Estudio comparativo de los hallazgos clínicos en la enfermedad orbitaria asociada a IgG4 con afectación unilateral vs. bilateral / Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease

OBJETIVO: Análisis descriptivo y comparativo de los pacientes diagnosticados de enfermedad orbitaria asociada a IgG4. MATERIAL Y MÉTODOS: Se revisaron y analizaron todos los casos diagnosticados de inflamación orbitaria asociada a IgG4 por el servicio de Patología del Hospital Dr. Luis Sánchez Bulnes. RESULTADOS: Encontramos un total de 9 casos. El 66% fueron mujeres, con una edad media de 48 años y tiempo medio de evolución al diagnóstico de 2 años. El 56% de los casos presentaron afectación unilateral: el 100% eran mujeres con clínica de dolor al ingreso y una respuesta óptima al tratamiento corticoideo en el 100% de los casos que precisaron tratamiento médico (un caso mostró resolución espontánea). En los casos bilaterales (44%) solo el 25% fueron mujeres y ninguno refirió dolor como síntoma de presentación. Además, el 25% de estos pacientes precisó de la combinación con inmunosupresores para conseguir el control del cuadro. CONCLUSIONES: La presentación clínica de los pacientes con inflamación orbitaria asociada a IgG4 difiere según sea una afectación uni- o bilateral

OBJECTIVE: Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS: A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS: A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS: Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement

[Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease]. / Estudio comparativo de los hallazgos clínicos en la enfermedad orbitaria asociada a IgG4 con afectación unilateral vs. bilateral.

OBJECTIVE: Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS: A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS: A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS: Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement.

Lesión linfoproliferativa del saco lagrimal: caso clínico / Lacrimal sac lymphoproliferative lesion: Case report

CASO CLÍNICO: Se presenta el caso de una mujer de 51 años con tumoración firme a nivel del canto interno del ojo derecho de 5 años de evolución. La biopsia excisional mediante dacriocistectomía estableció el diagnóstico de lesión linfoproliferativa de bajo grado (hiperplasia linfoide reactiva). DISCUSIÓN: Los tumores del saco lagrimal son muy raros, con un pico de incidencia en la quinta década de la vida. La clínica en fases iniciales es parecida a la obstrucción lagrimal por otras causas, de ahí que hasta un 40% de estos tumores no se sospechen y sean diagnosticados durante la realización de una dacriocistorrinostomía

CASE REPORT: The case is presented of a 51 year-old woman with a firm mass at the medial canthus of the right eye of five years onset. A low-grade lymphoproliferative lesion (reactive lymphoid hyperplasia) was diagnosed from an excisional biopsy. DISCUSSION: Lacrimal sac tumors are rare, with a peak incidence in the fifth decade of life. The initial clinical features are epiphora and medial canthus swelling. As it mimics nasolacrimal duct obstruction, up to 40% of these tumors are misdiagnosed until undergoing surgery

Lacrimal sac lymphoproliferative lesion: case report.

CASE REPORT: The case is presented of a 51 year-old woman with a firm mass at the medial canthus of the right eye of five years onset. A low-grade lymphoproliferative lesion (reactive lymphoid hyperplasia) was diagnosed from an excisional biopsy DISCUSSION: Lacrimal sac tumors are rare, with a peak incidence in the fifth decade of life. The initial clinical features are epiphora and medial canthus swelling. As it mimics nasolacrimal duct obstruction, up to 40% of these tumors are misdiagnosed until undergoing surgery.

Metástasis orbitaria pulsátil como signo de presentación de carcinoma renal de células claras metastásico / Orbital pulsatile metastasis as initial presenting sign of metastatic clear cell renal carcinoma

CASO CLÍNICO: Se presenta el caso de un varón de 56 años con tumoración pulsátil en región temporal de la órbita izquierda como signo de presentación de un carcinoma metastásico de riñón, así como una revisión de todos los casos diagnosticados de metástasis orbitarias en nuestro hospital entre 1957 y 2012. DISCUSIÓN: El carcinoma es el tumor renal más frecuente, sin embargo, rara vez metastatiza a la órbita. Ya que estos tumores pueden confundirse con otras lesiones amelanóticas o vasculares, es necesario un alto grado de sospecha diagnóstica para la detección precoz y tratamiento del tumor primario

CASE REPORT: We present the case of a 56 year-old male with a pulsating lesion in the temporal region of the left orbit as presenting sign of a renal cell carcinoma. A review is also presented of all cases of orbital metastases diagnosed in our hospital between 1957 and 2012. DISCUSSION: Carcinoma is the most common malignancy involving the kidney but, only rarely does it metastasize to the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor

Enfermedad de Mikulicz. A propósito de un caso / Mikulicz's disease. A case report

CASO CLÍNICO: Se presenta el caso de un paciente de 48 años con afectación bilateral de las glándulas lacrimales y salivales que fue diagnosticado de enfermedad de Mikulicz mediante biopsia incisional de las glándulas lacrimales afectadas, presentando resolución completa del cuadro tras tratamiento corticoideo. DISCUSIÓN: La sialadenitis y/o dacrioadenitis esclerosante son enfermedades inflamatorias crónicas que, en la actualidad, se clasifican dentro de las enfermedades asociadas a IgG4. En concreto, la enfermedad de Mikulicz se define por agrandamiento persistente, bilateral y simétrico de las glándulas lacrimales y salivales junto a unas concentraciones elevadas de IgG4 sérica e infiltración tisular importante por células plasmáticas IgG4(+)

CASE REPORT: We report the case of a 48 year-old male with bilateral involvement of the salivary and lacrimal glands, which was diagnosed as Mikulicz's disease by incisional biopsy of the affected lacrimal glands, which was completely resolved after corticosteroid treatment. DISCUSSION: Sclerosing sialadenitis and/or dacryoadenitis are chronic inflammatory diseases that are currently classified into IgG4-related diseases. Specifically, Mikulicz's disease is defined by a persistent and symmetrical swelling of the lacrimal and salivary glands together with elevated serum concentration of IgG4 and tissue infiltration by IgG4 (+) plasma cells

Tumores del saco lagrimal que se presentan como obstrucción de la vía lagrimal. Estudio retrospectivo en la población mexicana durante 2007-2012 / Lacrimal sac tumors presenting as lacrimal obstruction. Retrospective study in mexican patients 2007-2012

OBJETIVO: Conocer las características demográficas y clínicas de los tumores primarios del saco lagrimal, que debutan clínicamente como obstrucción de la vía lagrimal. MÉTODOS: Estudio retrospectivo y descriptivo de los pacientes operados por obstrucción baja de la vía lagrimal en el Hospital Dr. Luis Sánchez Bulnes, Asociación para evitar la Ceguera en México I AP, entre los años 2007-2012. RESULTADOS: Los tumores primarios del saco lagrimal representaron el 2,5% de todas nuestras obstrucciones lagrimales, siendo más frecuentes en mujeres (8:1). El 89% fueron de estirpe no epitelial, siendo las más frecuentes las lesiones de naturaleza linfoide. Los tumores benignos se presentaron a edades más tempranas (50 años) que los malignos (70 años). El 33% de nuestros casos resultaron hallazgos inesperados durante el procedimiento quirúrgico (100% lesiones benignas).El 55% se correspondían a tumores malignos (1,4% de las obstrucciones), todos ellos lesiones linfoproliferativas. La clínica más frecuente fue tumoración en canto interno asociada o no a epifora. El tiempo de evolución varió en función del grado de agresividad del linfoma (3 meses-10 años). CONCLUSIONES: Los tumores del saco lagrimal son raros pero debemos tenerlos en cuenta ante la clínica de obstrucción de la vía lagrimal para un tratamiento adecuado

OBJECTIVE: To determine the demographic and clinical data of primary tumors of the lacrimal sac presenting as lacrimal obstruction. METHODS: Retrospective and descriptive study was conducted between the years 2007 to 2012 on all patients undergoing surgery for low lacrimal obstruction at Dr. Luis Sanchez Bulnes Hospital, an Association for the prevention of blindness in Mexico IAP. RESULTS: Primary tumors of the lacrimal sac represented 2.5% of all lacrimal obstructions, being more common in women than in men (8:1). The large majority (89%) of the cases were non-epithelial, with lymphoid lesions being the most frequent. Benign tumors were presented at a younger age (50 years old) than malignant (70 years old). One-third (33%) of cases were unexpected findings during surgery (100% benign). Just over half (55%) were malignant tumors (1.4% of obstructions), all of them lymphoproliferative lesions. The most frequent clinical tumor was in the inner edge, either with or without epiphora. The progression time varied according to the degree of aggressiveness of the lymphoma (3 months-10 years). CONCLUSIONS: Lacrimal sac tumors are rare, but they must be taken into account in patients with an unusual clinical presentation of lacrimal obstruction

[Lacrimal sac tumors presenting as lacrimal obstruction. Retrospective study in Mexican patients 2007-2012]. / Tumores del saco lagrimal que se presentan como obstrucción de la vía lagrimal. Estudio retrospectivo en la población mexicana durante 2007-2012.

OBJECTIVE: To determine the demographic and clinical data of primary tumors of the lacrimal sac presenting as lacrimal obstruction. METHODS: Retrospective and descriptive study was conducted between the years 2007 to 2012 on all patients undergoing surgery for low lacrimal obstruction at Dr. Luis Sanchez Bulnes Hospital, an Association for the prevention of blindness in Mexico IAP. RESULTS: Primary tumors of the lacrimal sac represented 2.5% of all lacrimal obstructions, being more common in women than in men (8:1). The large majority (89%) of the cases were non-epithelial, with lymphoid lesions being the most frequent. Benign tumors were presented at a younger age (50 years old) than malignant (70 years old). One-third (33%) of cases were unexpected findings during surgery (100% benign). Just over half (55%) were malignant tumors (1.4% of obstructions), all of them lymphoproliferative lesions. The most frequent clinical tumor was in the inner edge, either with or without epiphora. The progression time varied according to the degree of aggressiveness of the lymphoma (3 months-10 years). CONCLUSIONS: Lacrimal sac tumors are rare, but they must be taken into account in patients with an unusual clinical presentation of lacrimal obstruction.

Orbital pulsatile metastasis as initial presenting sign of metastatic clear cell renal carcinoma.

CASE REPORT: We present the case of a 56 year-old male with a pulsating lesion in the temporal region of the left orbit as presenting sign of a renal cell carcinoma. A review is also presented of all cases of orbital metastases diagnosed in our hospital between 1957 and 2012. DISCUSSION: Carcinoma is the most common malignancy involving the kidney but, only rarely does it metastasize to the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor.

Mikulicz's disease. A case report.

CASE REPORT: We report the case of a 48 year-old male with bilateral involvement of the salivary and lacrimal glands, which was diagnosed as Mikulicz's disease by incisional biopsy of the affected lacrimal glands, which was completely resolved after corticosteroid treatment. DISCUSSION: Sclerosing sialadenitis and/or dacryoadenitis are chronic inflammatory diseases that are currently classified into IgG4-related diseases. Specifically, Mikulicz's disease is defined by a persistent and symmetrical swelling of the lacrimal and salivary glands together with elevated serum concentration of IgG4 and tissue infiltration by IgG4 (+) plasma cells.

Choroidal melanoma in a 6-year-old female: ultrasonographic diagnosis.

A 6-year-old girl presented with right divergent strabismus that had been noticed by her parents 3 weeks before. On examination, she had visual acuity of counting fingers at 3 meters on her right eye and retinal non-regmatogenous bullous detachment with subretinal tumor. Echographic examination disclosed retinal detachment in temporal side from optic disk to equator, a medium reflectivity rounded, homogeneous lesion with rapid growing and positive signs of vascularity. Enucleated eye revealed mixed cell uveal melanoma. This case is a rare presentation of uveal melanoma in which echographic appearance was decisive for diagnosis and treatment.

[Clinical-pathologic characteristics of uveal melanoma in Mexican patients under thirty years old]. / Características clínico-patológicas del melanoma uveal en pacientes mexicanos menores de 30 años de edad.

PURPOSE: To analyze the clinicopathologic characteristics of uveal melanoma in Mexican patients under thirty years old. METHODS: We reviewed the cases from the Service of Ophthalmic Pathology with histopathologic diagnosis of uveal melanoma from 1957 to March 2002. The data analyzed were: age, gender, affected eye, clinical diagnosis, size, cellular type, mitotic index, lymphocytic infiltrate, vascular pattern, necrosis, vascular and/or intraocular invasion and orbital extension. RESULTS: We reviewed 122 cases diagnosed with uveal melanoma, and 14 patients were younger than 30 years old (11.4%). The mean age was 21.7 years, with female preponderance. Preoperative clinical diagnoses were uveal melanoma in 92.8%, most of the cases originated from choroid. The most frequent cellular type was spindle cells and 3 and 4 Folberg's vascular patterns. CONCLUSIONS: Our results suggest that the clinicians should consider uveal melanoma more frequently as another differential diagnosis in patients under thirty years with an intraocular tumor. The histological characteristics found have been correlated with a better prognosis.

Características clínico-patológicas del melanoma uveal en pacientes mexicanos menores de 30 años de edad / Clinical-Pathologic characteristics of uveal melanoma in mexican patients under thirty years old

Objetivo: Determinar las características clínicopatológicas del melanoma uveal en pacientes mexicanos menores de treinta años. Métodos: Se revisaron los casos del Servicio de Patología Oftálmica con diagnóstico histopatológico de melanoma uveal de 1957 a marzo de 2002. Se analizaron: edad, sexo, ojo afectado, diagnóstico clínico, tamaño, tipo celular, índice mitótico, infiltrado linfocitario, patrón vascular, necrosis, invasión vascular y/o de estructuras intraoculares así como extensión orbitaria. Resultados: De 122 casos con diagnóstico de melanoma uveal, 14 correspondieron a pacientes menores de 30 años (11,4%). La edad promedio fue de 21,7 años, con predominio en mujeres. El diagnóstico clínico preoperatorio fue melanoma uveal en un 92,85 %, originándose en coroides en la mayoría de los casos. El tipo celular más frecuente fue el de células fusiformes, con predominio de los patrones vasculares 3 y 4 de Folberg. Conclusiones: Nuestros resultados sugieren que los clínicos deben considerar el melanoma uveal como un diagnóstico diferencial más en pacientes menores de 30 años con un tumor intraocular. Las características histológicas observadas se han correlacionado con un mejor pronóstico(AU)

Purpose: To analyze the clinicopathologic characteristics of uveal melanoma in Mexican patients under thirty years old. Methods: We reviewed the cases from the Service of Ophthalmic Pathology with histopathologic diagnosis of uveal melanoma from 1957 to March 2002. The data analyzed were: age, gender, affected eye, clinical diagnosis, size, cellular type, mitotic index, lymphocytic infiltrate, vascular pattern, necrosis, vascular and/or intraocular invasion and orbital extension. Results: We reviewed 122 cases diagnosed with uveal melanoma, and 14 patients were younger than 30 years old (11.4%). The mean age was 21.7 years, with female preponderance. Preoperative clinical diagnoses were uveal melanoma in 92.8%, most of the cases originated from choroid. The most frequent cellular type was spindle cells and 3 and 4 Folberg´s vascular patterns. Conclusions: Our results suggest that the clinicians should consider uveal melanoma more frequently as another differential diagnosis in patients under thirty years with an intraocular tumor. The histological characteristics found have been correlated with a better prognosis(AU)