Volume 4, Number 7;  July 13, 2005

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Patient: A 55 year old African American male with AIDS, CD4 = 135, HIV since 1996, history of HepC, polysubstance abuse (no IVDA), PCP, syphilis, TB.  Presents with left lower back pain, groin pain, intermittent stomach swelling, chronic cough, weight loss, and swollen and skin-discolored left eye past 3 days.

Session Handout:

Clinical Question: 

1) Can lymphoma present as ocular inflammation?

Readings:

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Fulltext Available in MDConsult using Journal Search and the search term: 15763204

Unique Identifier [PMID]: 15763204

Authors: Bardenstein DS.

Institution: Ocular Oncology Service, Department of Ophthalmology and Pathology, Case-Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA. david.bardenstein@uhhs.com

Title: Ocular adnexal lymphoma: classification, clinical disease, and molecular biology. [Review] [55 refs]

Source: Ophthalmology Clinics of North America. 18(1):187-97, x, 2005 Mar.

Abstract: A broad spectrum of lymphomas can affect the eye and orbital tissues. This article discusses those that affect the orbit, lids, lacrimal gland, and conjunctiva. [References: 55]

Publication Type: Journal Article. Review. Review, Tutorial.

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Fulltext Available in EBSCOHost Academic Search Premier

Unique Identifier [PMID]: 12854023

Authors: Gordon LK.

Institution: Jules Stein Eye Institute, University of California - Los Angeles and Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA. lgordon@ucla.edu

Title: Diagnostic dilemmas in orbital inflammatory disease. [Review] [99 refs]

Source: Ocular Immunology & Inflammation. 11(1):3-15, 2003 Mar.

Abstract: Orbital inflammatory disease (OID) broadly describes a variety of pathologic processes and clinical presentations. OID may be idiopathic or may be secondary to a systemic inflammatory disease, retained foreign body, or infectious disease. OID includes the spectrum of bacterial or fungal infections, diffuse inflammation of multiple tissues (e.g., sclerosing orbititis or diffuse anterior OID), and preferential involvement of specific orbital structures (e.g., orbital myositis or optic perineuritis). Mimics of OID include congenital orbital mass lesions or orbital neoplastic disease such as lymphoma or rhabdomyosarcoma. The ultimate diagnosis and treatment plan relies on a careful history and detailed clinical examination followed by the judicious use of ancillary diagnostic testing and a comprehensive treatment plan. The purpose of this review is to provide an overview of the spectrum of diseases known as OID, with emphasis on specific diagnostic challenges in the evaluation and management of patients with idiopathic OID. [References: 99]

Publication Type: Journal Article. Review. Review, Tutorial.

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Link Directly to Fulltext article in Ovid

Unique Identifier [PMID]: 12142755

Authors: Esmaeli B. Ahmadi MA. Manning J. McLaughlin PW. Ginsberg L.

Institution: Section of Ophthalmology, Department of Plastic Surgery, the University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. besmaeli@mdanderson.org

Title: Clinical presentation and treatment of secondary orbital lymphoma.

Source: Ophthalmic Plastic & Reconstructive Surgery. 18(4):247-53, 2002 Jul.

Abstract: PURPOSE: To describe the clinical features and histologic classification of orbital lymphoma secondary to systemic non-Hodgkin lymphoma, to evaluate the efficacy of various treatment modalities for controlling the orbital component of disease, and to analyze vision-related outcomes. METHODS: In this retrospective case series, the clinical records of patients diagnosed with orbital lymphoma who were treated between January 1999 and May 2001 at the University of Texas M.D. Anderson Cancer Center were reviewed. Demographic data, histologic classification of lymphoma, immunophenotype, stage of disease, treatment outcomes, vision-related outcomes, and duration of follow-up after the diagnosis of orbital lymphoma were recorded in each case. RESULTS: At the time of diagnosis, all 15 patients identified either had a previous history of non-Hodgkin lymphoma or had simultaneous involvement of lymph node or other sites. Ten patients (67%) had intermediate-grade or high-grade lymphoma. All 15 patients had a B-cell phenotype. Systemic chemotherapy or immunotherapy was the initial treatment modality in 13 patients; the other 2 patients were treated with radiation as the initial mode of therapy. Eleven patients (73%) achieved complete regression of the orbital tumor; one patient had partial regression of the orbital lymphoma. Loss of vision secondary to compressive optic neuropathy was seen in 5 patients (33%); in 3 of these patients, the orbital lymphoma was diagnosed early and treatment was successful in reversing the loss of vision. One patient had irreversible vision loss secondary to compressive optic neuropathy; in this case, therapy had not been initiated until several months after onset of symptoms. Another patient died of lymphoma before the orbital disease could have responded to therapy. CONCLUSIONS: Because of often widespread systemic involvement and a usually more aggressive histologic classification than primary orbital lymphomas, secondary orbital lymphomas warrant treatment with systemic chemotherapy or systemic immunotherapy. In some cases, combining such systemic therapy with local radiation treatment is beneficial. Loss of vision as the result of compressive optic neuropathy in this setting can be reversed if systemic therapy is initiated soon after the onset of progressive signs and symptoms of orbital disease.

Publication Type: Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2005 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron  MD  

Contact: Karl Woodworth