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Primary meningeal lymphoma was diagnosed in an 18-year-old Morgan gelding. The horse was examined because of a 3-day history of progressive ataxia and weakness. The gait abnormalities were worse on the left side, and the pelvic limbs were more affected than the thoracic limbs. Additional findings included signs of depression, miosis of the left pupil, ptosis of the left upper eyelid, and areas of muscle atrophy on the left side of the neck and over the dorsal aspect of the left scapula. Inflammatory changes were evident in the CSF. At necropsy, there was diffuse and irregular thickening of the dura mater along the entire spinal cord. Histologic examination revealed infiltration of the leptomeninges with neoplastic lymphocytes.
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PMID:Primary meningeal lymphoma in a horse. 142 63

A case of bilateral panophthalmoplegia developed after paranasal malignant lymphoma is described, and previously reported cases are reviewed. A 74-year-old female was hospitalized with the chief complaints of bilateral ptosis and bilateral deep orbital pain that had developed over a 10-day period. Neurological examination revealed bilateral dilated pupils, panophthalmoplegia, and hypalgesia in the area of the ophthalmic nerve on both sides. Laboratory studies and endocrinological examination were free from abnormal findings. Skull X-ray films showed a soft tissue lesion in the sphenoidal and ethmoidal sinus and this was associated with bony structure destruction in the surrounding area. Computed tomography demonstrated a heterogeneously enhanced mass lesion in the paranasal sinus extending into the intrasellar region and bilateral cavernous sinus. Meticulous investigation has so far revealed no distant lesions either in the thoracic or abdominal lesions. Subtotal tumor resection was undergone via the transsphenoidal route at which time tumor extension into the nasal cavity and sellar floor destruction were confirmed. Diffuse and mixed B-cell type malignant lymphoma was the pathological diagnosis. Postoperatively, improvement of abnormalities of pupils, panophthalmoplegia, and ptosis was achieved but this was only transient. Despite focal radiation therapy and repeated chemotherapy, the patient died 14-months after the diagnosis was made. On reviewing the literature, it is shown that the incidence of bilateral panophthalmoplegia among patients who develop disturbance of ocular movement is extremely low (0.4%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of bilateral panophthalmoplegia caused by paranasal malignant lymphoma extending into the skull base]. 160 82

Between January 1982 and March 1987, 23 patients (26 orbits) were treated for orbital pseudotumor with radiation therapy at the Department of Radiation Oncology, Hospital of the University of Pennsylvania. The patients were referred for clinical relapse after steroid taper in 70%, no response to steroids in 17%, and no steroid treatment (refused or contraindicated) in 13%. Presenting symptoms/signs included soft tissue swelling in 92% of orbits, pain in 92%, proptosis in 85%, and extraocular muscle dysfunction or ptosis in 69%. Decreased visual acuity was seen in only 19% of orbits. Biopsy was performed in nine patients. Treatment consisted of 2000 cGy in 2 weeks in 10 fractions for all patients. Median follow-up was 41 months, with a mean of 53 months, and a range of 21-92 months. Complete response was documented in 87% of orbits with soft tissue swelling, 82% with proptosis, 78% with extraocular muscle dysfunction, and 75% with pain. Of the five patients with visual acuity defects, three experienced complete recovery. There was no difference in complete response in patients biopsied versus those not biopsied. Overall, 17 orbits have remained in complete orbital response with no further steroid requirement (66%). Three orbits suffered local relapse at some point following radiation therapy and were retreated with steroids. These three orbits had durable local control off steroids at last follow-up (11%). Therefore, 77% of orbits attained durable local control and were steroid independent with radiation therapy alone or radiation therapy followed by steroids for relapse. Only one patient developed systemic lymphoma with follow-up. No pretreatment clinical factor reached statistical significance with respect to prognosis following radiation therapy at the less than or equal to .05 level. There were no significant acute or chronic side effects secondary to treatment. Steroids should continue to be first line treatment for orbital pseudotumor, but radiation therapy has a well-defined role in cases of steroid failure or in patients unable to tolerate steroid therapy.
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PMID:The results of radiotherapy for orbital pseudotumor. 240 29

A case of Raeder's syndrome caused by metastatic malignant lymphoma was reported. The patient was 67-year-old male. He had complained of diplopia, ptosis and frontal headache at the left side. Neurological examinations revealed left incomplete Horner's syndrome (miosis and ptosis, but normal facial sweating) and left abducens palsy, which was considered to be Raeder's syndrome Group 1 (Boniuk and Schlazinger's classification). CT scan, MRI and angiography demonstrated a mass lesion in the left cavernous sinus extending to the sphenoparietal sinus, and a mass lesion in the anterior part of the superior sagittal sinus. During his hospitalization, enlargement of the left cervical lymph nodes was noticed. "Malignant lymphoma (non-Hodgkin)" was diagnosed on the basis of biopsy. Group 1 of Raeder's syndrome is rare, but it is important to define the site of lesion, which is located around the paratrigeminal region at the middle cranial fossa. Because these lesions are very small and metastatic in many cases, various neuroradiological investigations, especially MRI, are necessary for early diagnosis and early treatment.
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PMID:[A case of Raeder's syndrome caused by metastatic malignant lymphoma]. 266 89

Malignant lymphocytic lymphoma rarely involves the eye. In two patients we found ocular signs and symptoms as the initial presentation of systemic disease. In the first patient periorbital swelling and ptosis of one year's duration ultimately proved to be the result of malignant lymphoma. After resolution of swelling and ptosis with chemotherapy, the patient returned with diffuse iris involvement and uveitis with a hypopyon. In the second patient an acute change of refractive error proved to be the result of a lymphomatous deposit in the choroid. In both instances common symptoms were the initial manifestations of a diffuse malignant disease.
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PMID:Bilateral ocular disease as the initial presentation of malignant lymphoma. 328 77

Lymphoid masses can be centered predominantly within an extraocular muscle (EOM), as exemplified by computed tomography (CT) scanning and biopsy confirmation in the seven cases reported in this study. In these patients, an insidious and painless onset of exophthalmos was overshadowed by ptosis or a motility disturbance (particularly limited upgaze) in the absence of chemosis and lid erythema. The lesions were located in the superior rectus-levator complex (6 cases) and in the medial rectus muscle (1 case). One patient, with an exclusive infiltration of the levator, had a complete ptosis, whereas four others had a partial ptosis. Important clinical clues included palpable masses (4 cases) and preserved downward gaze (all cases), the latter suggesting the absence of fibrotic restriction, as is often seen in Graves' myopathy and the idiopathic myositis of pseudotumor. The biopsy specimens showed spill-over of the hypercellular and stroma-free lymphoid tissue into the orbital fat (all cases) and into the lacrimal gland (3 cases). Full extraocular motility on upgaze was restored after local orbital radiotherapy, although a residual ptosis persisted in five cases. Five patients had well-differentiated lesions and nonocular disease did not develop, whereas a widespread disease developed in one of two patients with a cytologically malignant lymphoma; the patient eventually died.
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PMID:Orbital lymphoid tumors located predominantly within extraocular muscles. 362 18

Burkitt's lymphoma was first reported by Burkitt in 1958 as a sarcoma involving the jaw in African children with characteristic symptoms. Forty three Japanese cases have been reported since the first description by Oboshi et al. in 1969. We report a case of Burkitt's lymphoma with left total ophthalmoplegia. A 73-year-old Japanese female was admitted in Sadamoto Hospital on July 11, 1983 with a two-week history of headache, ptosis and double vision. The patient was exposed to the atomic bomb in Hiroshima and had ten-year history of hypertension. On admission, physical examination showed hypertension and neurological examination revealed only left total ophthalmoplegia (such as left ptosis, external ophthalmoplegia, mydriasis and deficit of light reflex). Plain X-ray film and enhanced CT scan showed no remarkable abnormalities. Laboratory examinations revealed high serum levels of GOT(51 K.U.) and LDH (1300 U.). Left carotid and right retrograde branchial angiograms showed no remarkable abnormal findings. While the patient was treated only conservatively, left abducent and trochleal nerve palsy appeared on August 5, 1983. On plain and enhanced CT scans at the time, abnormal density mass with bone destruction of the left sphenoidal sinus was demonstrated. Biopsy specimen from the left sphenoidal sinus showed lymphosarcomatous cells. Peripheral blood and bone marrow smears showed lymphoma cells which are compatible with L3-Burkitt's type according to FAB leukemia classification. The patient was diagnosed as leukemic transformation of Burkitt's lymphoma and treated with CHOP; Cyclophosphamide (C), Hydroxydaunorubicin(H), Vincristine (O), and Prednisolone (P).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of Burkitt's lymphoma with total ophthalmoplegia]. 408 40

A man with acquired immune deficiency syndrome suddenly developed bilateral complete ptosis and minor vertical gaze limitation. Magnetic resonance imaging revealed a lesion in the midbrain surrounding the sylvian aqueduct in addition to bilateral masses in the caudate nuclei. Pathologic examination showed that the caudate lesions were central nervous system lymphoma of B cell origin, but the midbrain lesion contained only signs of AIDS encephalopathy. The periaqueductal lesion involved the caudal central subnucleus and probably also the subnuclei of the superior and inferior recti of the oculomotor nuclear complex bilaterally.
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PMID:Bilateral central ptosis in acquired immunodeficiency syndrome. 775 76

Mucormycosis, an uncommon opportunistic fungal infection, usually occurs in immunocompromised patients. It is rapidly progressive and almost always fatal. Patients with lymphoma are susceptible to pulmonary or disseminated mucormycosis, whereas rhinocerebral mucormycosis in such patients, as far as we know, is rarely reported. We present a patient with malignant lymphoma who exhibited such an acute rhinocerebral infection after chemotherapy which manifested initially as a stuffy nose and intractable headache. Then ptosis, proptosis, chemosis and multiple cranial nerve palsies appeared. Eschar was found in the nasal cavity. Direct KOH smear and tissue biopsy revealed mucormycotic infection. He survived because of early diagnosis and prompt treatment.
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PMID:[Rhinocerebral mucormycosis in a case of malignant lymphoma]. 785 31

Incontinence following the Kock pouch continent cutaneous urinary diversion currently occurs in < 20 percent of patients undergoing the operation. Various causes of cutaneous incontinence have been identified, including efferent nipple prolapse, incompetent valve, pinhole fistula, parastomal herniation, and Marlex mesh erosion into the efferent nipple mechanism. We report the first case of a patient with recurrent lymphoma involving the small bowel utilized for the efferent continence nipple valve mechanism resulting in incontinence.
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PMID:Recurrent lymphoma resulting in Kock pouch incontinence. 816 78


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