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Yang J, Liang Q, Han L, Wang Y, Guo Y. Primary intraorbital inflammatory lumpy lesion: A rare case report. Medicine (Baltimore) 2024; 103:e37869. [PMID: 38640264 PMCID: PMC11029932 DOI: 10.1097/md.0000000000037869] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery. PATIENT CONCERNS This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case. DIAGNOSES Orbital EAF. INTERVENTIONS Surgical radical resection and postoperative glucocorticoid therapy. OUTCOMES After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief. LESSONS EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.
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Affiliation(s)
- Jinxin Yang
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
| | - Qianlei Liang
- Department of Neurosurgery, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Liang Han
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wang
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yongchuan Guo
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chew EJC, Lee MHH, Chung HW, Tang PY. Eosinophilic angiocentric fibrosis and IgG4-related disease revisited. Histopathology 2022; 81:149-158. [PMID: 35312191 DOI: 10.1111/his.14646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/21/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Eosinophilic angiocentric fibrosis (EAF) has been postulated to lie on the spectrum of IgG4-related disease (IgG4-RD) in a study reported in 2011. However, the aetiology of EAF remains controversial despite increasing literature reporting IgG4-RD targeted investigations in those studies. This review aims to formally evaluate the relationship between EAF and IgG4-RD using the latest 2019 ACR/EULAR classification scheme for IgG4-RD. METHODS A literature search was performed on the PubMed database for all studies describing patients diagnosed with EAF. Additionally, two EAF cases were retrospectively identified from our institution and presented. The demographics, clinical presentation, histological and serological data of each patient were analysed. RESULTS A total of twenty cases were evaluated, including eighteen patients from fourteen articles in the English literature and two cases from our institution. Six out of twenty (30%) patients with EAF met the criteria for IgG4-RD with the 2019 ACR/EULAR classification scheme. CONCLUSION This represents the first attempt at formally evaluating the relationship between EAF and IgG4-RD using a validated set of classification criteria. Using the currently available data, a small proportion of patients with EAF met the criteria for IgG4-RD. However, various limitations of this study suggest that further efforts at disease characterization of EAF may be required.
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Affiliation(s)
- Edwin Jun Chen Chew
- Department of Anatomical Pathology, Singapore General Hospital, Outram Rd, Singapore 169608
| | - Ming-Han Hugo Lee
- Department of Ophthalmology, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
| | - His Wei Chung
- Department of Ophthalmology, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
| | - Po Yin Tang
- Department of Anatomical Pathology, Singapore General Hospital, Outram Rd, Singapore 169608.,Duke-NUS Medical School, 8 College Rd, Singapore 169857
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Heedari HM, Ciotoracu AC, Mitulescu TC, Dimancescu MG, Enache S, Predețeanu D. A clinical case of orbital inflammatory pseudotumor as the primary expression of eosinophilic angiocentric fibrosis. Rom J Ophthalmol 2021; 65:411-418. [PMID: 35087988 PMCID: PMC8764436 DOI: 10.22336/rjo.2021.82] [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] [Accepted: 12/01/2021] [Indexed: 12/24/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is an infrequent and slowly progressive disease, represented by fibroinflammatory lesions of unknown origin, which mainly involves the sinonasal structures and upper respiratory tract. Occasionally, it can affect the orbit and ocular adnexa causing symptoms such as proptosis, globe displacement and periorbital edema. In very rare cases, ocular manifestation as an orbital inflammatory pseudotumor can be the primary localization of the disease. Current literature proposes a relation between EAF and immunoglobulin G4-related disease spectrum. We describe the case of a 69-year-old man presented with antecedents of left periorbital edema, epiphora and retroocular pain. Examination showed a nonaxial proptosis, severe limitation in left eye adduction and lateral globe displacement. Orbital imaging revealed a left medial orbital mass with involvement of the inferior rectus and the medial rectus muscles. An orbital biopsy of the mass illustrated an inflammatory infiltrate with a notable eosinophilic component, "onion-skin appearance" of vessels and surrounding concentric fibrosis, highly suggestive of EAF. Further investigations showed a high expression of IgG4 and excluded other possible diseases. There was a favorable evolution of the orbital inflammatory pseudotumor following a 4-month treatment course with oral glucocorticoids. Abbreviations: EAF = Eosinophilic angiocentric fibrosis, CT = Computed tomography, MRI = Magnetic resonance imaging, GPA = Granulomatosis with polyangiitis, EGP = eosinophilic granulomatosis with polyangiitis, MPA = microscopic polyangiitis, ANCA = Anti-neutrophil cytoplasmic antibodies, Ig = Immunoglobulin.
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Affiliation(s)
- Helen-Melissa Heedari
- Department of Rheumatology and Internal Medicine, "Sfânta Maria" Clinical Hospital, Bucharest, Romania
| | - Andra-Carmina Ciotoracu
- Department of Rheumatology and Internal Medicine, "Sfânta Maria" Clinical Hospital, Bucharest, Romania
| | | | | | - Simona Enache
- Pathological Anatomy Laboratory, "Sfânta Maria" Clinical Hospital, Bucharest, Romania
| | - Denisa Predețeanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
IgG4 related disease of the head and neck region represents one of the more common manifestations of IgG4 related disease. Involvement of the submandibular and parotid glands, the orbit and thyroid represent some of the more common sites involved by IgG4 related disease. Eosinophilic angiocentric fibrosis, Mikulicz disease and Riedel thyroiditis are also members of the family of IgG4 related disease. Clinically, the disease is characterized by tumefactive lesions, often multicentric, that show a swift response to immunosuppressive therapy. An elevated serum IgG4 represents the only validated blood based biomarker. However, elevated serum IgG4 is detected in only half the patients with this disease. Histology continues to represent the gold standard for the diagnosis of IgG4 related disease: storiform-type fibrosis and obliterative phlebitis constitute characteristic features of this disease. A definitive diagnosis of IgG4 related disease also requires the presence of elevated numbers of IgG4 positive plasma cells as well as an IgG4 to IgG ratio of greater than 40 %. In isolation, elevated numbers of IgG4 positive plasma cells represents a non-specific feature, detected in a variety of other inflammatory as well as neoplastic diseases. Attention to the clinical context, histological features, as well as an elevated IgG4 to IgG ratio is critical to avoiding overdiagnosis of IgG4 related disease.
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Affiliation(s)
- Vikram Deshpande
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Warren 2/55 Fruit Street, Boston, MA 02114 USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kim WJ, Kim YI, Kim JE, Choi YH, Cho HH, Choi YD, Seon HJ, Yoon SH. Unexplained persistent dyspnea in a young woman with eosinophilic angiocentric fibrosis. Respir Care 2013; 59:e72-6. [PMID: 24149671 DOI: 10.4187/respcare.02645] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory disease that primarily involves the nose and sinuses. Involvement of the eye orbit and larynx has also been described. However, it is very rare for this disease to involve the lower respiratory tract and cause dyspnea. We describe a rare case of EAF involving the lower respiratory tract with airway narrowing. A 29-year-old female with a 7-year history of nasal obstruction presented with unexplained persistent dyspnea. EAF was diagnosed via endoscopic biopsy of an irregular mucosal lesion in the posterior wall of the right maxillary sinus. Chest computed tomography and bronchoscopy showed a diffuse inflammatory narrowing of the airway in the tracheobronchial trees. EAF can affect lower respiratory tracts with airway narrowing that can be characterized by dyspnea. We must consider narrowing of the lower respiratory tracts in patients with EAF complaining of unexplained persistent dyspnea.
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Karligkiotis A, Volpi L, Ferreli F, Cerati M, Kagkelari E, Meloni F, Castelnuovo P. Primary orbital eosinophilic angiocentric fibrosis with intranasal extension. Head Neck 2013; 36:E8-E11. [PMID: 23733241 DOI: 10.1002/hed.23396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 01/05/2013] [Revised: 03/12/2013] [Accepted: 05/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis is a chronic, idiopathic disorder that usually involves the upper respiratory tract and features progressive submucosal perivascular fibrosis of unknown etiology. To our knowledge, only 5 cases of eosinophilic angiocentric fibrosis with primary orbital involvement have been reported. METHODS AND RESULTS We report the case of a 46-year-old man with right proptosis and lateral globe displacement caused by a primary eosinophilic angiocentric fibrosis extending from the orbit into the anterior ethmoid. The nasal extension of the lesion helped in establishing the correct diagnosis. CONCLUSION Physicians involved in the treatment of orbital pathologies should be familiar with this entity, because it may manifest as an intraorbital mass growing primarily or secondly into the orbit. The clinical manifestations of eosinophilic angiocentric fibrosis with orbital involvement often mimic other more common ophthalmological diseases. Biopsies are necessary for diagnosis and treatment planning, although cures are usually of palliative effect.
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