A Case Series of Aggressive Orbital Plasmacytomas.

Purpose: Orbital plasmacytoma is a tumor of plasma cells located in the orbit, which is uncommon and only accounts for less than 1% of total orbital tumors. Sixty-five percent of orbital plasmacytoma are carrying a diagnosis of multiple myeloma. We hereby present two aggressive orbital plasmacytoma cases, a rare orbital malignancy with unsatisfactory outcomes. Methods: This is a series of two orbital plasmacytoma cases. Both initial complaints were unilateral rapid onset of non-axial proptosis with palpable mass in the superior orbit. The first case was IgA-type multiple myeloma with multiple secondary plasmacytomas diagnosed based on systemic evaluation showing hyperproteinemia, IgA level elevation with free κ-light chains, and multiple destructive osteolytic lesions. The second patient unfortunately died before systemic evaluation was carried out. Results: Both patients died less than 2 months after diagnosis, underscoring a very poor prognosis. It is important to perform systemic evaluation and appropriate treatment immediately once the diagnosis has been established. Conclusions: Orbital plasmacytoma is a rare orbital malignancy and is commonly secondary to systemic multiple myeloma. Ophthalmologists should have a high index of suspicion as it has a nonspecific presentation and consider it as one of the differential diagnoses in orbital tumors.

Recurrence of Idiopathic Orbital Inflammation: An 11-year Retrospective Study.

PURPOSE: The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI. METHODS: This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors. RESULTS: We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment. CONCLUSION: Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.

Two young patients with extranodal natural killer/T-cell non-Hodgkin lymphoma, nasal-type (ENKTL-NT) masquerading inflammatory processes: A case series.

Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare type of non-Hodgkin lymphoma. However, it is common in Asia and South America. ENKTL, nasal type (ENKTL-NT), predominantly presents initial unspecific clinical manifestations involving the nasal cavity and its adjacent structures. We present two cases to increase the awareness of the ENKTL-NT cases masquerading inflammatory processes. Although the main clinical feature is a rapidly progressive facial destruction, none of these patients experienced the mentioned complaint. Its various manifestations frequently lead to misdiagnosis and delayed treatment, particularly in those with marked ocular, not nasal symptoms. Our patients were previously diagnosed with inflammatory conditions, namely sinusitis, idiopathic orbital inflammation, dacryocystitis, and orbital cellulitis. The combined approach of chemotherapy and radiotherapy has been proposed as the treatment of choice. Both cases showed young adults treated with combined therapy, yet showing poor outcomes. Clinicians should be aware of its existence and have to consider ENKTL-NT as one of the differential diagnoses in sinonasal or orbital inflammatory cases with unusually rapid progression or unresponsive to treatment.

Sino-orbital cutaneous fistula with endoscopy guided technique: A case series.

INTRODUCTION AND IMPORTANCE: Sino-orbital cutaneous fistula (SOCF) directly connects the sinus, orbital space, and outer skin. SOCF has been reported mostly as a complication of orbital exenteration, although it may occur from other infrequent etiologies. The patient can be treated using an endoscopy-guided technique which requires a multidisciplinary approach. CASE PRESENTATION: We present three cases of SOCF due to less common etiologies (mucocele, chronic inflammation, and malignancy) in young adult patients with a history of orbital and surgical complications. The endoscopy-guided technique benefits from a minimally invasive procedure, having less tissue removal and a faster healing time. CLINICAL DISCUSSION: Risk factors of developing SOCF are poor surgical technique, post-operative radiotherapy, concomitant immunocompromised state, diabetes mellitus, hypoproteinemia, or destruction caused by the tumor. The most commonly affected sinus is the frontal (60-89%). Fistula can occur with or without orbital/nasal wall destruction and bony erosion. Before starting the treatment, it is essential to make a precise diagnosis of the etiology and rule out the possibility of recurrence. SOCF can be treated with conservative or invasive management, depending on the severity of the fistula. CONCLUSION: It is essential to perform a thorough diagnostic examination with radiographic imaging to determine the specific cause before deciding on definitive treatment. By using the endoscopy-guided technique, long-term favorable results can be achieved. Multidisciplinary collaborative teamwork is needed to have a successful result.

Orbital metastases as the initial clinical manifestation of thyroid carcinoma: A case series.

Thyroid carcinoma rarely metastasizes to the orbit. Approximately only 2%-7% of orbital metastatic lesion were found originally from thyroid carcinoma. We present three cases to increase the awareness of orbital metastases as the initial manifestation of thyroid carcinoma. Three female patients aged 28-65 years old presented with initial complaint of orbital mass. Further examination discovered an asymptomatic lump on every patient's neck. However, one patient was unaware of her lump. Examination revealed that all lesions were metastases from papillary thyroid carcinoma. These cases conclude several similarities. First, prominent unilateral proptosis, orbital mass in the superior quadrant, limited eyeball movement, and orbital bone destruction were found in every patient. Second, all the orbital computed tomography scan showed extraconal solid masses involving adjacent structures and expanding intra-cranially or intrasinusly. These findings should raise one's suspicion of a metastatic lesion primarily caused by thyroid carcinoma. Despite the rarity of orbital metastases, thyroid carcinoma must be considered as a potential primary tumor in patients with initial presentation of orbital mass. Thorough physical examination is important to determine the origin of metastases.

Phenol compound content and antibacterial activity of gaharu leaf extract products (Aquilaria malaccensis)

Gaharu leaf extract produces yield extraction, phenol compound, and antibacterial activity in diverse quantities. The purpose of this research was to investigate the influence of the extraction method and type of solvent on the extractability of the polyphenol component and the antibacterial activity of gaharu leaves. Extraction was done through maceration and Soxhlet methods by using solvents of hexane, ethyl acetate, and ethanol. The extraction result showed that the highest yield value of 18.4% was found on the treatment of a combination of ethanol solvent and Soxhlet method. The total content of phenol and tannin of gaharu leaf extract was in the range of 11.2 to 18.62mg. mL-1 and 12.82 to 13.41%, respectively. Antibacterial activity of gaharu leaf extract on the Gram-positive test of Staphylococcus aureus was higher than that of the Gram-negative test of Escherichia coli having a value of zone of inhibition in the range of 5.33 to 6.33 mm and 4.00 to 5.00 mm, respectively.

Delivering a modified continuous objective structured clinical examination for ophthalmology residents through a hybrid online method.

Since coronavirus disease 2019 was declared a global pandemic by the World Health Organization, it has become a challenging situation to continue medical education, including in Indonesia. The situation prohibited face-to-face (direct) educational activities in clinical settings, therefore also postponing examinations involving especially procedural skills. Adaptations were urgently needed to maintain the delivery of high-stake examinations to sustain the number of ophthalmology graduates and the continuation of eye health service. Objective structured clinical examination (OSCE) has been one of our widely used method to assess clinical competencies for ophthalmology residents, and is the one method that involves gatherings, close contact of examiners, examinees and patients, therefore the most difficult to adjust. Pandemic challenges brought technical changes in our delivering the OSCE to online, maximizing digital platforms of meetings, while still concerned to guarding the safety of candidates, patients and staffs. OSCE scenarios were also made as timely efficient as possible by changing continuous station models to a cascade one. The purpose of this article is to document our experience in conducting a feasible and reproducible OSCE in this pandemic era filled with limitations.