeding (P = 0.001) each. Ten cases with combined ON invasion (pre-laminar) and focal choroidal invasion were reclassified pT2a in the AJCC 8th edition instead of pT2b in the older 7th edition. CONCLUSIONS Our demographic and basic clinical data for advanced RB are comparable to other similar reports. The tumor growth pattern correlates well with the type of seeding observed in enucleated globes with RB. Less tumor differentiation is a relative risk of massive choroidal invasion. It is advocated to implement the AJCC 8th edition by ocular pathologists worldwide aiming to histopathologically classify the RB tumor in cases for selective adjuvant chemotherapy.
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Affiliation(s)
- Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Faisal Saeed AlQahtani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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9
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Alkatan HM, Al Marek F, Elkhamary S. Demographics of Pediatric Orbital Lesions: A Tertiary Eye Center Experience in Saudi Arabia. J Epidemiol Glob Health 2020; 9:3-10. [PMID: 30932383 PMCID: PMC7310758 DOI: 10.2991/jegh.k.181224.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 11/07/2017] [Indexed: 12/23/2022] Open
Abstract
Orbital lesions vary in their classification, incidence, and presentation depending on the age and geographic distribution. Such lesions in the pediatric age group have been studied extensively because of the possibility of faster progression of orbital involvement and the higher risk of morbidity in this age group in which vision is still developing. In Saudi Arabia, orbital lesions were studied over a 6-year period in the late 1980s, when retinoblastoma cases used to present late with orbital involvement. In this study, we revisited the same topic 20 years later aiming to find out the most recent prevalence of orbital lesions in a similar population of patients over a longer period (14 years) in the same eye center, and compare the current results to other reports worldwide. A total of 107 lesions from 106 patients were identified by tissue diagnosis, of which more than half of the lesions were benign cystic (being the most common), vasculogenic, and inflammatory in 63% [95% confidence interval (CI, 53.3-72.0)] of all biopsied lesions. Neoplasms accounted for 37% [95% CI (28.0-45.8)] with rhabdomyosarcoma being the most common, accounting for about one third of neoplasms, and no orbital cases of retinoblastoma were found. Our results demonstrated different distribution of orbital lesions in recent years reflecting the indirect effect of the improved health awareness and medical care in Saudi Arabia. This baseline demographic study is expected to be helpful for further clinical and prognostic studies with emphasis on pediatric orbital malignant lesions, their clinical presentation, management, and prognosis.
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Affiliation(s)
- Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, PO Box 18097, Riyadh, Postal code 11415, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Faisal Al Marek
- Department of Ophthalmology, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sahar Elkhamary
- Department of Diagnostic Radiology, Mansoura Faculty Of Medicine, Egypt
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10
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Maktabi AMY, Al-Hussain H, Khoja H, Alkatan HM. Unusual Recurrent Lateral Canthus Mass in a 16-Year-Old Male Patient: Neurothekeoma. Case Rep Oncol 2019; 12:693-697. [PMID: 31607885 PMCID: PMC6787406 DOI: 10.1159/000502948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
Neurothekeoma (NTK) is a specific benign soft tissue tumor, typically involving the skin of the head and neck area as well as the upper part of the body in young age with female predominance. It has a typical lobular pattern of growth but often displays atypical features such as myxoid stroma or fascicular pattern, which makes the diagnosis more difficult and may necessitate the use of immunohistochemical staining to differentiate NTK from nerve sheath tumor. Ocular NTK in general is very rare with only 11 cases previously reported. We are presenting a case of recurrent mixed cellular/myxoid NTK involving the lateral canthal area of a 16-year-old-boy and we demonstrate the diagnostic challenge in such cases to attract the attention of ophthalmologists and pathologist to the rare occurrence of NTK in the ocular region.
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Affiliation(s)
- Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hailah Al-Hussain
- Oculoplastic Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hatim Khoja
- Anatomic Pathology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, King Saud University, Riyadh, Saudi Arabia
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11
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Al-Rajhi AA, Helmi HA, Alkatan HM, Al-Obailan M, Al-Rajhi A. Successful Treatment of Corneal Opacification with Associated Thickened Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH). Saudi J Ophthalmol 2019; 33:203-208. [PMID: 31686959 PMCID: PMC6819717 DOI: 10.1016/j.sjopt.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/10/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose To study clinical and histopathological findings of corneal opacification caused by thickened epithelium leading to reduced vision and topographical changes and to evaluate the outcome of its removal. Methods Twelve patients (17 eyes) with central, paracentral or peripheral corneal opacification were reviewed to obtain their visual acuity, describe their slit lamp (SL) appearance (depth, extent and density) and document their topographic changes before and after peeling of the epithelium under SL or surgical removal under the microscope. Specimens of six cases were available for histopathological examination and immunohistochemical staining. Results Most of the eye opacifications were secondary to corneal procedures in 10 [Penetrating keratoplasty (PKP) in 7 for congenital glaucoma, keratoconus or adherent leukoma – usually over graft-host junction –, Photorefractive keratectomy (PRK) in 2 and Phototherapeutic keratectomy in one], chronic inflammation following trachoma or non-specific causes (3), and herpetic scar (1). Three cases were considered to be idiopathic. All cases presented with decreased vision, astigmatism or changes in topography or refraction. Their vision, clinical symptoms and topography improved after treatment. Histopathologically, all six cases shared findings that are similar to what have been described as peripheral hypertrophic subepithelial corneal degeneration (PHSCD) rather than Salzmann’s nodular degeneration. None of the cases showed inflammation or subepithelial pannus formation in the excised tissue. However, our cases did not fit into the diagnosis of PHSCD because of the location of the corneal opacification (being peripheral in 41% of the corneas, the presence of underlying primary etiologic factors in 82% of the eyes and the bilateral occurrence in 5 patients. Conclusions Meticulous SL examination aided by corneal imaging may accurately diagnose and determine the depth of corneal opacification as a cause for reduced vision. Histopathologically, the removed tissue is similar to PHSCD, but cases differ in their clinical profile. Peeling the thickened epithelial/subepithelial tissue is curative in most patients, improves visual and clinical outcome and avoids unnecessary corneal grafting.
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Affiliation(s)
- A A Al-Rajhi
- Ophthalmology Resident, PSMMC, Riyadh, Saudi Arabia
| | - H A Helmi
- Alfaisal University, Riyadh, Saudi Arabia
| | - H M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M Al-Obailan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Al-Rajhi
- Specialized Experts Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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12
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Alrashed SH, Alkatan HM, Helmi AA, Maktabi AMY. Focal perifollicular mucinosis of the eyelid presenting as a benign nevus. Can J Ophthalmol 2018; 53:e149-e151. [PMID: 30119811 DOI: 10.1016/j.jcjo.2017.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Adel Ayman Helmi
- Dalhousie University, Halifax, N.S; King Fahad Medical City, Riyadh, Saudi Arabia
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13
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Alkatan HM, Alrashed SH, Al-Rikabi AC, Al-Faky YH. Orbital T-cell lymphoma in youngest recorded patient - early diagnosis, management, and successful outcome: a case report and review of the literature. J Med Case Rep 2018; 12:139. [PMID: 29754589 PMCID: PMC5950188 DOI: 10.1186/s13256-018-1630-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 02/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary orbital peripheral T-cell lymphoma, not otherwise specified is an exceedingly rare disorder with a very poor outcome, and to the best of our knowledge only a few cases have been reported in the English literature. We present the youngest reported case describing the successful outcome after management with a thorough review of the English literature of all the reported cases of primary peripheral T-cell lymphoma, not otherwise specified. CASE PRESENTATION Our patient is a 3-year-old Syrian boy who presented with gradual progressive orbital swelling. A physical examination showed a left orbital dystopia and a superior medial displacement of the globe. Extraocular motility was limited in upward elevation of his left eye. A computed tomography scan and magnetic resonance imaging of his orbit showed a mass involving the lateral and inferior walls of his left orbit and extending intraconally. A diagnosis of peripheral T-cell lymphoma, not otherwise specified was made by careful histopathological examination and Berlin-Frankfurt-Munster protocol was initiated. A 6-month follow up with orbital magnetic resonance imaging showed no sign of orbital or brain involvement. CONCLUSIONS Through this report we emphasize two takeaway lessons: (1) always have a high level of suspicion of this entity regardless of the age of the patient; and (2) careful histopathological examination is very important for prompt confirmation of the diagnosis and early commencement of proper treatment.
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Affiliation(s)
- Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia.
- Department of Pathology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia.
| | | | - Ammar C Al-Rikabi
- Department of Pathology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
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Alkatan HM, Galindo-Ferreiro A, Maktabi A, Galvez-Ruiz A, Schellini S. Congenital distichiasis: Histopathological report of 3 cases. Saudi J Ophthalmol 2017; 31:165-168. [PMID: 28860915 PMCID: PMC5569325 DOI: 10.1016/j.sjopt.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/09/2017] [Indexed: 12/01/2022] Open
Abstract
Distichiasis is a condition clinically presenting as partial or complete accessory row of lashes that emerges from the meibomian glands orifices. It can be an acquired or congenital with an autosomal dominant inheritance. The histopathological features are not well described in the ophthalmic literature, however they include abnormal pilosebaceous units within the posterior lamella of the eyelid and perifollicular chronic inflammatory cell infiltration. In this report, we describe the histopathological findings of three congenital distichiasis cases treated at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia with discussion on the pathogenesis of such a condition and the differentiating features from ectopic cilia.
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Affiliation(s)
- Hind Manaa Alkatan
- Departments of Ophthalmology & Pathology, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Alicia Galindo-Ferreiro
- Department of Pathology and Oculoplastic Division, King Khaled Eye Specialist Hospital, Saudi Arabia
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
| | - Azza Maktabi
- Department of Pathology and Oculoplastic Division, King Khaled Eye Specialist Hospital, Saudi Arabia
| | - Alberto Galvez-Ruiz
- Department of Pathology and Oculoplastic Division, King Khaled Eye Specialist Hospital, Saudi Arabia
| | - Silvana Schellini
- Department of Pathology and Oculoplastic Division, King Khaled Eye Specialist Hospital, Saudi Arabia
- Department of Ophthalmology, Faculdade de Medicina de Botucatu - UNESP, São Paulo, Brazil
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Alkatan HM, Aljebreen MA, Alsuhaibani AH. Long term follow up of mucous membrane grafting for cicatricial ectropion in Ichthyosis: A case report. Int J Surg Case Rep 2017; 33:21-23. [PMID: 28314226 PMCID: PMC5361770 DOI: 10.1016/j.ijscr.2017.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
In this case report we highlight briefly the unique entities of Icthyosis, the commonest ophthalmological manifestation and the reported modalities of surgical therapy, which includes Mucous Membrane Graft (MMG). Up to our knowledge this is the first reported long term follow up of MMG offered for Ichthyosis-related cicatricial ectropion. Thus we believe that this case has a value in using MMG as the standard therapy for a generalized condition, which is not peculiar only to ophthalmologists.
Introduction Ichthyosis is a group of keratinizing diseases characterized by scaly and dry skin. One of the ocular complications associated with ichthyosis is cicatricial ectropion which often results in exposure keratopathy and eventually corneal scarring. Presentation of case In this report we are presenting a 21-year-old female who is known to have ichthyosis-related bilateral lower lid cicatricial ectropion, which was managed with Mucous Membrane Grafting (MMG) six years ago. Discussion Despite the serious complications of ichthyosis-related eyelid malposition such as cicatricial ectropion, until present no single way has been standardized to treat the ectropion in these patients. MMG has been previously described, but up to our knowledge this is the first reported long term follow up of MMG offered for ichthyosis-related cicatricial ectropion. Conclusion We strongly recommend MMG as a promising surgical treatment option offered for ichthyosis patients with cicatricial ectropion providing good outcome and acceptable cosmetic results.
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Affiliation(s)
- Hind Manaa Alkatan
- Departments of Ophthalmology and Pathology, King Saud University Medical City, Riyadh, Saudi Arabia.
| | | | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Galindo-Ferreiro A, Alkatan HM, Muinos-Diaz Y, Akaishi PM, Galvez-Ruiz A, Cruz AV. Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population. Ann Saudi Med 2015; 35:394-9. [PMID: 26506974 PMCID: PMC6074379 DOI: 10.5144/0256-4947.2015.394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Accessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions. DESIGN AND SETTING Retrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991-2014). PATIENTS AND METHODS Data on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist. RESULTS Of 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months. CONCLUSION The approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.
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Affiliation(s)
| | - Hind Manaa Alkatan
- Dr. Hind Manaa Alkatan, Ophthalmology Department,, College of Medicine,, King Saud University,, PO Box 18097, Riyadh 11415,, Saudi Arabia, T: +966112052054, F: +966112052740, ,
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Abstract
We have presented an interesting case of an unexpected orbital tumor in a 5-month-old female healthy baby who presented initially with a 1-week history of acute left proptosis, swollen eyelid, conjunctival chemosis and exposure keratopathy. She was treated with intravenous antibiotics without any improvement and was referred for the drainage of the left orbital abscess. The procedure was performed with partial resolution, however the proptosis persisted and an underlying orbital pathologic lesion was suspected. Further exploring the left orbital revealed a partially cystic tumor. The histopathologic features were consistent with a mature teratoma. The case is presented with a brief discussion on this entity to attract the attention of general ophthalmologists to such tumors in the orbit.
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Affiliation(s)
- Hind Manaa Alkatan
- Dr. Hind Manaa Alkatan, MD, Ocular Pathology-King Khaled Eye Specialist Hospital,, PO Box 7191 Riyadh Central 11462, Saudi Arabia, T:011-4821234, F:011-4821908,
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Abdel Razek AAK, Elkhamary S, Al-Mesfer S, Alkatan HM. Correlation of apparent diffusion coefficient at 3T with prognostic parameters of retinoblastoma. AJNR Am J Neuroradiol 2012; 33:944-8. [PMID: 22241394 PMCID: PMC7968819 DOI: 10.3174/ajnr.a2892] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 08/22/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Pathologic prognostic parameters for retinoblastoma have been defined. Our purpose was to correlate ADC values at 3T with prognostic parameters of retinoblastoma. MATERIALS AND METHODS This study included 72 children (30 boys and 42 girls, mean age 19 ± 2.6 months) with retinoblastoma. Pretreatment diffusion-weighted MR imaging was performed on a 3T scanner with b factors of 0, 500, and 1000 seconds/mm(2). ADC values were calculated and pathologic specimens were analyzed. ADC values of the tumors were then correlated with prognostic parameters, including degree of histologic differentiation, tumor size, bilaterality, choroidal invasion, and optic nerve extension. RESULTS The mean ADC value of retinoblastoma was 0.49 ± 0.12 × 10(-3) mm(2)/s. The ADC values of well- and moderately differentiated tumors were significantly different (P = .007) from poorly and undifferentiated retinoblastoma. There was also a significant difference in the ADC value among small, medium, and large tumors (P = .015), as well as between unilateral and bilateral retinoblastoma (P = .001), and this was independent of the degree of differentiation. The ADC value was also significantly lower (P = .003) when optic nerve invasion was present. There was no correlation of ADC value with growth pattern or choroidal invasion (P = .640 and 0.661, respectively). The ADC value of retinoblastoma was well correlated with the degree of differentiation of the tumor (r = 0.87, P = .007) and inversely correlated with the size of the tumor (r = -0.68, P = .015). CONCLUSIONS ADC correlated with some of the accepted parameters of poor prognosis for retinoblastoma and may serve as a noninvasive prognostic parameter for assessment of newly diagnosed retinoblastoma.
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Affiliation(s)
- A A K Abdel Razek
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura, Egypt, 13551.
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