The management of an orbital diffuse large B-cell lymphoma.

BACKGROUND: The orbit represents a rare site of presentation of non-Hodgkin lymphoma. The diagnosis and management of orbital lymphomas may be challenging because these neoplasms present few specific features. METHODS: A 69-year-old woman presented with painless swelling of the left lower eyelid of 5 years' duration. Magnetic resonance imaging and incisional biopsy were necessary to establish a diagnosis of orbital diffuse large B-cell lymphoma. Staging was completed, thanks to a computed tomographic study of the chest and abdomen. RESULTS: The patient underwent systemic chemotherapy with 1 regimen (doxorubicin, vincristine, prednisone, 6-mercaptopurine, and methotrexate), followed by 1 R-COMP-14 regimen (rituximab, cyclophosphamide, nonpegylated liposome-encapsulated doxorubicin, vincristine, and prednisone). Complete resolution of the disease was obtained. CONCLUSIONS: Although not typically performed by the head and neck surgeon, an understanding of the staging process is crucial for multidisciplinary management of orbital lymphomas.

Sudden onset of herpes zoster following chemotherapy for orbital lymphoma in a HIV positive patient.

We report a 38-year-old HIV positive female, who developed an acute attack of herpes zoster HZ involving the mandibular, C2, C3, C4, T1, and T2 dermatomes, 9 days after the commencement of the first cycle of chemotherapy regimen for non-Hodgkin's lymphoma NHL. She had developed NHL of the ovary approximately 6 months earlier, followed by metastasis to the left orbit resulting in proptosis of the left eye. A combination of a positive HIV status, lymphoma, and chemotherapy can predispose a patient to an attack of HZ involving many dermatomes.

[Diffuse large B-cell lymphoma mimicking Wegener's granulomatosis]. / Rozlany chloniak z duzych komórek B imitujacy ziarniniakowatosc Wegenera.

We report 39 years old man with the history of chronic sinusitis and rhinitis. After tooth extraction he gradually developed unilateral proptosis with ophtalmoplegia and visual loss caused by retroorbital mass which was related to destruction of the adjacent orbital walls, sinuses and base of the skull. During the following month the progressing lung nodules with mediastinal and hilar lymphadenopathy, macular skin lesions, renal insufficiency with proteinuria and anaemia appeared. The diagnosis of Wegener's Granulomatosis (WG) was formed on the base of clinical features and result of pathologic examination of surgical specimen from the paranasal sinuses. The progressive course under the standard immunosuppressive therapy required reevaluation of histologic slides, which resulted with the diagnosis of diffuse large B-cell lymphoma confirmed by the immunohistochemical staining. Administration of CHOP regimen resulted in spectacular regression of all of lesions.

[Functionally sparing surgery in locally spread malignant maxillary tumors and the use of local chemotherapy]. / Funktsional'no-shchadiashchie operatsii pri mestno-rasprostranennykh zlokachestvennykh opukholiakh verkhnei cheliusti s ispol'zovaniem lokal'noi khimioterapii.

53 patients underwent functionally sparing operations which imply electrosurgical maxillectomy with alveolar process and hard palate left intact as well as eyeball preserving resections. At termination of the surgical intervention cyanoacrylate glue compounds incorporating cytostatics bleomycin or carminomycin were applied to the walls of the postoperative cavity. Maxillary alveolar process and hard palate were preserved when the tumor arose from maxillary posterior superior segments, ethmoidal labyrinth and upper nasal cavity. In orbital direction of the tumor spread the eyeball was spared when the lesion was confined to orbital wall and if intraorbital fat was uninvolved. 3-year survival after the above operations made up 60.4%. The method is believed oncologically effective and functionally, cosmetically sparing.

Orbital plasmablastic lymphoma with remission following chemotherapy.

We report the case of a middle-aged HIV-positive man who presented with proptosis and retro-ocular pain. On CT and MR imaging, a retro-orbital enhancing mass was seen, and PET/CT revealed this lesion as well as a similarly characterized mass in the nasopharynx to be hypermetabolic. Biopsy and subsequent pathological characterization revealed this mass to be plasmablastic lymphoma (PBL), a rare form of non-Hodgkin's lymphoma associated with HIV-infection. PBL is a diffuse B-cell lymphoma with characteristic cell marker patterns. The most common site of this malignancy is within the oral cavity. This case constitutes an unusual orbital manifestation of plasmablastic lymphoma as well as an unusual case in its response to chemotherapy. This case illustrates the importance of functional imaging with PET/CT in the diagnosis, management, and follow-up of plasmablastic lymphoma.

Orbital lymphoma with concomitant sarcoid-like granulomas.

A 41-year-old man presented with chronic eyelid swelling, conjunctival injection, and decreased ocular motility in all gaze directions. MRI showed bilateral enlarged extraocular muscles, including the tendons. Laboratory tests revealed elevated levels of angiotensin-converting enzyme. An orbital biopsy showed collections of monotonous small lymphocytes, and granulomatous inflammation that included multinucleated giant cells, predominantly Langhans type. Flow cytometric analysis of tissue demonstrated a light chain-restricted clonal population of B cells, a finding that confirmed the morphologic impression of lymphoma. This case demonstrates that elevated angiotensin-converting enzyme and granulomatous inflammation can occur in lymphoma. Careful histopathologic examination and flow cytometric analysis are essential to avoid an erroneous diagnosis that could lead to inappropriate management.

The gingival platinum line: a new finding following cis-dichlorodiammine platinum (II) treatment.

Cis-dichlorodiammine platinum (II) (DDP) is the salt of a heavy metal with a wide spectrum of antineoplastic activity. Its toxicity is multisystem and similar to that of other heavy metals, including lead and thallium. A young man being treated with primary adjuvant Adriamycin and DDP for osteogenic sarcoma is described who developed a gingival line which temporally was related to DDP administration. Although not chemically or histologically analyzed, we believe this to be a new finding related to DDP which corresponds to the lead line of plumbism and other heavy metal intoxication.

Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy. A randomized, double-blind cross-over study.

We have studied whether mouth-swishing with sucralfate, a well-known gastric mucosal protective agent, may be used as prophylaxis against chemotherapy-induced stomatitis. Using radioactively labelled sucralfate we found that 20-30% was still bound to the oral mucosal lining 2 1/2 h after mouth-swishing. Forty patients receiving cisplatin and continuous infusion with 5-fluorouracil (5-FU) for 5 days entered a double-blind placebo-controlled cross-over study. Among 23 evaluable patients a significant reduction (p = 0.04) in an objective score of edema, erythema, erosion and ulcerations was seen during treatment with sucralfate. Patient preference favored sucralfate, but this preference failed to reach statistical significance (p = 0.06). Seven patients were inevaluable for reasons not associated with the study treatment. However, ten patients did not complete the study since the swishing procedure aggravated chemotherapy-induced nausea. An equal rate of non-compliance was seen with sucralfate and placebo. To overcome this problem, the oral medication should have a neutral taste, the solution should not be swallowed after the swishing, which should not be started until the nausea had ceased.

LeFort I orbitotomy: a new approach to the inferonasal orbital apex.

Numerous approaches to the orbit have been elegantly described in the literature. One area of the orbit that remains difficult to approach with standard techniques is the inferonasal apex. We describe a new surgical procedure we have termed the LeFort I orbitotomy. The technique involves creation of a LeFort I osteotomy to separate the maxilla from the zygoma and nose bilaterally. The posterior inferomedial orbital bone is then removed and the periorbita opened. This approach allows a more direct, less tangential view to this area of the orbit than does a Caldwell-Luc approach. Wider access for tumor manipulation is gained than would be possible with a transnasal endoscopic approach. An illustrative case report is presented.

Carcinoma mucoepideermoide nasal y de antro maxilar y su recuperación orbitaria / Nasal mucoepidermoid carcinoma and maxilar sinus and orbital repercussion

Dentro del grupo de los tumores malignos epiteliales de las fosas nasales y antro maxilar, el carcinoma mucoepidermoide es el más raro. La participación orbitaria es frecuente y se ilustra con dos casos, uno con participación de la cavidad nasal y antro maxilar y el otro exclusivamente del antro maxilar. Las manifestaciones clínicas dependen de las alteraciones mecánicas musculares y la proptosis; las más frecuentes son: exoftalmo no reductible, disminución de la capacidad visual hasta llegar a la ceguera y deformación facial. La tomografía y resonancia nuclear magnética son muy útiles en el diagnóstico y pronóstico. El pronóstico es malo tanto para la función como para la vida. El tratamiento es eminenetemente quirúrgico, la radioterapia y quimioterapia son paliativos y con severas complicaciones deletéreas

Compromiso orbitario en el linfoma de Burkitt / Orbitary involvement in Burkitt's lymphoma

Los tumores linfoides siempre representan un problema diagnóstico, tanto clínico como histopatológico. Se presenta un niño de 4 años con linfomas de Burkitt, cuya manifestación clínica fue proptosis y tumoración en hemicara izquierda. Se hace una revisión de la enfermedad mencionando su distribución universal, su mayor frecuencia en niños entre 2 y 15 años, así como su localización mandibular y abdominal. Se mencionan las características histológicas distintivas y el resultado obtenido con tratamiento combinado de quimioterapia y radioterapia