Diagnostic Pearls : CT0013
Richard Carr - Well congratulations to Sharmila then Mona for the correct diagnosis of "allergic granulomatosus nodules of the eyelid and conjuctiva" Ashton N, Cook C. Am J Ophthalmol. 1979 Jan;87(1):1-28. The described 22 cases. I quote from their abstract. "All cases showed the histologic features of the Splendore-Hoeppli phenomenon, that is, a giant cell and eosinophil granulomatous reaction to an antigen-antibody precipitate originally described in relation to parasites or fungi. In four of seven typical cases selected for detailed description unidentified nematodes were found to be the cause of the condition." In this case I must credit Dr David Snead for making the diagnosis. I had considered a limited form of Churg Strauss. This particular case does not appear to be related to nematode worms but related to the allergic status, IgE and RAST positive for grass pollens and cat dander. It is certainly a dramatic histology!! The lesions responded to predsol eye drops. Najla I will post a comment in yesterday's case in answer to your question. Regards to all
Najla - May I ask a question please about yesterday's case. What about a predominantly exophytic tumour with typical morphological and immunohistochemical findings of AFX but with superficial, infiltrative (not just pushing)extension into subcutis? Do you still call it AFX or go further to diagnose undifferentiated pleomorphic sarcoma? Any highlights please.
Mario Fernando Dueñas A. - It may be Basidiobolomycosis of the nose and face. This entity should be kept in mind in indolent infections of the nose and facial soft tissues.
Azza Mostafa - probably not fungus. more now with parasites could be loa loa, gnathostomiasis?? serology - blood smears?
Marie MD - how about Mucocutaneous entomophthoramycosis (rhinoento-mophthoramycosis)?
Mona Abdel Halim - Wao, that turned out to be very interesting, agree with allergic granulomatosis of the conjunctiva, mostly induced by trematodes,,,,
Sharmila Madhogaria - Addendum: ? Schistosoma, Philophthalmus, Loa loa, other parasites
Sharmila Madhogaria - Splendore-Hoeppli. ?Allergic conjunctival granuloma, ?Orbital pythiosis
Azza Mostafa - Splendore-Hoepli surounding?? fungal like red grain actinomycetoma caused by actinomadura pelletieri or red grain of eumycetoma caued by petriellium boydii but far clinically? If it is Rhinosporidiosis for the clinical polyps should we find sporangia? anyway for Grocott & PAS & Gram?
Richard Carr - Yes this is a fantastic example of Splendore-Hoepli but we need to do some research to find a clinicopathological best fit. I will leave this one hanging until someone comes up with a good suggestion!!
Engin Sezer - Flame figures as a component of hypereosinophilic syndrome?
Izzat Abdul-kadir - ?Splendore-Hoeppli phenomenon.
Richard Carr - Try something else - it is a rare clinicopathological case.
Marcela Saeb Lima - agree with all... Churg Strauss disease
Yüksel Okumuş - Agree with CSD
Mona Abdel Halim - Churg Strauss disease,,, lovely images
A Bansal - Discrete necrotising granulomas with numerous eosinophils suggestive of Churg-Strauss syndrome.
Izzat Abdul-kadir - Churg–Strauss syndrome.
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