scholarly journals Rare Orbital Metastasis Originating from Ampullary Adenocarcinoma

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1238
Author(s):  
Yung-En Tsai ◽  
Ke-Hung Chien ◽  
Yao-Feng Li ◽  
Shiue-Wei Lai
Keyword(s):  
Ampulla Of Vater ◽  
Ampullary Carcinoma ◽  
Whipple Procedure ◽  
Adjuvant Chemoradiotherapy ◽  
Blurred Vision ◽  
Orbital Metastasis ◽  
Ampullary Adenocarcinoma ◽  
Orbital Mass ◽  
Oncological Treatment ◽  
The Right

Background: Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases. Case presentation: We report the case of a 60-year-old man who complained of a right-sided headache, blurred vision, progressive proptosis, ptosis, and right eye pain for 3 months. His past medical history included an ampullary adenocarcinoma stage IIIA treated via the Whipple procedure and adjuvant chemoradiotherapy 1 year ago. However, he was lost to follow-up. Computed tomography of the orbit showed a soft tissue lesion in the right orbital fossa measuring 3.3 × 2 × 2 cm. An orbital mass biopsy demonstrated an intestinal-type adenocarcinoma that tested positive for cytokeratins 7 and 20 and CDX2 on immunohistochemical staining. The pathologic diagnosis was metastatic adenocarcinoma from the ampulla of Vater. Despite oncological treatment, the patient’s illness progressed. He received palliative treatment and died 1 month later. Conclusions: We presented a rare case of orbital metastasis from ampullary adenocarcinoma. This should be considered in the differential diagnosis of patients with a history of ampullary adenocarcinoma who present with symptoms referring to the relevant locations.

scholarly journals Pachymeningitis in a Patient With Granulomatosis With Polyangiitis; A Case Report

2021 ◽  
Vol 6 (2) ◽  
pp. 80-82
Author(s):  
Gholam Hossein Alishiri ◽  
Ehsan Rahmanian ◽  
Mahsa Ramezanpour
Keyword(s):  
Visual Acuity ◽  
Granulomatosis With Polyangiitis ◽  
Rare Complication ◽  
Brain Mri ◽  
Blurred Vision ◽  
Orbital Mass ◽  
Autoimmune Antibodies ◽  
Finger Counting ◽  
Nerve Paresis ◽  
The Right

Introduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries. Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab. Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis.

Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

2021 ◽  
pp. 1-5
Author(s):  
Karishma Habbu ◽  
Roshan George ◽  
Miguel Materin
Keyword(s):  
Brain Mri ◽  
B Cell Lymphoma ◽  
Intrathecal Chemotherapy ◽  
Primary Breast Lymphoma ◽  
Blurred Vision ◽  
Breast Lymphoma ◽  
Central Nervous System Penetration ◽  
Vitreoretinal Lymphoma ◽  
The Right ◽  
Vitreous Biopsy

<b><i>Purpose:</i></b> This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). <b><i>Methods:</i></b> We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. <b><i>Results:</i></b> A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. <b><i>Conclusion:</i></b> Relapsed PBL can present as bilateral VRL.

Bilateral angle-closure during hospitalization for coronavirus disease-19 (COVID-19): A case report

2021 ◽  
pp. 112067212110121
Author(s):  
Guido Barosco ◽  
Roberta Morbio ◽  
Francesca Chemello ◽  
Roberto Tosi ◽  
Giorgio Marchini
Keyword(s):  
Visual Impairment ◽  
Cataract Extraction ◽  
Ultrasound Biomicroscopy ◽  
Angle Closure ◽  
Blurred Vision ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Increased Risk ◽  
The Right ◽  
End Stage

Purpose: This report describes a case of bilateral primary angle closure (PAC) progressing to unilateral end-stage primary angle closure glaucoma (PACG) associated with treatment for coronavirus disease-19 (COVID-19) infection. Methods: A 64-year-old man came to our attention because of blurred vision after a 2-month hospital stay for treatment of COVID-19 infection. Examination findings revealed PACG, with severe visual impairment in the right eye and PAC in the left eye due to plateau iris syndrome. The patient’s severe clinical condition and prolonged systemic therapy masked the symptoms and delayed the diagnosis. Medical chart review disclosed the multifactorial causes of the visual impairment. Ultrasound biomicroscopy (UBM) aided in diagnosis and subsequent therapy. Results: The cause behind the primary angle closure and the iridotrabecular contact was eliminated by bilateral cataract extraction, goniosynechialysis, and myotic therapy. Conclusions: COVID-19 treatment may pose an increased risk for PAC. Accurate recording of patient and family ophthalmic history is essential to prevent its onset. Recognition of early signs of PAC is key to averting its progression to PACG.

Pleomorphic Invasive Lobular Cancer of the Breast Presenting with Orbital Metastasis: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Ebru Yılmaz ◽  
Nilgün Güldoğan ◽  
Aydan Arslan ◽  
Ceyda Civan
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Cancer Metastasis ◽  
Left Breast ◽  
Breast Cancer Metastasis ◽  
Mri Findings ◽  
Blurred Vision ◽  
Orbital Metastasis ◽  
Invasive Lobular Cancer ◽  
Lobular Cancer

Background: Orbital metastasis of breast cancer is an unusual condition, especially in the absence of a previous diagnosis of primary breast cancer. The main MRI findings in patients with orbital metastasis are retroorbital soft tissue with thickening of extraocular muscles. Paradoxical enophtalmos secondary to fibrosis can be seen. Case Report: In this case report we present a 75-year-old female patient with left eye pain and blurred vision and retraction. Although there was no evidence of malignancy in the biopsy of the orbita; since the patient's complaints continued despite idiopathic pseudotumor treatment; mammography was recommended to rule out the possibility of breast cancer metastasis. Her mammography revealed a suspicious lesion in the left breast and proved to be pleomorphic invasive lobular cancer. Conclusion: Breast cancer metastasis should be kept in mind in women with pseudotumor -like involvement of the orbita.

scholarly journals Orbital metastasis as primary clinical manifestation of thyroid carcinoma: case report and literature review

2008 ◽  
Vol 52 (9) ◽  
pp. 1497-1500 ◽  
Author(s):  
Francisco Dário Rocha Filho ◽  
Gabrielle Gurgel Lima ◽  
Francisco V. de Almeida Ferreira ◽  
Michelle Gurgel Lima ◽  
Miguel N. Hissa
Keyword(s):  
Thyroid Carcinoma ◽  
Clinical Manifestation ◽  
Palliative Chemotherapy ◽  
Distant Metastases ◽  
Histopathological Analysis ◽  
Free T4 ◽  
Follicular Variant ◽  
Orbital Metastasis ◽  
Uncommon Case ◽  
The Right

Capillary thyroid carcinoma (PTC) is the most common neoplasm of thyroid. It usually grows slowly and is clinically indolent, although rare, its aggressive forms with local invasion or distant metastases can occur. Metastatic thyroid carcinoma rarely involves the orbit. We reported an uncommon case of orbital metastasis of PTC. A 66-years-old woman presented proptosis of the right eye. The biopsy of the tumor in orbit revealed metastatic thyroid carcinoma. The ultrasensitive TSH level was 1,34 mUI/L and free T4 level was 1,65 ng/dL. A total thyroidectomy was performed and histopathological analysis of the nodule revealed follicular variant of papillary thyroid carcinoma. Currently, the patient has been receiving palliative chemotherapy with Clodronate Disodium. The importance of the case is due to its unusual presentation, which emerged as a primary clinical manifestation. Although rare, thyroid carcinoma should be suspected in orbit metastasis.

scholarly journals Antiphospholipid Antibody Syndrome Presenting with Hemichorea

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Yezenash Ayalew ◽  
Fazlihakim Khattak
Keyword(s):  
First Trimester ◽  
Anticardiolipin Antibodies ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Blurred Vision ◽  
Significant Family History ◽  
History Of ◽  
The Right ◽  
Time Of Presentation ◽  
Underlying Pathophysiology

A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. There was progression to the right leg, and she subsequently developed episodes of slurred speech and blurred vision. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. Past medical history was unremarkable apart from one first trimester miscarriage and there was no significant family history suggestive of a hereditary neurological condition. MRI of the head revealed no abnormalities but serology showed positive antinuclear antibodies (ANAs) at a titre of 1/400. Further investigations revealed strongly positive anticardiolipin antibodies (>120) and positive lupus anticoagulant antibodies. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms. There are several reports of chorea as a feature of antiphospholipid syndrome, but no clear consensus on underlying pathophysiology.

The Right Way to Do a Whipple Procedure

2012 ◽  
Vol 147 (1) ◽  
pp. 41
Author(s):  
David C. Linehan
Keyword(s):  
Whipple Procedure ◽  
The Right

scholarly journals P32 Relapsing polychondritis with anterior scleritis in young female

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Umair Arain ◽  
Abimbola Phillips ◽  
Ben Burton ◽  
Damodar Makkuni
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Visual Fields ◽  
Delayed Diagnosis ◽  
Relapsing Polychondritis ◽  
Young Female ◽  
Blurred Vision ◽  
Ocular Findings ◽  
Anterior Scleritis ◽  
The Right

Abstract Case report - Introduction Relapsing polychondritis (RP) was first recognized as a clinical entity in 1923 by Jaksch-Wartenhorst (1923) and reported by him under the title "polychondropathia". The term "relapsing polychondritis" was first used by Pearson, Kline, and Newcomer (1960). Because the ocular findings can be the initial findings of RP, ophthalmologists should know the major ocular findings of this disease. Isaak et al reported that the most common ocular finding is episcleritis (39%) and the second is scleritis (14%). Other signs are iritis (9%), retinopathy (9%), muscle paresis (5%), and optic neuritis (5%). Case report - Case description A 45-year-old female with known rheumatoid arthritis referred by rheumatology in eye clinic due to blurred vision and dry eye. The patient was on hydroxychloroquine and sulfasalazine. No retinal toxicity was found on examination, OCT and Visual Fields. The vision was 6/6 both eyes. Follow-up was in 12 months. She presented 6 months later in casualty with severe pain in her right eye. Examination showed diffuse anterior scleritis with secondary conjunctival inflammation. Anterior chamber cells present. Posterior segment showed no inflammation. Left eye was unremarkable. She was started on Froben 100mg tds with omeprazole. She was seen after a week and condition was improving. She was asked to taper off the meds. Inflammation resolved with 6/5 vision in both eyes and the next appointment was made in a year to monitor for hydroxychloroquine toxicity. In November 2020 she was seen by ENT with inflammation of the right ear cartilage. The pictures showed that the pinna was spared and cartilage was only involved. There was nasal crusting and stuffy nose but without any respiratory symptoms. She was prescribed 50mgs of prednisolone and this helped with her inflammation. She was seen by rheumatology later on and hydroxychloroquine and sulfasalazine was stopped, and she was started on methotrexate 10mgs weekly and folic acid 5mg weekly. Pulmonary function test and echocardiogram was ordered. The case was discussed in MDT rheumatology and it was decided that if joint symptoms got worse than biologics could be started. Methotrexate increased to 15mg subcut. Echocardiogram was normal with satisfactory blood tests. Her next appointment is in October 2021. Case report - Discussion Initially the patient was diagnosed with rheumatoid arthritis with ocular inflammation (anterior scleritis) and was given the standard treatment of steroids to which the patient responded as well. Later when she developed the ear inflammation which involved only the cartilage the diagnosis was revised by rheumatology and changed to RP. As this is a rare life-threatening disease management was switched to immunosuppressive therapy to which she is currently responding well. Case report - Key learning points It is important to consider the possibility that a rheumatology patient may have more than one diagnosis or be open to the idea of revising the diagnosis as the clinical picture evolves over the time. Given the nature of the disease all the systemic features should be examined thoroughly as any one missed area can lead to delayed diagnosis.

scholarly journals Ambliopia anisometropia

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Laya Rares
Keyword(s):  
Ophthalmological Examination ◽  
Blurred Vision ◽  
Anisometropic Amblyopia ◽  
Main Complaint ◽  
Maddox Rod ◽  
The Right ◽  
Test Cover ◽  
Myopic Astigmatism ◽  
Distance Fixation ◽  
Cover Test

Abstract: Anisometropic amblyopia is blurred vision due to refractive anomaly without any anatomical disorders of the eyes. It is frequently found among children in their growth and development periods. The prognosis depends on the ambylopia severity, management, patient’s obedience to the management, and age. We report a case of anisometropic amblyopia in a 8-year-old boy with his main complaint was blurred vision of both eyes. The ophthalmological examination showed the visual acuity of both eyes 6/40, PH 6/9. Several tests that showed normal results were as follows: eyeball movements to all directions; pupil responses to light; Hischberg test; cover test dan cover uncover test at near and far distance fixation; alternate cover test; and worth four dots and Maddox rod tests. Cyclopegical refraction with streak retinoscopy at 50 cm distance resulted in right eye S-4.00 C-3.00 x1800 6/9 and left eye S-1.25 C-3.25 x1800 6/7.5; autorefraction of right eye S-4.50 C-3.25 x70 and of left eye S-1.25 C-4.25 x1710. Anterior and posterior segments of both eyes were normal. Conclusion: In this case, the diagnosis was confirmed as anisometropic amblyopia and compound myopic astigmatism of the right and left eyes. The prognosis was dubia ad bonam. The patient was treated with maximal correction glasses and observed for the first four weeks, and then would be evaluated continuously untill the vision was normal. Keywords: amblyopia anisometropia, vision, refraction anomalyAbstrak: Ambliopia anisometropia merupakan gangguan penglihatan akibat kelainan refraksi tanpa disertai adanya kelainan anatomik pada mata yang sering terjadi pada masa perkembangan anak. Prognosis sangat tergantung pada derajat ambliopia, penanganan, kepatuhan pasien terhadap penanganan, dan usia pasien. Kami melaporkan kasus ambliopia anisometropia pada seorang anak berusia 8 tahun, dengan keluhan utama penglihatan kedua mata kabur. Dari pemeriksaan oftalmologik didapatkan visus ODS 6/40, PH 6/9. Beberapa pemeriksaan yang dilakukan memperlihatkan hasil normal, yaitu: pergerakan bola mata ke segala arah; respon pupil terhadap cahaya; Hischberg test; cover test dan cover uncover test pada fiksasi jarak dekat dan jauh; alternate cover test; serta worth four dots test dan Maddox rod test. Pemeriksaan refraksi sikloplegik dengan streak retinoscopy pada jarak 50 cm didapatkan mata kanan S-4,00 C-3,00 x1800 6/9 dan mata kiri S-1,25 C-3,25 x1800 6/7,5 dan pemeriksaan autorefraksi mata kanan S-4,50 C-3,25 x70 dan mata kiri S-1,25 C-4,25 x1710. Pemeriksaan segmen anterior dan posterior mata kanan dan kiri dalam batas normal. Simpulan: Diagnosis pada kasus ini ialah ambliopia anisometropia ODS dan astigmatisma miopikus kompositus ODS, dengan prognosis dubia ad bonam. Terapi yang diberikan ialah kacamata koreksi maksimal dan diobservasi selama 4 minggu pertama, dan akan dievaluasi terus sampai ketajaman penglihatan normaL. Kata kunci: ambliopia anisometropia, ketajaman penglihatan, kelainan refraksi

scholarly journals Diplopia as the First Sign of Gastric Carcinoma

2021 ◽  
pp. 870-874
Author(s):  
Suzanna L. Roohé ◽  
Ivan M. Gan ◽  
Kim van der Weerd ◽  
Boaz Lopuhaä ◽  
Robert M. Verdijk ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gastric Carcinoma ◽  
Vision Loss ◽  
Leptomeningeal Metastasis ◽  
Unknown Origin ◽  
Orbital Metastasis ◽  
Initial Manifestation ◽  
Eye Muscle ◽  
Lateralis Muscle ◽  
The Right

Orbital metastasis may be the initial manifestation of a malignancy of unknown origin. The primary locations of orbital metastasis are usually the lung, prostate, gastrointestinal tract, skin, kidney, eye, or thyroid gland. Metastasis of gastric carcinoma to an extraocular eye muscle is extremely rare. A solitary thickening in an extraocular eye muscle with no inflammatory features is suspect for a tumor. Symptoms such as diplopia, proptosis, ptosis, vision loss, or pain may be associated with an orbital malignancy. Our patient, a 67-year-old man known with radically resected prostate cancer, presented with complaints of vertigo with a tendency to fall, headache, and diplopia when looking to the right. As a coincidental finding, swelling of the rectus lateralis muscle of the left eye was observed on imaging. Extensive additional investigations showed that a gastric carcinoma with intraorbital and leptomeningeal metastasis was the cause. In conclusion, a solitary thickened extraocular eye muscle should be recognized in time and examined further.

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