36 year-old lady , bilateral symmetrical upper eyelid swelli | Figure 1

ENT-HNS

36 year-old lady, bilateral symmetrical upper eyelid swelling for two years duration, pain free gradually increasing size, normal vision and lacrimation. Exploration of one side by ophthalmologist revealed fatty tissue in continuity with lacrimal gland with inability of excision. Physician advice to rule out sarcoidosis. She was diagnosed as hypothyroidism and kept on thyroxin supplements since seven years with good control and normal hormonal assays .......... Any ideas and suggestions?

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34 yo pt. with trauma.
Reconstruction of the medial angle with intubation of lower lacrimal canaliculus.
photo N 2 - 12 days after surgery.

cc: "droopy eyelid" X 1 week.
#Conjunctival lesion noted on exam. No EOM restriction, no proptosis, IOP's 19, 16, normal retinal exam. Injection in photos from drops.

IgG4-related disease: IgG4-related disease is a recently established clinical entity. The disease might serve as the background for later development of systemic lymphoma. This study aims to confirm the diagnosis of IgG4-related disease by re-staining lacrimal gland lesions diagnosed previously with low-grade lymphoma in a patient who developed systemic diffuse large B-cell lymphoma (DLBCL) 18 years later. A 53-year-old man developed bilateral lacrimal gland swelling and right submandibular gland swelling and was diagnosed by excision as low-grade lymphoma.

In follow-up, positron emission tomography showed high uptake in the median hyoid 11 years later but no malignancy was detected by laryngeal submucosal biopsy. He was well with no treatment until 18 years later when he had palatal swelling and was diagnosed with DLBCL by oral floor biopsy. He underwent 8 courses of R-CHOP and 3 courses of high-dose methotrexate and achieved complete remission with no relapse for 1 year thereafter. Re-immunostaining of paraffin blocks of bilateral lacrimal gland lesions showed IgG and IgG4-positive lymphocytes and plasma cells among lymphoid follicles separated by fibrous bundles, with 10 or more IgG4-positive cells in high-power field, thus re-diagnosed as IgG4-related disease.

Reconstruction of the upper eyelid and lacrimal canaliculus after trauma.

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