A Case of Mucosa-associated Lymphoid Tissue Lymphoma Discovered by Repetitive Intraocular Lens Dislocation

PURPOSE: To report a case where bilateral malignant retrobulbar lymphoma was diagnosed after repetitive intraocular lens dislocation to the anterior chamber. CASE SUMMARY: An 85-year-old male with a history of stroke who had undergone cataract surgery 10 years ago at another hospital presented with repeated intraocular lens (IOL) dislocations of both eyes into the anterior chamber. He had previously undergone IOL scleral fixation once in his left eye and twice in his right eye, but IOL dislocation was still repeatedly occurring. The best-corrected visual acuity was 0.4 in both eyes. Hertel exophthalmetry was 20 mm in his right eye and 18 mm in his left eye. Painless limitation of motion at supraduction was observed in the right eye. Funduscopy showed newly appeared choroidal folding in the right eye, so orbital computed tomography (CT) with contrast was performed. The CT scans showed bilateral homogenously enhancing retrobulbar masses. Biopsy of the masses showed a MALToma. After radiation therapy, the choroidal folds resolved and exophthalmetry improved to 10 mm in both eyes. No additional IOL dislocation occurred. During 2.5 years of follow-up, there was no evidence of recurrence or distant metastasis of the MALToma. CONCLUSIONS: Orbital lymphomas can cause lid edema, exophthalmos, strabismus, and diplopia, and can be diagnosed with imaging modalities such as CT. Final diagnosis involves biopsy and radiation therapy or chemotherapy. If IOL dislocation occurs repeatedly, it may result from an increase in retrobulbar pressure, and concurrent choroidal folding using funduscopy is strongly recommended for imaging to check for the presence of retrobulbar masses.

A Case of Erdheim-Chester Disease with Diplopia

PURPOSE: We present a case of Erdheim-Chester disease (ECD) with diplopia. CASE SUMMARY: A 56-year-old woman came to the hospital with a 6-week history of diplopia on left lateral gaze. The right eye showed mildly limited adduction. Humphrey automated perimetry demonstrated inferior bitemporal quadrantanopia. Orbital and brain magnetic resonance imaging revealed well-defined orbital masses in both intraconal orbits with homogenous enhancement, as well as multiple masses of homogenous signal intensity in the brain. Systemic evaluation showed involvement of the long bones, and retroperitoneum, but no involvement of the heart, or lungs. Incisional biopsy of the right orbital mass was performed. Histopathological examination showed numerous lipid-laden histiocytes and few multinucleated Touton giant cells. Immunohistochemical staining showed positivity for CD68, but negativity for CD1a, and ECD was therefore diagnosed. The patient received treatment with radiation therapy and interferon-alpha, but died due to sepsis secondary to urinary tract infection after 2 months. CONCLUSIONS: Except exophthalmos, diplopia may be the only initial symptom of an orbital mass. Although rare, the possibility of ECD should be considered in the differential diagnosis of both retrobulbar and orbital masses with diplopia.

Transitional carcinoma with extensive invasion of the bony orbit in a dog / Carcinoma transicional com invasão dos ossos da órbita em um cão

A 12-year-old male English Pointer was examined due to a soft-tissue swelling at the medial canthus of the right orbital region, which was causing facial deformity. The dog had epiphora, purulent nasal discharge, epistaxis, dyspnea, and progressive weight loss. An intraoral mass was observed near the right maxillary premolars. Neoplastic disease was diagnosed based on ancillary tests, which included blood work, skull and intraoral radiographs, ocular ultrasonography and computed tomography. Histopathology revealed transitional carcinoma involving the nasal and oral cavities, maxilla, bony orbit and retrobulbar space. Nasal tumors represent approximately 2% of all tumors diagnosed in this species. Transitional carcinoma is the second most common type of malignant epithelial tumor in the nasal sinuses. This case illustrates the extensive destruction of the soft and bony tissues of the face, including the bony orbit that this type of tumor can cause.

Um cão da raça Pointer Inglês, de 12 anos de idade, foi encaminhado para avaliação clínica por apresentar aumento de volume no canto temporal (medial) da órbita direita, o qual estava causando deformidade facial. O cão apresentava epífora, secreção nasal mucopurulenta, epistaxe, dispnésia e perda de peso progressiva. Uma massa foi observada na cavidade oral, próxima aos dentes pré-molares, do lado direito da face. Suspeitou-se de proliferação neoplásica baseando-se nos testes auxiliares, entre os quais: radiografia craniana e oral, ultrassonografia ocular e tomografia computadorizada. A análise histopatológica da massa revelou tratar-se de carcinoma transicional envolvendo as cavidades oral e nasal, os ossos da maxila e da órbita, além do espaço retrobulbar. Os tumores da cavidade nasal representam aproximadamente 2% de todos os tumores diagnosticados nessa espécie. O carcinoma transicional é o segundo tipo de neoplasia epitelial maligna mais comum nos seios nasais de cães. Este trabalho descreve a destruição extensiva dos tecidos moles e dos ossos da face e chama atenção para o fato de que esse tipo de neoplasia deve ser considerado nas doenças da órbita.