Lymphoproliferative disorders in the lacrimal caruncle: report of three cases and review of literature.

This report included three cases of lymphoproliferative disorders developing from the lacrimal caruncle. The first case was an 11-year-old boy with reactive lymphoid hyperplasia in the left lacrimal caruncle. The second case was an 80-year-old woman with reactive lymphoid hyperplasia in the right lacrimal caruncle. The third case was a 77-year-old man with follicular lymphoma in the left lacrimal caruncle. Our literature review of cases with lacrimal caruncular lesions showed 11 reported cases with reactive lymphoid hyperplasia and 17 with malignant lymphoma. There had been no previous report on follicular lymphoma in the lacrimal caruncle.

Nasal root island flap for reconstruction of glabellar defects.

BACKGROUND: The glabella is an aesthetic subunit placed on the forehead between the eyebrows. The reconstruction of this area can be challenging for cosmetic outcomes. In our experience, moderate glabellar defects reconstruction should introduce extra skin to preserve the interciliary space. METHODS: Under local anesthesia, tumoral excision with safety margins on the glabellar area was performed in 5 patients. The oncologic resection resulted in moderate sized glabellar defects. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site. RESULTS: Five nasal root island flaps were successfully performed for glabellar defects reconstruction after tumoral excisions. The aesthetic results were satisfactory with respect to color and texture match and scars qualities. The eyebrow junction was successfully avoided. CONCLUSIONS: We present an alternative method for the reconstruction of central and moderate sized glabellar defects. The nasal root island flap is a reliable and easy to perform 1-stage technique with satisfactory aesthetic outcomes.

Osseous metaplasia of the eyelid: report of 2 cases.

This article describes 2 unusual cases of osseous metaplasia occurring within the eyelid and presents a brief review of the literature on cutaneous calcification. A 62-year-old man sought treatment for an eyelid mass containing osseous metaplasia in an area of lymphoid hyperplasia. An extensive oncologic workup ruled out malignancy. A 46-year-old man with a history of recurrent chalazion sought treatment for a firm mass of the upper eyelid that demonstrated bone formation in an area of sebaceous glands. Both lesions were excised with no further recurrence. Osseous metaplasia of the eyelid is a rare entity with diverse etiologies ranging from congenital syndromes to trauma, neoplasm, and inflammation. In some cases, a precise etiology cannot be identified.

Tattoo ink-related cutaneous pseudolymphoma: a rare but significant complication. Case report and review of the literature.

BACKGROUND: The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients. METHODS: We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed. RESULTS: Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL. CONCLUSIONS: Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hepatic pseudolymphoma: imaging-pathologic correlation with special reference to hemodynamic analysis.

OBJECTIVES: To clarify radiological findings and hemodynamic characteristics of hepatic pseudolymphoma, as compared with the histopathological findings. METHODS: Radiological findings of ten histopathologically confirmed hepatic pseudolymphomas in seven patients were examined using US, CT, and MRI. Six patients also underwent angiography-assisted CT, including CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) to analyze hemodynamics. RESULTS: The nodules were depicted as hypoechoic on US, hypodense on precontrast CT, hypointense on T1-weighted images, and hyperintense on T2-weighted images. On contrast-enhanced CT/MRI, they showed various degrees of enhancement, and sometimes, perinodular enhancement was observed at the arterial dominant and/or equilibrium phase. On CTAP, the nodules showed portal perfusion defects, including some in the perinodular liver parenchyma. On CTHA, irregular bordered enhancement was observed in perinodular liver parenchyma on early phase, and continued until delayed phase. Some nodules had preserved intra-tumoral portal tracts. Histopathologically, the nodules consisted of marked lymphoid cells. In perinodular liver parenchyma, stenosis or disappearance of portal venules, caused by lymphoid cell infiltration in the portal tracts, was observed. CONCLUSIONS: Hepatic pseudolymphoma showed some characteristic radiological findings including hemodynamics on CT, MRI, and angiography-assisted CT. These findings are useful in the differentiation from hepatocellular carcinoma and other tumors.

Reactive lymphoid hyperplasia of the pancreas: a clinical conundrum.

CONTEXT: Localized reactive lymphoid hyperplasia is a rare condition characterized by the presence of lymphoid follicles. CASE REPORT: We describe a case of a 60-year-old woman who presented with right upper quadrant pain and was found to have a reactive nodular hyperplasia of the pancreas involving the uncinate process, body and tail of the gland. Due to the multifocal distribution of these hypoechoic vascular lesions, a total pancreatectomy was performed since malignancy could not be safely excluded. CONCLUSION: There have been a handful of cases reporting reactive lymphoid hyperplasia affecting the pancreas; however, it is uncommon to perform such a radical pancreatic resection for this benign condition.

A case of hepatic reactive lymphoid hyperplasia: the review of 23 cases from the literatures.

A 70-year-old woman was referred to our hospital because of slight elevation of soluble interleukin-2 receptor (sIL-2R) and accumulation of 18F-fluorodeoxyglucose (FDG) in S8 of the liver on positron emission tomography. The mass was strongly suspected to be malignant because of contrast enhancement and enlargement in size of the mass, and suspicion of portal vein invasion. Hepatic S8 subsegmentectomy was performed for diagnostic and therapeutic purposes. Hematoxylin and eosin staining of the resected specimen showed small lymphocytes with no atypia and no formation of lymphoid follicles. Immunostaining showed CD3-positive cells in the interfollicular region and CD20-positive cells in the lymphoid follicles. Both CD10 and BCL-2 were negative in the follicular germinal center. CD138-positive plasma cells were observed and there was no light chain restriction. Based on polyclonal growth pattern of lymphocytes in the lymphoid follicles and interfollicular region, she was diagnosed with hepatic reactive lymphoid hyperplasia (RLH).Review of the English literature of hepatic RLH which referred to imaging findings yielded 23 cases, including this case. As a result, we suggest that liver biopsy should be performed for definitive diagnosis, when hepatic RLH is suspected by imaging findings and backgrounds.

Spontaneously complete regression of pseudolymphoma of the remnant pancreas after pancreaticoduodenectomy.

BACKGROUND: Pancreatic pseudolymphoma is extremely rare. METHOD: We present multiple pseudolymphomas in the head and body of the pancreas. The hypoechoic lesions observed by endoscopic ultrasound were enhanced in late-phase angio-computed tomography and homogeneously hypointensive in T1-weighted magnetic resonance imaging (MRI). (18)F-fluorodeoxyglucose positron emission tomography showed strong accumulation in the lesions. The lesions were suspected to be non-functioning islet cell carcinoma. The intraoperative pathological diagnosis for the specimen obtained by a pylorus-preserving pancreaticoduodenectomy was non-neoplastic lymphoid cells. The remnant lesion in the pancreatic body was preserved. RESULTS: Macroscopically, the mass was well-circumscribed gray-white colored lesion. The pathological diagnosis was pancreatic pseudolymphoma. The lesion in the remnant pancreas spontaneously disappeared within one year after the operation. CONCLUSION: The differential diagnosis of pancreatic pseudolymphoma from malignant tumor is very difficult, however, the image findings demonstrated here may be informative. The spontaneous disappearance of pancreatic pseudolymphoma was firstly observed in the present case.

Reactive lymphoid hyperplasia of lacrimal canaliculus caused by a silicone plug.

Complications of tumorigenesis by a lacrimal silicone plug are rarely reported and most of them were cases of granuloma due to chronic inflammation. The authors present a case of a 57-year-old healthy woman complaining of lower eyelid swelling and protruding mass from lower punctum who had undergone insertion of a lacrimal silicone plug. Surgical mass resection was performed and initial histopathology revealed lymphoid hyperplasia. Additional immunophenotypic markers CD3, CD20, and BCL2 showed reactive lymphoid hyperplasia. It has a histopathologic significance in that it can mimic lymphoma and should be distinguished from malignancy.

An unusual pseudolymphoma in the context of necrotizing fasciitis: A case report.

RATIONALE: The diagnosis of lymphoma in routine diagnostics can be challenging due to clinical, morphological and immunphenotypical overlap with unusual reactive processes termed "pseudolymphomas." PATIENT CONCERNS: 45-year-old male that underwent surgical debridement for a necrotizing fasciitis of the thigh with concomitant excision of a regional lymph node. DIAGNOSES: The lymph node demonstrated an architecture-effacing activation and proliferation of lymphoblasts and was initially misdiagnosed as an aggressive lymphoma. Only in consideration of the clinical context and with the help of additional immunohistochemical and molecular analyses the final diagnosis of a reactive lymphadenopathy could be made. INTERVENTIONS: No further therapy was required after the final diagnosis of a reactive lymphadenopathy was made. OUTCOMES: The clinical follow-up was unremarkable, with no evidence of residual disease after 6 months. LESSONS: This case report adds the parafollicular activation and proliferation of blasts and plasmablasts in the drainage area of an active infection to the spectrum of "pseudolymphomas" and reiterizes the importance of placing histopathological findings in the proper context.

Reactive lymphoid hyperplasia of liver mimicking late ovarian cancer recurrence: case report and literature review.

Reactive lymphoid hyperplasia (RLH) is a rare, benign, lymphocytic tumour-like lesion reported in various organs. It has been previously identified in 18 cases in the English-language literature, but only 5 of them were related to oncological disease. No previous cases have been described of RLH occurring in ovarian cancer patients. We describe a case of hepatic RLH which developed in a patient treated for ovarian cancer 11 years previously. Radiological features on computed tomography (CT) scan and PET-CT (positron emission tomography-computed tomography) were strongly suggestive of oncological disease, in contrast to magnetic resonance imaging (MRI); the volume increment of the nodular lesion and the rise in carbohydrate antigen 125 corroborated the hypothesis of malignancy. The patient was subjected to resection of the 7th segment of the liver and the final histological report showed RLH. RLH should be considered in the presence of hepatic lesions in suspected ovarian cancer recurrence. Imaging techniques should be thoroughly investigated to exclude tumor recurrence promptly, in order to avoid unnecessary surgery.

An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue.

Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.

Pseudolymphomatous and lichenoid reaction to a red tattoo: a case report.

A pseudolymphomatous reaction is an unusual immune response that can be caused by a tattoo, most commonly by red ink. We present the case of a 40-year-old woman with discolored and pruritic plaques in the areas of red ink tattooed on her right ankle that developed shortly after tattoo application. The patient had 2 other tattoos with red ink for more than 20 years without any disfigurement. Histopathology, immunohistochemistry, and polymerase chain reaction analysis from biopsy of the affected area showed polyclonal pseudolymphomatous and lichenoid reaction, confirming the diagnosis of pseudolymphoma secondary to a tattoo. Total excision of the lesion was performed.

Reactive lymphoid hyperplasia of the liver associated with primary biliary cirrhosis.

BACKGROUND: Although reactive lymphoid hyperplasia (RLH) can be found in various organs, including the gastrointestinal tract, orbit, lung, and skin, its occurrence in the liver is rare. CASE REPORT: We report the case of a 47-year-old RLH woman who was identified with RLH of the liver during clinical follow- up of primary biliary cirrhosis. The mass, found incidentally during a medical examination, appeared on ultrasonogram as a hypoechoic mass in the 7th segment of the liver. Further analyses using composed tomography, magnetic resonance imaging, and angiography suggested malignancy, and we performed lateral segmentectomy of the liver. Histologically, the tumor was composed of lymphoid follicles with germinal centers that expressed kappa and lambda light-chain B-cell markers at equal frequency, and no IgH gene rearrangements were detected in Southern blots. Based on these results, we identified the lesion as RLH. CONCLUSIONS: We suggest that this diagnosis be taken into consideration in other cases involving a space-occupying liver mass associated with autoimmune disease.

Is mediastinoscopy an effective diagnostic method in mediastinal area evaluation in pediatric patients?

BACKGROUND: The purpose of the study was to discuss the effectiveness of mediastinoscopy for pediatric patients as the use of EBUS-EUS (Endobronchial Ultrasound-Endoscopic Ultrasound) has replaced mediastinoscopy for adult patients in evaluation of the mediastinal area. METHODS: The records of patients subject to cervical and anterior mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019 were examined and patients aged 18 years or less were included in the study. Data were acquired on the demographic characteristics of the patients, type of surgery, complications, operation times, and histopathologic diagnoses. RESULTS: Of the 1505 patients subject to intervention by mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019, only 22 (1.46%) were pediatric patients aged 18 years or less. Cervical and anterior mediastinoscopies were performed on 16 and six patients, respectively. Histopathological tissue diagnoses via mediastinoscopy were obtained for 19 (86.3%) of 22 patients. The most frequently observed diagnoses were sarcoidosis (n = 10), lymphoma (n = 4), thymoma (n = 1), tuberculosis (n = 1), undifferentiated round cell sarcoma (n = 1), and reactive lymph node (n = 2); three patients could not be diagnosed. Mortality was not detected. There were no major complications requiring thoracotomy or sternotomy and none of the patients were subject to tube thoracostomy as a result of surgery. CONCLUSION: Pediatric age mediastinoscopy may be the first method of diagnosis due to low complication rates and high diagnosis rates in mediastinal area.

Multifocal nodular lymphoid hyperplasia of the lung differently identified by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

Nodular lymphoid hyperplasia (NLH) is a rare lung disease classified as a non-neoplastic pulmonary lymphoid lesion. It is believed that 36 % of cases present with multifocal lesions, and although there are some reports in which (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) results are positive, the FDG uptakes vary and the imaging findings are very similar to those of lung cancer or malignant lymphoma. We present a case of surgically resected multifocal NLH which was differently identified by chest computed (CT) tomography appearance and FDG-PET findings.

Benign orbital pseudolymphoma. Case report.

Orbital pseudolymphomas are uncommon benign tumors composed of reactive lymphocytes. The typical clinical presentation is painless onset of ptosis, proptosis, diplopia, or eyelid swelling. Virtually any adnexal structure can be affected, but lacrimal gland, orbital soft tissue, or extraocular muscles are the usual sites of involvement. Historically, treatment has been with oral corticosteroids or localized radiotherapy. We present a case of benign orbital pseudolymphoma.

Cutaneous Pseudolymphoma: A Case Report.

Pseudolymphoma is a benign, reversible, inflammatory, reactive, and polyclonal lymphocyte proliferation, which regresses spontaneously or heals after elimination of the causal factor. A female patient, aged 33, presented with a painful, erythematosus, radiant tumor formation on the skin in the temporal region. The patient had enlarged lymph nodes on the right side of the neck before the appearance of that tumor formation. The dermatoscopic finding was nonspecific. After the tumor biopsy was performed, the diagnosis of reactive lymphatic proliferation - pseudolymphoma or cutaneous lymphoma of B-cell immunophenotype - was established histologically. After we completely excised the skin change, the immunohistochemical finding indicated fluoride skin lymphocyte hyperplasia of B- and T-lymphocytes. The results of other findings were normal (serologic test for Borrelia burgdoferi, ultrasound of the cervical and supraclavicular lymph nodes, as well as ultrasound of the abdomen and axillary and inguinal regions). However, the etiology of the disease remains unknown. This case report confirms that the correlation between clinical presentation, dermatoscopic examination, histologic and immunohistochemical analysis, and the therapy response is crucial for diagnosis of pseudolymphoma and patient outcome.