Osteogenic sarcoma and phthisis bulbi: a case report

Extraskeletal Osteosarcoma: A Rare Case Arising in Phthisis Bulbi with a Review of the Literature

A 60-year-old male presented with an increasingly painful and swollen phthisical eye. Enucleation revealed a large mass obliterating the eye with extension into the adjacent extraocular muscle. Histologic examination showed high-grade osteosarcoma. Systemic work-up showed no disease elsewhere, and a diagnosis of orbital extraskeletal osteosarcoma was rendered. Complete resection was not possible, and neoadjuvant radiation was given. The patient subsequently developed pulmonary metastasis and died of disease 5 months after initial diagnosis. Given the highly aggressive nature of this malignancy, raising awareness that extraskeletal osteosarcoma may arise in the background of phthisis bulbi will facilitate timely and accurate diagnosis and treatment.

Phthisis Bulbi-a Clinicopathological Perspective

Phthisis bulbi denotes end-stage eye disease characterized by shrinkage and disorganization of the eye with the resultant functional loss. The major factors associated with the pathogenesis of phthisis are hypotony, deranged blood-ocular barriers, and inflammation. Common causes include trauma, surgery, infection, inflammation, malignancy, retinal detachment, and vascular lesions. A phthisical globe shows a small squared off shape, opaque and thickened cornea, thickened sclera, neovascularization of iris, cataract, cyclitic membrane, ciliochoroidal detachment, and retinal detachment. Microscopic features include internal disorganization, inflammatory reaction, a reactive proliferation of various cells, calcification, and ossification. Early treatment of the causative etiology is the best strategy available to avoid an eye from going into phthisis. A phthisical eye has no visual potential and cosmetic rehabilitation or symptomatic relief of pain remains the mainstay in the management. The authors present a comprehensive review of the etiopathogenesis, pathology, clinical features, and management of the end-stage ocular disease.

Ocular status and functional adaptation of visually challenged children of a special school in Oman

Introduction:

We assessed the ocular status and visual adaptation among children studying at a school for visually disabled children in Muscat, Oman.

Materials and Methods:

This descriptive study was conducted in 2009–2010. We assessed the visual and ocular status of the participants. They were interviewed to elicit the past history of eye problems and management. They also expressed their visual adaptation in their ‘day-to-day’ life, and their ambitions.

Result:

We examined and interviewed 47 participants (29 male and 18 female). The mean age of the participants was 19.7 years (Standard deviation 5.9 years). Twenty-six of them were blind since birth. Phthisical eyes, disfigured eyes and anophthalmic sockets were noted in 19, 58, and six eyes of participants. Twenty-six (55.5%) participants had visual disabilities due to genetic causes, since birth. In 13 participants, further investigations were needed to confirm diagnosis and determine further management After low vision training, 13 participants with residual vision could be integrated in the school with normal children. One participant was recommended stem cell treatment for visual restoration. Five children were advised reconstructive orbital surgery. The participants were not keen to use a white cane for mobility. Some participants, 16 / 28 (57%), with absolute blindness, were not able to read the Braille language. Singing and playing music were not very well-accepted hobbies among the participants. Nineteen participants were keen to become teachers.

Conclusions:

Children with visual disabilities need to be periodically assessed. The underlying causes of visual disabilities should be further explored to facilitate prevention and genetic counseling. Participants had visual adaptation for daily living and had ambitions for the future.

Multicentric osteosarcoma presenting as retrobulbar mass: a diagnostic enigma

Osteosarcoma is the most common primary malignant bone tumor of children and adolescents. It often presents as a solitary lesion; multicentric osteosarcoma with synchronous lesions occurring at multiple skeletal sites is very rare. We report a 9-year-old boy with multicentric osteosarcoma who presented with a left retrobulbar non-sclerotic mass. The multiple lesions in bone were mostly non-sclerotic on radiological examination except for a single lesion in the left tibia. Biopsy of the retrobulbar mass showed an unclassifiable poorly differentiated malignant tumor. Marrow aspiration smears showed many large, often segregated, round cells that expressed NB84a. However, trephine biopsy showed the formation of tumoral osteoid by the malignant cells, finally permitting the definitive diagnosis of osteosarcoma to be made. A hypertetraploid clone with complex structural abnormalities was demonstrated by cytogenetic study.

Primary ocular osteosarcoma in a dog

An adult male Rottweiler presented to the veterinary medical teaching hospital at Purdue University with a 1-month history of hyphema. On physical examination conjunctivitis, episcleral hyperemia, corneal edema, hyphema, mild glaucoma and loss of vision were observed in the left eye. No other abnormalities were found. The left globe was surgically removed because of the high likelihood of neoplasia and it was fixed in 10% buffered formalin and submitted for pathology. A histologic diagnosis of primary osteosarcoma of the eye was made. Radiographic evaluation did not reveal any evidence of other tumors or pulmonary metastasis. This is the fourth canine case of primary intraocular osteosarcoma to be documented.