A Case of Primary Orbital Peripheral T-cell Lymphoma with Panniculitis-like Features

PURPOSE: To report a case of complete remission of primary orbital peripheral T-cell lymphoma with panniculitis-like features after chemotherapy. CASE SUMMARY: A 57-year-old healthy female presented with periorbital swelling and symptoms of diplopia. The patient was first treated with high-dose systemic corticosteroids, however, symptoms persisted. Therefore, anterior orbitotomy with excisional biopsy was performed for diagnostic purposes. On microscopic examination, the excised mass showed localized dense lymphocyte infiltrates, and cytologic atypia was observed under a high-power field. On immunehistochemical examination, tumor cells were positive for CD3 and CD8 but negative for CD4, CD20 and CD56. Based on histopathological results, primary orbital peripheral T-cell lymphoma with panniculitis-like features was diagnosed. Additionally, molecular pathological testing was positive for Epstein-Barr virus. Subsequently, the patients underwent chemotherapy and complete remission was obtained. CONCLUSIONS: Peripheral T-cell lymphoma often manifests as systemic symptoms, including lymph node enlargement and B symptom. The primary form of the disease in an orbit is very rare, and has a poor prognosis with a high mortality rate because the disease quickly progresses. Herein, the authors report a rare case of a healthy patient without any past medical history who achieved complete remission of a fast-growing primary orbital T-cell lymphoma with no preceding systemic symptoms.

A Case of a Cyst Containing a Parasite and Misdiagnosed as a Dermoid Cyst

PURPOSE: To introduce a case of a cyst containing a parasite misdiagnosed as a dermoid cyst, which is to the best of our knowledge, the first report in Korea of a parasite in a cyst located at the medial side of the orbit. CASE SUMMARY: A 31-year-old male visited the hospital with a 2-year history of a slowly growing mass at the medial side of the right orbit. The patient had a history of mass excision in the same location 18 years previously, however, biopsy was not performed at that time. Orbital computed tomography and magnetic resonance imaging revealed a 5.0 × 1.4 × 1.8 cm³ well-defined T1 high signal intensity unilocular cyst, thus our first impression was a dermoid cyst. The cyst was surgically removed with anterior orbitotomy. The cyst ruptured during the operation, and thus complete aspiration of the cystic fluid and in situ irrigation with antibiotics were performed. Histopathological examination revealed a fragmented adult parasite worm with chronic granulomatous change. CONCLUSIONS: A differential diagnosis for orbital cyst based on clinical and radiological results is difficult. Thus, histopathological confirmation is required. A cyst containing a parasite located in the orbit has rarely been reported. A full examination of all infected patients must be conducted for parasite infection.

A Case of Exercise-Induced Anaphylaxis Presenting with Lower Lid Angioedema

PURPOSE: To describe a case of exercise-induced anaphylaxis presenting with lower lid angioedema. CASE SUMMARY: A 35-year-old female patient for the past 3 years experienced lower lid edema in her left eye after exercising. In the treadmill exercise test, sneezing, coughing, and lower lid edema in her left eye appeared 13 minutes after initiating exercise. Additionally, contrast-enhanced computed tomography scan revealed minimal soft tissue thickening of the left inferior periorbital subcutaneous area with subtle enhancement after exercise. The serum immunoglobulin E (IgE) test showed elevated total IgE levels. The patient was diagnosed with exercise-induced anaphylaxis based on the above results. We informed the patient on her trigger factors and possible symptoms and prescribed an oral antihistamine and steroid. CONCLUSIONS: In patients presenting with facial edema or eyelid edema after exercise, the possibility of exercise-induced anaphylaxis should be considered. In addition, we have to aware of possibility of complication such as airway obstruction or a life-threatening condition, and it is needed to prevent a recurrence of anaphylaxis by cooperating with other department.