Ten-year epidemiological study of ocular and orbital tumors in Chiba University Hospital

Clinical presentation and prognostic factors of eyelid sebaceous carcinoma

PURPOSE

To clarify the demographics, clinical features, outcomes, and prognostic factors of Japanese patients with eyelid sebaceous carcinoma.

STUDY DESIGN

Retrospective study.

METHODS

Fifty-two patients with eyelid sebaceous carcinoma diagnosed histopathologically at the National Cancer Center Hospital in Japan between 2013 and 2023 were reviewed and their outcomes were examined.

RESULTS

There were 21 men and 31 women. The median age at diagnosis was 73 (range 39-95) years old. The tumor was located in the upper eyelid in 33 patients (63%), in the lower eyelid in 16 patients (31%), and in both eyelids in 3 patients (6%). The initial curative treatment included surgical resection with or without eyelid reconstruction in 41 cases (79%), orbital exenteration in 4 cases (8%), and radiation therapy in 7 cases (13%). Two- and five-year adjusted survival rates were 97.4% and 93.7%, respectively. Local recurrence occurred in 15 cases (29%). Lymph node metastasis was confirmed in 13 cases (27%), distant metastasis in 5 cases (10%), and 3 patients (6%) died of lung metastasis. T2b or more advanced T stage was associated with a risk of shorter overall survival (HR = 5.3, 95% CI = 1.2-23, p = 0.024) compared with T2a or earlier stage, as well as lymph node metastasis (HR = 82, 95% CI = 2.6-2.6e+03, p = 0.013). A positive surgical margin increased the risk of local recurrence (HR = 37, 95% CI = 5.9- 235, p = 0.00012).

CONCLUSION

Proper diagnosis and margin-free resection are necessary before eyelid sebaceous carcinoma can further develop.

A Systematic Review and Meta-Analysis of Ocular and Periocular Basal Cell Carcinoma with First-Time Description of Dermoscopic and Reflectance Confocal Microscopy Features of Caruncle Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) of the ocular and periocular region is characterized by a painless progressive extension. An early diagnosis can limit the extent of facial tissue involvement and subsequent resection resulting in better cosmetic and functional results. Objectives: The aim is to provide the largest and most up-to-date overview of ocular and periocular BCCs. We also reported the first case of caruncle BCC investigated by dermoscopy and reflectance confocal microscopy (RCM). Methods: A systematic review and meta-analysis (Prospero ID CRD583032) were carried out by searching PUBMED-MEDLINE, including all articles with a full-text English version and with BCCs in eyelids, medial and lateral canthus, caruncle, conjunctiva, and orbit. The following data were collected: authors, year, title and type of publication, medical specialization, number, sex, age and comorbidities of the patients, anatomic localization of the disease, clinical and dermoscopic aspect, histological examination, and treatment. Results: We identified 731 articles through a database search, of which 236 articles matched our inclusion criteria. A total of 71.730 patients with ocular and periocular BCCs were included in the present study, and all data collected were reported in a dataset. Most of the articles included were described by ophthalmologists (67.5%), dermatologists (11.2%), or plastic surgeons (5.6%). The proportional meta-analysis revealed varying significance and heterogeneity for each type of study included. Conclusions: BCC more frequently affects the lower eyelid. The most common BCC subtype of ocular and periocular area is the nodular form. Limited data are available concerning the application of dermoscopy and RCM in this area. RCM may be particularly useful for early diagnosis, mapping, and treatment monitoring of ocular and periocular BCCs. Surgery still remains the first-choice treatment.

Epidemiology of oculo-orbital tumours in Malawian children: a 10-year review of cases from tertiary hospitals

BACKGROUND

Ocular tumours, regardless of type, impose significant economic and psychosocial burdens on sufferers and their families [1]. Paediatric cases can lead to substantial challenges, including developmental delays, economic strain, and psychological distress. The aim of this study was to determine the prevalence and presentation of ocular tumours among children in Malawi.

METHOD

The study was designed as a hospital-based cross-sectional retrospective review of paediatric files obtained from the Ophthalmology Department of the four tertiary hospitals (Kamuzu, Queen Elizabeth, Mzuzu and Zomba Central Hospitals) in Malawi from 2009 to 2019. Data was analysed using the Statistical Package for the Social Sciences version 26.0 for data analysis. A p-value of < 0.05 was considered statistically significant.

RESULTS

A total of 1,014 out of 40,423 children were diagnosed with ocular tumours representing an overall prevalence of 2.51% (CI: 2.36-2.67). Among them, 485 were females (47.8%) and 529 males (52.2%), which was not statistically significant (p = 0.426). Most (46.1%) of the cases were from the Queen Elizabeth Central hospital with most cases recorded in 2019. Patients aged 3-5 years had the most cases of ocular tumours. Retinoblastoma was the most prevalent malignant tumour (41.6%), while dermoid cysts was the most common (20.7%) benign tumour. Tumours were more frequently found in the left eye (51.1%) compared to the right eye (43.8%), with 5.1% involving both eyes. The proportion difference in laterality between the right and left eye was statistically significant (p = 0.012). Imaging was performed in 10.0% of cases, with MRI being the most common (6.5%), followed by B-scan (2.4%), CT-scan (0.9%), among others. Surgical procedures were performed in 80.4% of cases, with excision being the most common (47.3%), followed by enucleation (27.2%), and exenteration (4.2%).

CONCLUSION

The study observed a high prevalence of ocular malignancies with children aged 3 to 5 years being the most affected age group. Surgical excision was the main stay of treatment for children affected by ocular tumours in Malawi. Poor diagnostic and therapeutic options remain a big limitations to the provision of care for this population as such there is an urgent need to improve paediatric oncology services in Malawi. Policymakers and healthcare providers must prioritize investments in diagnostic infrastructure, training, and integrated care pathways to enhance the management of paediatric ocular tumours and improve survival rates.

Pattern of Orbito-ocular Tumours in Nigeria: a systematic review

BACKGROUND

Orbito-ocular tumours are stereotypical, monotonous growths of the orbit, eyeball, and extra-orbital tissues. Among the challenges facing patients with orbital tumors are cosmetic deficits, vision loss, and life-threatening conditions. The regional burden varies for various reasons.

AIM

To describe the patterns of these tumors in Nigeria.

METHODS

A systematic literature search was conducted on Google Scholar and PubMed using the following keywords: pattern, orbit tumour, ocular tumour, Nigeria. A total of 66 articles were retrieved from databases, and 20 were included in the review, having met the inclusion criteria.

RESULT

A total of two thousand six hundred and forty-three (2643) patients with orbito-ocular tumors was reported to have been published in Nigerian articles over the past five decades, the age range of the reported cases was 1 month-93 years with a male preponderance. Malignant tumors ranked highest at nearly 60%, with retinoblastoma (RB) and conjunctival squamous cell carcinoma (SCC) having the highest frequency. RB and SCC were the most common tumours in children and adults respectively. Squamous cell papilloma had the highest distribution among the benign category. The eyeball and conjunctiva were the most common anatomical location of orbito-ocular tumors. Proptosis was the most common symptom. Treatment options ranged from enucleation, exenteration and excision biopsy.

CONCLUSION

There were more malignant than benign tumours from this review. The most common malignant tumours were retinoblastoma (in children) and conjunctival squamous cell carcinoma (in adults) while squamous papilloma was the most common benign tumour. Chemotherapy with or without surgeries was the most common intervention with varied treatment outcomes due to the nature and stage of tumour, adherence to treatment, and follow-up plan.

Eyelid sebaceous gland carcinoma: a protocol for a systematic review and meta-analysis of clinicopathological studies of prevalence

INTRODUCTION

Sebaceous gland carcinoma (SGC) of the eyelid is an aggressive tumour with the ability to metastasise and an increased morbidity. Controversies regarding the epidemiology of this malignant eyelid tumour is widespread in the scientific literature. Western reports repeatedly describes eyelid SGC as a rare occurring tumour in general, accounting for 1%-3% of all eyelid tumours, however studies from Asia have uncovered a higher frequency of eyelid SGC including 54% of all eyelid tumours in Japan, and 43%-56% in India. We wish to retrieve observational data of eyelid SGC prevalence in proportion to total eyelid tumours, from pathological studies published worldwide to resolve this controversy.

METHODS AND ANALYSIS

We will search Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Google Scholar to identify published reports on eyelid SGC prevalence proportions, aiming to clarify the incidence of the tumour. We will include observational clinicopathological studies reporting prevalence with confirmed histopathology. No limitations on publication date or language will be applied. Data from the individual studies and study quality will be extracted by two individual reviewers. Study quality will be assessed using the JBI Critical Appraisal Instrument for Studies Reporting Prevalence Data. Raw proportions will be transformed and pooled using a random effects model for meta-analysis. And subgroup analysis according to geography will be performed. If data are deemed unsuitable for a meta-analysis, a narrative synthesis will be presented. We will judge the certainty of evidence and present whether this has an overall effect on the results. The results may shed light on a long-standing academic disparity of the scientific literature.

ETHICS AND DISSEMINATION

This systematic review does not require ethical approval. The results of this proposed review will be the subject to a publication in an international peer-reviewed journal within the ophthalmic or pathological specialty.

PROSPERO REGISTRATION NUMBER

CRD42023487141.

Primary ophthalmic natural killer/T-cell lymphoma: A population-based study

BACKGROUND

Ophthalmic lymphomas, a subgroup of extra-nodal lymphomas, have seen an increase in incidence in recent decades. Of these, the NK/T-cell lymphoma (NKTL) subtype is particularly aggressive. Though prevalent mostly in Asian patients, data on ophthalmic NKTL is still limited, especially in the western population. This study aimed to provide an additional analysis of primary ophthalmic NKTL using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

A retrospective analysis was performed on the SEER database covering records from 2000 to 2020. Patients diagnosed with extranodal NKTL originating primarily from an ophthalmic structure were identified.

RESULTS

Out of 4540 ophthalmic lymphomas registered in the SEER database between 2000 and 2020, 9 cases (0.2%) corresponded to ophthalmic NKTL, occurring in patients with a median age of 67 years. The majority of these patients underwent chemotherapy (88.8%) and radiotherapy (66.6%). The 6-month overall survival (OS) and cancer-specific survival (CSS) were both at 50.8%, dropping significantly at the 2-year follow-up.

CONCLUSION

Primary orbital NKTL has a notably severe prognosis. An early diagnosis is important due to the aggressive nature of NKTL.

Squamous cell carcinoma of the eyelid

Eyelid squamous cell carcinoma is a major type of rare eyelid cancer, together with basal cell carcinoma and sebaceous gland carcinoma. It is a painless disease that progresses slowly and is often detected by the appearance of nodules or plaques. Risk factors include exposure to ultraviolet light, fair skin, radiation and human papillomavirus infection. The standard treatment is surgical removal, and in cases of orbital invasion, orbital content removal is required. If sentinel node biopsy reveals a high risk of lymph node metastasis, adjuvant radiotherapy may be considered. Local chemotherapy, such as imiquimod and 5-fluorouracil, may be used for eyelid squamous cell carcinoma in situ. When surgery or radiotherapy is not recommended for distant metastases or locally advanced disease, drug therapy is often according to head and neck squamous cell carcinoma in Japan. The treatment often requires a multidisciplinary team to ensure the preservation of function and cosmetic appearance.

Machine Learning Model with Texture Analysis for Automatic Classification of Histopathological Images of Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma of Two Different Origins

PURPOSE

The purpose of this study was to develop artificial intelligence algorithms that can distinguish between orbital and conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas in pathological images.

METHODS

Tissue blocks with residual MALT lymphoma and data from histological and flow cytometric studies and molecular genetic analyses such as gene rearrangement were procured for 129 patients treated between April 2008 and April 2020. We collected pathological hematoxylin and eosin-stained (HE) images of lymphoma from these patients and cropped 10 different image patches at a resolution of 2048 × 2048 from pathological images from each patient. A total of 990 images from 99 patients were used to create and evaluate machine-learning models. Each image patch of three different magnification rates at ×4, ×20, and ×40 underwent texture analysis to extract features, and then seven different machine-learning algorithms were applied to the results to create models. Cross-validation on a patient-by-patient basis was used to create and evaluate models, and then 300 images from the remaining 30 cases were used to evaluate the average accuracy rate.

RESULTS

Ten-fold cross-validation using the support vector machine with linear kernel algorithm was identified as the best algorithm for discriminating between conjunctival mucosa-associated lymphoid tissue and orbital MALT lymphomas, with an average accuracy rate under cross-validation of 85%. There were ×20 magnification HE images that were more accurate in distinguishing orbital and conjunctival MALT lymphomas among ×4, ×20, and ×40.

CONCLUSION

Artificial intelligence algorithms can successfully distinguish HE images between orbital and conjunctival MALT lymphomas.

Utility of Precision Oncology Using Cancer Genomic Profiling for Head and Neck Malignancies

BACKGROUND/AIM

In recent years, individual patient cancer genomic profiling (CGP) has become more accessible, allowing determination of therapeutic strategies using driver gene mutations in cancer therapy. However, this precision oncology approach, tailored to specific patients, remains experimental. In this study, we verified the feasibility and benefit of using CGP to guide treatment of malignant head and neck tumors. We aimed to evaluate the profiling and clinical courses of patients with head and neck malignancies who underwent CGP and determine the extent to which CGP for head and neck malignancies has resulted in beneficial drug administration.

PATIENTS AND METHODS

We analyzed CGP results, prognosis, and drug administration status in 27 patients. These patients had completed (or were expected to complete) standard therapy or had rare cancers without standard therapy.

RESULTS

At least one somatic actionable gene alteration was seen in 25 (92.6%) patients, with a median number of actionable alterations per patient of 4 (range=0-11). Drugs in clinical trials were recommended to 22 (81.5%) patients, but none could participate. However, 3 patients (11.1%) could use approved drugs off-label based on CGP results. The most common genetic abnormality was TP53 (66.7%), with TP53 mutations leading to poor prognosis.

CONCLUSION

CGP is clinically useful and serves as a bridge to increase the number of therapeutic options. However, candidate drugs confirmed using CGP may be ineffective when administered. Therefore, oncologists should not blindly accept CGP therapeutic recommendations but should make recommendations that lead to optimal therapies after proper verification.

Incidence and clinical characteristics of pediatric ocular tumors in a Midwestern US population

PURPOSE

To investigate the incidence and clinical characteristics of pediatric ocular tumors in a US Midwestern county population.

METHODS

Retrospective population-based cohort study of all Olmsted County, Minnesota, pediatric patients (<18 years old) diagnosed with any ocular neoplasm from January 1, 2006, to December 31, 2015. Subjects were identified via the Rochester Epidemiology Project, a record-linkage system that captures virtually all medical care provided in this county. Medical records were reviewed to confirm diagnoses. Age- and sex-adjusted incidence rates were calculated and adjusted to the 2010 Olmsted County, Minnesota, pediatric population.

RESULTS

There were 87 incident pediatric ocular tumor diagnoses, yielding an overall age- and sex-adjusted incidence rate of 24.0 per 100,000 per year (95% CI, 19.0-29.1). Females accounted for 46 cases (53%) cases, and 62 (85%) were White. Incidence rate for ocular tumors overall did not differ by patient age (P = 0.08) or sex (P = 0.47). All tumors were benign lesions. The most frequent adnexal/orbital, ocular surface, and intraocular tumors were epidermal inclusion cyst in 18 (21%) cases, conjunctival nevus in 10 (12%), and choroidal nevus in 18 (21%), respectively. The mean follow-up duration was 25.5 months (range, 7 days to 138.6 months), and benign tumor growth occurred in one conjunctival nevus. There were no cases of malignant transformation.

CONCLUSIONS

Pediatric ocular tumors were rare with an estimated incidence of approximately 1 in 4,200 pediatric patients in Olmsted County, Minnesota. All lesions were benign, with benign growth in only 1% of cases, and no tumors underwent malignant transformation.

Two Advancement Flaps for Eyelid Margin Reconstruction of Small and Medium Defects and a Novel Design to Reduce Ocular Injury

Purpose

The key point of eyelid margin reconstruction is to keep both the support function and aesthetic appearance. The eyelid's complex anatomical structures make eyelid margin reconstruction demanding. Eyelid margin defects are conventionally classified by their width relative to the eyelid width: small, medium, or large. In this study, we introduce a reconstruction method for small to medium defects.

Patients and Methods

We conducted a single-center case series of patients from the practice of a single experienced plastic surgeon at a tertiary center. We included consecutive outpatients from 2014 to 2021. The inclusion criteria were (1) eyelid margin mass and (2) willingness to receive eyelid margin reconstruction by the reported method. The exclusion criteria were (1) eyelid margin mass involving most or all of the tarsus and (2) less than one year of follow-up. Patients were followed up face to face or online. Patients' demographics, clinical characteristics and outcomes, and satisfaction were collected. The clinical outcomes were assessed and scored by two plastic surgeons.

Procedure

We reconstructed the anterior lamella with an advancement musculocutaneous flap and repaired the posterior lamella with a specially designed advancement tarsoconjunctival flap, of which a piece of tarsus was shaved and the corresponding remnant conjunctiva was bent forward to cover the tarsus edge to avoid ocular injury.

Results

We included 24 patients (25 lesions). Almost all patients had eyelash discontinuity. One patient presented slight notching of the lower eyelid margin. The other patients reported no complications or recurrence. The average outcome score was 1.23±0.69, indicating that our method was excellent. All patients were very satisfied with the surgery. The average follow-up time was 5.75 years.

Conclusion

We report a reconstruction method for small to medium eyelid margin defects and a novel design for preventing ocular injury, which is an especially good option for transverse defects.

Proteotranscriptomics of ocular adnexal B-cell lymphoma reveals an oncogenic role of alternative splicing and identifies a diagnostic marker

Background

Ocular adnexal B-cell lymphoma (OABL) is a rare subtype of non-Hodgkin lymphoma. The molecular characteristics of OABL remain poorly understood. We performed an integrated study to investigate the proteotranscriptome landscape and identify novel molecular characteristics and biomarkers of OABL.

Methods

Integrated quantitative proteome and transcriptome were performed on 40 OABL 12 idiopathic orbital inflammation, 6 reactive lymphoid hyperplasia, and 13 aesthetic orbital plastic surgery specimens. Complete clinicopathologic and prognostic data of the patients were recorded.

Results

We identified high global protein-mRNA concordance as a novel characteristic of OABL. High concordance was related to OABL recurrence. By integrated expression profile, motif enrichment and trend analysis, we found that alternative splicing is inflammation-independently dysregulated in OABL. After portraying the aberrant alternative splicing event landscape, we demonstrated the oncogenic role of ADAR, a core splicing regulator that regulates the splicing of Rho GTPase and cell cycle members. We found that ADAR regulates cell proliferation and Rho GTPase inhibitor sensitivity of lymphoma. We identified DNAJC9 as a potential biomarker for OABL in proteomic analyses. Immunohistochemistry and immunofluorescent staining showed the nuclear staining of DNAJC9 was significantly higher in extranodal marginal zone lymphomas compared with inflammation specimens.

Conclusions

These results provide an integrated gene expression profiling and demonstrate that high global protein-mRNA concordance is a prognosis-related molecular characteristic of OABL. We portray the alternative splicing events landscape of OABL, and reveal the oncogenic role of ADAR. We identified strong nuclear staining of DNAJC9 as a promising pathology diagnostic biomarker for extranodal marginal zone lymphomas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13046-022-02445-8.

Local recurrence as extraocular muscle lymphoma after 6 years of chronic myositis: a case report

Background

Extraocular muscle is usually affected by thyroid disease or inflammatory pseudotumor, but seldom by neoplastic process. Primary malignant lymphoma involving isolated extraocular muscle is very rare, especially after 6 years of chronic myositis.

Case presentation

A middle-aged female presented with swelling of the lower lid of the right eye for 2 months. Magnetic resonance imaging showed significant enlargement of the right inferior rectus muscle belly. The patient first presented 6 years prior with upper eyelid swelling. A total of 5 surgical biopsies of the right eye were performed during 6 years with the following successive findings: inflammatory pseudotumor, chronic inflammation, inflammatory lesions, IgG4-related ophthalmic disease, and lastly, extraocular muscle extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).

Conclusion

MALT lymphoma may have occurred as a result of chronic extraocular myositis. Malignancy should be considered in patients with recurrent painless extraocular muscle hypertrophy. Differential diagnosis can rule out thyroid-associated ophthalmopathy (TAO), whose symptoms are similar. Diagnosis confirmation by biopsy is warranted if necessary.

Epidemiological characteristics of malignant eyelid tumors at a referral hospital in Japan

PURPOSE

To clarify the incidence and demographic characteristics of malignant eyelid tumors diagnosed in a single institute in Japan.

STUDY DESIGN

Retrospective, observational case series METHODS: Patients with malignant eyelid tumors diagnosed histopathologically at Tokyo Medical University Hospital between 1995 and 2019 were reviewed retrospectively. The incidence and demographic profile of malignant eyelid tumors were analyzed. The number of benign eyelid tumors diagnosed histopathologically during the same period was also counted.

RESULTS

A total of 412 patients with histopathologically proven malignant eyelid tumors were included. The most common malignant eyelid tumor was sebaceous carcinoma (n = 180, 44%), followed by basal cell carcinoma (n = 148, 36%), squamous cell carcinoma (n = 35, 9%), lymphoma (n = 28, 7%), Merkel cell carcinoma (n = 11, 3%) and others (n = 10, 2%). Mean age of all patients with malignant eyelid tumor at the time of diagnosis was 71.0 ± 13.0 years. For sebaceous carcinoma, the proportion of female patients was significantly higher than that of male patients (P = 0.0283) and the proportion of involvement of upper eyelid was significantly higher than that of lower eyelid (P = 0.0001). On the other hand, there was no sex predominance in basal cell carcinoma and squamous cell carcinoma. The proportion of involvement of lower eyelid was significantly higher than of upper eyelid in basal cell carcinoma (P = 0.001) and squamous cell carcinoma (P = 0.0012). There were 1433 patients with benign eyelid tumors accounting for 78% of all eyelid tumors during the study period.

CONCLUSIONS

Sebaceous carcinoma is the major malignant eyelid tumor in Japan and is more frequent in women than in men. Epidemiology of malignant eyelid tumors may be affected by the trend of population age structure associated with the recent population aging.