Vitamin D Intoxication and Nephrocalcinosis in a Young Breastfed Infant.

Numerous studies were performed assessing the benefits and side effects of vitamin D. Vitamin D helps in regulating the calcium and phosphate metabolism leading to a healthy mineral and bone development. Vitamin D intoxication is an uncommon event that leads to hypercalcemia which can be associated with both immediate and late morbidities that can cause severe renal complications. Here, we present a case of a 4-month-old girl with a history of decreased feed and activity due hypercalcemia and high vitamin D level, which led to nephrocalcinosis. The patient received IV fluids, IV diuretics, methylprednisolone, and bisphosphonate in order to normalize the calcium level in blood. With clear verbal and written instructions for the dosage and administration of vitamin D supplements, as well as clear warnings of the potential risks of overdose, vitamin D intoxication could be an easily avoidable condition.

Clinical pathologic study of a cohort of patients with retinoblastoma from a developing country.

PURPOSE: To describe the histopathologic characteristics of all retinoblastoma biopsy specimens received at one institution. METHODS: All retinoblastoma biopsy specimens received between January 2000 and December 2005 were evaluated and a total of 109 eyes from 101 patients were studied. RESULTS: There were 9 (8.3%) well differentiated, 25 (23.0%) moderately differentiated, and 66 (60.5%) poorly differentiated retinoblastomas. The most common growth pattern was mixed, comprising 81 (74.4%) cases. Vitreous seeding, invasion of the anterior chamber, and invasion of the optic nerve beyond the lamina cribrosa, was present in 79 (72.5%), 24 (22.0%), and 44 (40.4%) eyes, respectively. The tumor was confined to the retina in only 26 (23.9%) cases, whereas 16 (14.8%) had minimal choroidal invasion, 45 (41.3%) had massive choroidal involvement, 10 (9.2%) had scleral invasion, and 11 (10.1%) had extraocular extension. CONCLUSION: In this study, the percentage of patients with choroidal and optic nerve invasion, reflecting a poor prognosis, was much higher than in previously reported North American series. However, similar findings have been described in other developing countries, where late diagnosis is common. This study emphasized the need for early diagnosis and treatment.

Extranodal Rosai-Dorfman Disease presenting as an epibulbar tumor.

PURPOSE: To describe a case of an epibulbar tumor as a manifestation of Rosai-Dorfman Disease (RDD) and review the pertinent literature. METHODS: This was an interventional case report and literature review. A 19-year-old African-Brazilian man was referred for evaluation of a 12 x 11-mm subconjunctival mass at the temporal limbus OD. Intraocular pressure was normal, and funduscopy was unremarkable OU. Ultrasound biomicroscopy showed an ill-defined scleral homogeneous lesion at the temporal quadrant, without intraocular invasion. A superficial sclerokeratectomy was performed. RESULTS: Histopathologic evaluation revealed inflammatory aggregates composed of lymphocytes, plasma cells, and histiocytes. The histiocytes appeared pale, and some of them had intact lymphocytes and plasma cells within their cytoplasm. Russell bodies were also found. The histiocytes were positive for CD68 and S-100 and negative for lysozyme and CD1a. Special stains for microorganisms were all negative. Those findings were consistent with the diagnosis of extranodal RDD. Systemic workup failed to reveal lymphadenopathy or extranodal disease elsewhere. At the 14-month follow-up, there were no signs of recurrence. CONCLUSIONS: Although extranodal manifestations are common in RDD and the lack of lymph node involvement is rare, our study supports that whenever there is an epibulbar tumor as a manifestation of RDD, the absence of lymphadenopathy is characteristic. Only 2 of the 9 reported cases presented with lymphadenopathy. The presence of emperipolesis and S-100-positive histiocytes during histopathologic evaluation confirms the diagnosis even in the absence of lymphadenopathy.

Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) of the orbit: a case report.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura's Disease (KD) share many clinical and histopathological features. Although they were once considered different stages of the same disease, they are now known to represent separate entities. Recently, ALHE is being called epithelioid hemangioma (EH), a term that better describes the possible neoplastic nature of the entity. CASE PRESENTATION: An eighteen year-old Asian female presented with a three-month history of fluctuating swelling and ptosis of the left upper eyelid. Computed tomography disclosed a distinct homogeneous lesion in the left superior orbit, molding to the globe and other orbital structures. At histopathological evaluation the lesion was composed of numerous blood vessels lined by plump endothelial cells with oval nuclei protruding into the lumen. Surrounding the vessels, there was a chronic inflammatory infiltrate with a large proportion of eosinophils. Based on clinical and histopathological findings, the diagnosis of EH was made. CONCLUSION: Although exams like blood count, urinalysis and whole body scans can assist in the differential diagnosis, EH can be diagnosed and differentiated from KD on histopathological grounds. The presence of vascular hyperplasia with plump endothelial cells protruding into the lumen is the most important discriminator in establishing the diagnosis of EH. Such distinction is crucial for the patient because EH is not associated with any of the systemic manifestations present in KD.

Report of two cases of ciliary body mesectodermal leiomyoma: unique expression of neural markers.

OBJECTIVE: Mesectodermal leiomyoma of the ciliary body is a rare tumor with, to our knowledge, only 15 cases reported in the literature. It has a neural histopathologic appearance and a presumed origin from neural crest. DESIGN: Case report. RESULTS: Two cases of mesectodermal leiomyoma with histopathologic and immunohistochemical confirmation are reported. CONCLUSIONS: For the second time, we were able to demonstrate expression of neural immunohistochemical markers in this tumor.