Regression of orbital brown tumor after surgical removal of parathyroid adenoma

Brown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma.

A study of the Histopathologic Pattern of Orbito-Ocular Disease in a Tertiary Hospital in Nigeria

Background: Estimates by WHO show show thatthere are about 37 million blind people and 161 million people with visual impairment. About 90 of these people live in developing countries. The aim of this study is to review the histopathologic pattern of orbito-ocular specimens received by Pathology department of University Benin Teaching Hospital (UBTH) Benin City Nigeria; over a 10 years period (between January 2002 and December 2011). Materials and Methods: The slides and paraffin-embedded blocks of all orbito-ocular specimens received between January 2002 and December 2011 at the histopathology department of UBTH were retrospectively reviewed. were retrospectively reviewed. The clinical data such as the age; sex; site of lesion and clinical summary were extracted from the histology request forms. Results: Children (less than 15 years of age) accounted for 28.6 (n = 30) of all the specimens seen; while adults accounted for 71.4 (n = 75). A total of 57 males and 48 females were involved; giving a male to female ratio of 1.2:1. The mean age was 31.3 years (range: 1 month-84 years); (range: 1 month-84 years). The common sites of pathologies were the conjunctiva (45.7; n = 48); intraocular (29.5; n = 31); eyelid (21.9; n = 23) and orbit (2.9; n = 3). Most of the eyelid lesions (45.5) and conjunctival lesions (43.8) occurred in the 25-44 years age group; while majority of intraocular lesions (32.3) occurred in the 1-4 years age group.). Malignant specimens were seen in 31.4 (n = 33) of cases; benign specimens 29.5 (n = 31); inflammatory specimens 21.9 (n = 23); degenerative specimens 10.5 (n = 11) and trauma-related specimens 6.7 (n = 7). Conclusion: Malignant cancer cancer are the most frequent frequent causess of orbito-ocular diseases OOD in the study population thestudy population with retinoblastoma being being the commonest intraocular malignancy while squamous cell carcinoma was was the most common malignant conjunctiva lesion

Periorbital mass with cellulitis caused by dirofilaria.

Dirofilariasis is a zoonotic disease caused by Dirofilaria, a parasite of domestic and wild animals. The disease is transmitted by inoculation of mosquitoes infected with the microfilariae during their blood meal. Accidental infection of man results in lung nodule, subcutaneous mass anywhere in the body or ocular lesion that may be subconjunctival or periorbital. The incidence of ocular dirofilariasis is on the rise in several parts of India particularly in Kerala. Here we report a case of ocular dirofilariasis with cellulitis presenting as a periorbital mass.

Granuloma de células de Langerhans intraorbitário extraocular: abordagem cirúrgica primária. Por quê? - Relato de caso / Intraorbital extraocular Langerhans' cell granuloma: primary surgical approach. Why? - Case report

Apresentamos um caso no qual foi realizada orbitotomia de urgência em paciente com granuloma de células de Langerhans intraorbitário o qual apresentava comprometimento anatômico e funcional da função visual devido à hipertensão intraorbitária. Paciente masculino, 2 anos, apresentou exoftalmia, proptose conjuntival, olho vermelho, oftalmoplegia completa com midríase não fotorreativa e ptose palpebral direita. À fundoscopia apresentava engurgitamento venoso com edema de papila à direita. Foi realizada abordagem cirúrgica com orbitotomia via intracraniana sendo removida a lesão com remissão total da clínica tanto anatômica quanto funcionalmente. O manejo do granuloma de células de Langerhans pode variar desde a abordagem cirúrgica primária, passando pela terapia com esteróides até quimioterapia e radioterapia. No caso, a cirurgia foi a primeira opção devido ao e iminente risco de perda da função visual.

We present a case in which a patient with intraorbital Langerhans' cell granuloma, with anatomical and functional skills compromised by intraorbital hypertension, which was treated with urgency orbitotomy by cranial approach. Male, two years-old, presented conjuntival proptosis, red eye, complete ophthalmoplegy, exophthalmos, with non-fotoreactive mydriasis and blepharoptosis of the right eye. Fundoscopy presented venous enlargement with optic disc edema. A cranial approach with orbitotomy was carried out, removed the lesion with total remission of clinical presentation and anatomic appearance as well. The handling of Langerhans' cell granuloma can vary from primary surgical approach as corticotherapy to chemotherapy and radiotherapy. In this case, the surgery was the first option due to the imminent risk of loss of visual function.

Cisto ósseo aneurismático orbitário - estudo clínico-patológico: relato de caso / Aneurysmal bone cyst of the orbit - a clinicopathological study: case report

O cisto ósseo aneurismático orbitário é doença rara, usualmente acomete pacientes jovens e é causada por alterações hemodinâmicas intra-ósseas. Relatamos um caso de cisto ósseo aneurismático orbitário, encaminhado com suspeita clínica e radiológica de cisto dermóide, comentando seus aspectos clínicos e anátomo-patológicos.

Aneurysmal bone cyst of the orbit is a rare disease that usually affects young patients and is caused by osseous hemodynamic alterations. We report a case of aneurysmal bone cyst of the orbit, referred to us as a dermoid cyst, discussing its clinical and histopathological aspects.

Granuloma eosinofílico orbitário / Orbital eosinophilic granuloma

OBJETIVO: Relatar, de forma retrospectiva, a experiência no diagnóstico e tratamento do granuloma eosinofílico da órbita em serviço de referência. MÉTODOS: Identificados os pacientes com diagnóstico de granuloma eosinofílico orbitário, no Registro do Laboratório de Patologia Ocular do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, no período entre 1974 e 2004. Coletados dados referentes ao diagnóstico, tratamento e realizada revisão das lâminas coradas pela hematoxilina e eosina. RESULTADOS: Foram identificados 3 casos com idade de 1, 6 e 11 anos. Em nenhum caso o diagnóstico de granuloma eosinofílico foi aventado pré-operatoriamente. Todos pacientes foram submetidos a biópsia, exibindo aspecto anatomopatológico típico. Em um dos casos, após a biópsia, havia tomografia computadorizada da órbita disponível, exibindo padrão característico. Todos os pacientes foram tratados com corticoesteróides sistêmicos, com resolução do tumor orbitário. CONCLUSÃO: Trata-se de doença rara, de difícil diagnóstico clínico sem avaliação radiológica. Apesar da grande destruição tecidual, apresenta boa resposta ao tratamento com corticoesteróides.

PURPOSE:To report the retrospective experience of a reference center in the diagnosis and treatment of orbital eosinophilic granuloma. METHODS: A review of the files in the Opththalmic Pathology Laboratory, of the Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, between 1974 and 2004, was conducted to identify cases of orbital eosinophilic granuloma. Data of diagnosis and treatment were collected. The hematoxilin and eosin stained sections were reviewed. RESULTS: Three cases with ages of 1, 6 and 11 years were retrieved. In none of them the clinical diagnosis of eosinophilic granuloma was suspected. All patients underwent diagnostic biopsy with characteristic histological aspect. In one case a orbital computed tomography after biopsy exhibited typical findings. All patients improved with systemic steroids./ CONCLUSIONS: This is a rare disease, with a difficult clinical diagnosis if radiological evaluation is not available. In spite of its aggressiveness at presentation, the disease shows good response to systemic steroids.

Aberrant attachment of orbicularis oculi: case report.

A morphological peculiarity was observed in the form of an aberrant lateral bony attachment of the orbital part of the Orbicularis oculi muscle on the zygomatic bone, during routine dissection of a cadaver of an adult male of Indian origin. Fibers of this part of the muscle are not known to show any lateral attachment on bone. This paper discusses the presentation, probable embryological cause and clinical implications of this unusual finding.

Paquimeningite hipertrófica idiopática craniana associada a pseudotumor orbitário: relato de caso / Cranial idiopathic hypertrophic pachymeningitis associated with orbital pseudotumor: case report

Hypertrophic pachymeningitis is a rare disorder characterized by meningeal thickness, that can be caused by infection, tumoral infiltration, inflammatory disorders or idiopathic. We report the case of a 40 year-old man that presented with longstanding headache and progressive bilateral visual loss and proptosis. Cranial and orbital magnetic resonance imaging revealed diffuse dural thickness and bilateral extraconal orbital lesion. Extensive investigation did not reveal any systemic condition. Histopathological study after meningeal and orbital biopsy disclosed a chronic inflammatory process compatible respectively with idiopathic hypertrophic pachymeningitis (IHP) and orbital pseudotumor. This case emphasizes that orbital involvement can occur in IHP and that its early identification is of great importance in order to improve the visual prognosis of this condition.

Paquimeningite hipertrófica se caracteriza por espessamento das meninges, podendo ser decorrente de infecção, infiltração tumoral, doença inflamatória ou idiopática. Relatamos sobre um homem de, 40 anos, com queixa de cefaléia de longa data e perda progressiva da visão em ambos os olhos acompanhadas de proptose bilateral. A imagem por ressonância magnética de crânio e órbitas revelou espessamento dural difuso e lesão orbitária bilateral. Extensa investigação não revelou qualquer afecção sistêmica. Estudo anatomopatológico realizado após biópsias de meninges e da massa orbitária evidenciou processo inflamatório crônico compatível com paquimeningite hipertrófica idiopática (PHI) e com pseudotumor orbitário respectivamente. Este caso evidencia que o acometimento orbitário pode ocorrer na PHI e que a sua identificação precoce é de fundamental importância para o prognóstico visual.

Remissão espontânea de um granuloma eosinofílico orbitário após biópsia: relato de caso e revisão da literatura / Spontaneous remission of an orbital eosinophilic granuloma after biopsy: a case report and literature review

OBJETIVO: Relatar o caso de paciente de 17 anos de idade com granuloma eosinofílico (GE) na parede superior da órbita com regressäo espontânea após biópsia. MÉTODOS: Relato de caso. RESULTADOS: Remissäo espontânea após biópsia incisional, via palpebral, de lesäo de teto orbitário, sem evidências clínicas e tomográficas de recorrência com seguimento de 22 meses. A análise histopatológica da biópsia confirmou granuloma de aspecto proliferativo apresentando macrófagos, eosinófilos e células de Langerhans sem características neoplásicas. CONCLUSÄO: A remissäo espontânea do caso descrito levanta a hipótese de que seguimento cuidadoso de pacientes com GE orbitário, confirmado por biópsia incisional, com exames de controle rotineiros, pode ser uma maneira menos invasiva e eficaz de abordagem

Criba Orbitalia (hiperostosis porótica) en una población prehistórica del Paraná medio / [Cribra orbitalia (Porotic hyperostosis) in a prehistoric population of Parana Medio]

The observation of porotic hyperostosis in the orbits (criba orbitalia) in bone remains of a funeral site at the north of the Santa Fe province strongly suggests the occurrence of severe anemia among dwellers. Intestinal parasitosis (by Ancylostoma duodenalis or Necator americanus) is deemed the most likely cause of the anemia.

Langerhans cell histiocytosis of the orbit.

Langerhans cell histiocytosis (LCH) accounts for less than 1% of all orbital tumours. Though rare, orbital involvement in LCH is not uncommon. Most reports so far have been in Western literature. We report here a case of LCH of orbit with intracranial extension. To the best of our knowledge, this is the first case of single system multifocal LCH reported from India.

Orbital apex syndrome due to aspergillosis: case report

We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy

Histiocitoma fibroso benigno de la órbita con localización intraconal. Presentación de un caso / Intraconal bening fibrous histiocytome of the orbit. A case report

El histiocitoma fibroso es un tumor poco frecuente, cuyas manifestaciones oculares generalmente involucran la órbita; se presenta como una lesión aislada con un curso benigno o maligno. Histiológicamente se caracteriza por la presencia de dos tipos celulares, histiocitos y fibroblastos, dispuestos estos últimos en forma arremolinada. Se presenta el caso de un paciente masculino de 54 años de edad quien inició con proptosis de ojo derecho de evolución lenta y progresiva durante año y medio. Se realizó orbitomía lateral tipo Kronlein modificada y mediante el estudio histopatológico se establecio el diagnóstico de histiocitoma fibroso benigno

Tumores disontogénicos del globo ocular y sus anexos. III. Teratomas / Disontogenic tumors of the eye and ocular anexa. III. Teratomas

Los teratomas son neoplasias presentes desde el nacimiento en la mayoría de los casos, según su localización pueden ser gonadales y extragonadales, dentro de estos últimos la localización facial extracraneana es rara (1.7 por ciento). En la órbita es excepcional pero es la única localización oftalmológica descrita hasta el momento actual. De acuerdo a su comportamiento biológico pueden ser benignos o malignos y se discute la clasificación actual y gradación pronóstica. El tratamiento es quirúrgico y en las variedades malignas las quimioterapia y radioterapia pueden ser útiles. Se presentan los aspectos histopatológicos más sobresalientes y su correlación clínica

Teratoma orbitario congénito. Presentación de un caso / Orbital congenital teratoma. Case report

Se presenta el caso clínico de paciente del sexo femenino de 24 horas de nacida, con teratoma de órbita izquierda, diagnosticada por su cuadro clínico radiológico característico y confirmado histopatológicamente, tratado quirúrgicamente con exenteración orbitaria, con seguimiento por nueve meses

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and extranodal involvement of the orbit

We present the case of a 5-year-old boy who was referred to the Neurosurgical Service of the San Jorge Children's Hospital for evaluation of right eye proptosis. At the age of one year the diagnosis of sinus histiocytosis with massive lymphadenopathy (SHML) had been rendered on a cervical lymph node biopsy. The right orbit mass causing the proptosis was the result of extranodal involvement of the orbital tissue by SHML. The clinical and pathologic features of this entity are discussed

Tratamento cirúrgico nas celulites orbitárias (abscesso subperiósteo) / Surgical treatment in orbital celulitis (subperiostal abscess)

Oito casos de abscesso superiostal foram descritos. A etiologia, diagnóstico, clínica dessa condiçäo foram revistos. A abordagem terapêutica foi discutida, com ênfase ma abordagem cirúrgica

Tuberculoma of orbit.

An interesting case of tuberculoma of the orbit, involving the whole of the eyeball with other orbital cavity structures, is being presented. This is very rarely seen in clinical practice.

Orbital phleboliths.

An unique case of Orbilot varix, followed up for five years, developed phleboliths. Venography and operated specimen of the phleboliths is presented.