[Chalazion mimicking an eyelid tumor]

A 3-year-old girl had a tumor growing for a month on the superior right eyelid, attached on the free margin of the eyelid and partially necrotic. A surgical excision was performed under general anesthesia. The histopathological study found an inflammatory lesion with epithelioid and giant cells, evidence of a granuloma, suggesting the diagnosis of chalazion. This case shows the various clinical presentations of this common and benign disease of the eyelid.

Molluscum contagiosum de la paupière inférieure

A 6-year-old girl had a single molluscum contagiosum of the lower eyelid. Clinically, the tumor had grown slowly since it had been discovered 8 months before the child was seen at our consultation. It appeared as a nodular lesion on the middle part of the eyelid. Its surface was irregular and its color was the same as the epidermis. It was surgically excised, using the shaving biopsy technique. Its histopathological study showed a papillomatous lesion with the typical features of a molluscum contagiosum. The patient was lost to follow-up soon after the surgery.

[Conjunctival pyogenic granuloma in a patient with chalazions]

A 28-year-old male patient had a chalazion on his left eyelid. Increased discomfort led to the discovery of a conjunctival mass under the inner part of his upper eyelid. On clinical examination, a small reddish mass on the palpebral conjunctiva of the upper left eyelid was only visible on the underside of the lid; the mass was diffusely reddish. Additionally, a chalazion was present in the middle of the lower left eyelid. As this condition was a source of discomfort to the patient, the mass was surgically resected. The histological study found a typical pyogenic granuloma, a possible complication in the course of a chalazion.

[A cutaneous horn of the free margin of the eyelid: an anatomical and clinical observation]

A cutaneous horn was observed close to the free margin of the inferior right eyelid in a 26-year-old-male patient. A minimal resection was primarily performed. Histopathologic study disclosed a precancerous keratosis. As the tumor had not been entirely excised, a complementary resection was performed secondarily to obtain the entire resection of the tumor.

[Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case]

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

[Conjunctival semi-lunar fold nevus of presumed late onset]

Conjunctival nevi are lesions observed commonly occasionnally and can be found later in a life. Such a lesion was observed on the conjunctival semilunar fold in a 76-year-old female patient. It was oval in shape, pigmented, and was mainly visible when the affected eye was in abduction. As no accurate anterior clinical history was available, surgical resection was performed. Hitopathological study disclosed a subepithelial nevus, which was completely resected. Regular follow-up was recommended, as is usual after surgical resection of a conjunctival pigmented tumor.

[Hypertrophic eyelid conjunctival scar. A tarsal keloid]

The clinicopathologic case of a 53-year-old female patient with an abnormal tumor growing on the mucous part of the superior right eyelid is reported. The patient was operated on for ten years ago and a whitish mass slowly developed on the conjunctival face of the eyelid disturbing the use of corneal lenses. It was hard, painless and had the shape of a flat mushroom. The removal was performed under local anesthesia and allowed us to resect a hard and fibrous lesion. Histopathology showed that the lesion was made of a fibrous tissue organized like a hypertrophic scar. Surgical treatment of chalazion is frequent and rarely gives rise to abnormal scarring.

[Inflammatory pseudotumor of the caruncle]

A 6-year-old girl exhibited a recent caruncular tumor which was increasing in size. It was removed after a CT scan had showed a both medial and superficial mass. Fortunately, histological tests only found inflammatory cells attesting that the mass was due to an inflammation of this area. Inflammation is one of the different processes that may increase the size of the caruncle, but sometimes, only histopathology can provide conclusive evidence.

[Multilocular eyelid hidrocystoma: an anatomical and clinical observation]

A cystic cutaneous mass was observed on the lateral canthus of the left eyelid in a 25-year-old woman, 2 years after being operated on for a lesion that had existed in the same area several years before, but the patient could not identify its nature. The present mass appeared as a well-circumscribed bluish cystic lesion. A surgical resection was performed; pathological analysis disclosed a cystic sweat tumor composed of several contiguous cysts. One year of follow-up has revealed no complications.

[Actinic keratosis seborrheic wart and nevus: three distinct cutaneous eyelid skin lesions in a single patient]

A 67-year-old woman had three different tumors of the eyelids. The most prominent one was a nevus of the free margin of the inferior left eyelid. The nevus was followed for 18 months without change while two epidermal papillomatous tumors grew and were surgically removed. Histopathology disclosed that one tumor was a seborrheic keratosis and the other was a pre-epitheliomatous keratosis. Histologic evaluation of the margins showed that surgical removal was complete. A regular examination of the scars was recommended to the patient.

[Inflammation of an ectopic pinguecula]

An 80-year-old male patient experienced recently diagnosed swelling of the limbal conjunctiva. In his clinical history were found cataract surgery on the right eye 3 months before, chronic open angle glaucoma effectively treated by local eye drops, treated systemic hypertension and hypercholesterolemia. On ophthalmic examination, a conjunctival mass was present in the inferior lateral conjunctival quadrant next to the limbus, with numerous vessels visible at its top. Treatment with topical corticosteroids failed to obtain regression, but decreased the local inflammatory signs. The persistence of the mass led to its surgical excision under local anesthesia. Histopathology found a subepithelial accumulation of modified collagen bundles typical of elastotic degeneration. Capillary vessels were seen in the superficial subepithelial area, attesting to the high degree of vascularization observed clinically. The final diagnosis was a pinguecula, which was not exactly located on the horizontal meridian area as it is usual.

[Nevus mimicking a basal cell carcinoma of the eyelid]

A clinicopathologic case of a 41-year-old female patient exhibited a single cutaneous tumor at the inner part of the free margin of the inferior left eyelid. It was a pink, fleshy, and nodular well-circumscribed exophytic mass with thin vessels on its surface. Experienced already for 20 years, this lesion had been observed 6 years before and has not exhibited much change since then. However, its clinical appearance argued for a possible small basal cell carcinoma, which had grown over the inferior left lachrymal duct. After surgical removal, histopathology showed that the tumor was an amelanotic dermal nevus. No disturbance of lachrymal drainage was observed after surgery. This case shows that nodular amelanotic tumors of the eyelid, even when located on the inner segment of the eyelid, may be a nevus.

[Eyelid precancerous keratosis]

A 25-year-old-male patient had one keratinized tumor on the inferior right eyelid, first observed 5 months before. Its size had been increasing for the last three weeks. The visual function was normal. Clinical examination disclosed a papillomatous lesion on the cutaneous middle part of the eyelid. A surgical excision was performed under local anesthesia. The histopathological study found a papillomatous epidermal proliferation with both structural and cytological atypias, concluding with a precancerous keratosis of the eyelid.

[Eyelid neurofibroma affecting a young woman]

A 43-year-old female patient had an amelanotic single tumor thickening the upper right eyelid and observed since early childhood. Clinically, it appeared as a firm mass, without sharp margins, giving a thickened appearance to the superior eyelid. The ophthalmic clinical examination was normal but some subcutaneous nodules attested to the diffusion of the disease recognized as a limited form of neurofibromatosis 1. Although well tolerated, it gave rise to a cosmetic disturbance and the patient was willing to undergo an excision. A complete surgical excision was performed on the lesions and the pathological study disclosed a typical neurofibroma. Regular observation of the different cutaneous nodules was recommended.

[Seborrheic keratosis of the eyelid in a young woman]

A 46-year-old female patient had a tumor of the free margin area of the superior right eyelid, appearing as the fourth recurrence of a primary lesion, occurring 24 years before. The lesion was covered with a thick layer of keratin, giving it a grayish and black color. Excision was performed without involving the free margin. Histopathology disclosed that the tumor was a seborrheic keratosis, which was not completely removed. As the lesion was benign, no further surgery was performed but regular examination was recommended to the patient.

[Large basal cell carcinoma of the external palpebral angle]

A clinicopathologic case of an 89-year-old female patient with a single cutaneous tumor at the outer part of the outer left eyelids is reported. It was a pink nodular mass, well circumscribed, exophytic and with thin vessels. After surgical removal, histopathology showed that the tumor was a typical basal cell carcinoma, with many cystic-like cavities. Basal cell carcinomas can be commonly observed on the eyelids and surgical excision of these small size lesions is an easy way to perform a curative treatment. As often in other tumors, early diagnosis is probably the easiest way to improve the prognosis.

[Meibomian adenocarcinoma of the free palpebral edge. Report of a case]

A case of meibomian carcinoma of the left eyelid is reported in a 72-year-old female patient. The tumor had been present on the left eyelid for months. Clinically, the tumor appeared as a reddish mass implanted on the external part of the free margin of the left superior eyelid. An excisional biopsy disclosed meibomian carcinoma. A total resection of the left superior eyelid was followed by plastic surgery. Results after a one-month follow-up were very satisfactory. This case is emphasizes the importance of an early diagnosis which enabled us to perform a rather conservative treatment limited to the removal of the affected eyelid. The diagnosis of meibomian carcinoma is infrequent but it must be kept in mind in cases of tumor without the typical clinical characteristics of a basal cell or squamous cell carcinoma. Complete removal surgery may bring a curative effect and histopathology has a key role in the diagnosis of meibomian carcinoma.

[Limbal dermoid and Goldenhar syndrome. Report of an anatomoclinical study]

Dysembryoplastic neoplasm, the limbal dermoid is a benign congenital tumor involving the outer coat of the eye. This congenital tumor affected the right eye of a 6-year-old girl. The lesion was typically hemispheric, covered with pink skin, located in the inferior and temporal part of the cornea, and devoid of any major consequences except the cosmetic appearance of the eye. There were no other major abnormalities in the clinical examination but a single skin tag could be observed at the homolateral preauricular area without any visible cutaneous fistula next to it. This additional change allowed us to establish the diagnosis of a minor form of Goldenhar syndrome. This malformative syndrome typically includes several changes: dermoid and/or dermolipoma, preauricular tags and/or cutaneous fistulas in the same area, vertebral abnormalities etc. These findings may be limited to dermoid and cutaneous tags, as in our report. Such changes must be looked for in all limbal dermoids.

[Hyperkeratosis papilloma of the eyelid. An anatomic clinical case]

A clinicopathologic case of an 80-year-old male patient with a single cutaneous tumor on the upper part of the left eyelid is reported. It was a grayish and pigmented mass covered with a thick keratin layer, well circumscribed, and exophytic. After surgical removal, histopathology showed that the tumor had a papillomatous pattern and was growing under a thick layer of hyperkeratosis. It was a typical squamous cell papilloma. This tumor belongs to the benign eyelid tumor group and can be found on the eyelids of elderly people.

[Conjunctival in situ carcinoma in a patient with Waldenström's disease]

A 73-year-old male patient was treated for conjunctival in situ carcinoma invading the cornea of his right eye. The patient had been previously operated on for two corneoconjunctival lesions on the same eye (one was a pterygium, the other was simple epithelial hyperplasia) and was regularly followed for a systemic lymphoplasmocytic lymphoma (Waldenström's disease). After a corneoconjunctival excision of the tumor, the histological analysis was performed and established the diagnosis of in situ carcinoma. The tumor recurred a few months later and radiation therapy was then given. No recurrence was observed after this latter treatment.

[Papillomatous and nevus of the caruncle]

A 63-year-old male patient was operated of a single conjunctival papillomatous lesion located on the left caruncle. The curative tumoral excision was followed by its histological analysis. Histologically, the tumor associated an epithelial squamous papilloma with a subepithelial nevus, confirming a combination of two different lesions.

[Neovascular glaucoma following proton-beam therapy. Case report]

A 52-year-old-male patient was treated for a posterior choroid melanoma of the right eye. When it was diagnosed, it measured 6mm in thickness and 11.9mm for the largest diameter and had a typical mushroom shape. General investigations found no metastatic disease. It was treated with proton-beam irradiation. Seven years later, the patient experienced increased intraocular pressure associated with cataract and pain. The patient finally accepted enucleation, as the vision of this eye was completely lost and the eye had become painful. Histologic analysis of the eye showed changes affecting both the anterior and the posterior segments of the eye, mostly related to the tumor and the consequences of treatment. Neovascular glaucoma is a major complication that very often leads to enucleation.

[Choroidal melanoma. An anatomic-clinical case report]

A 78-year-old-male-patient had his left eye affected by a 10 mm thick choroidal malignant melanoma. The size of the tumor did not allowed to keep the eye, and no conservative treatment was used for therapy. Enucleation was performed and histopathological study of the eye showed a mushroom-shaped and mixed-cell choroidal melanoma, devoid of transcleral extension, but harboring intrascleral infiltration. A period of 2 year-follow-up without metastasis was observed since the removal of the tumoral eye.

[Malignant melanoma on primary acquired conjunctival melanosis]

A primary acquired melanosis occurred in the right bulbar conjunctiva of a 65 year-old caucasian woman. After four years of steadiness, this lesion gave raise to a malignant conjunctival melanoma. The evolution remained under control three years after the end of the therapeutic procedures. Clinical and histopathological data are presented.

[Black hidrocystoma of the free margin of the eyelid]

A clinico-pathologic case of a black hidrocystoma of the left eyelid margin is reported in a 45-year-old female patient. Clinically, a black nodule was disclosed after eversion of the superior left lid. A surgical full thickness eyelid focal resection was performed to remove the cyst. Histopathology found a cyst covered with an epithelium with a double layer of cells and filled with a brownish granular content, typical of a black hidrocystoma.

[Association of nevus and herpetic keratitis sequela. Apropos of an anatomo-clinical case]

Most conjunctival nevi are found during the two first decades of life. Beyond this period, the diagnosis must be assessed by histopathology. We report the case of a conjunctival nevus recently discovered in a 33-year-old patient who, additionally, was previously treated for herpetic disciform keratitis. The corneal scar decreased vision. A corneal graft and nevus excision were performed simultaneously. Histopathologic study confirmed the diagnosis of nevus and disclosed the corneal scar changes induced by herpes.

[Caruncular melanoma. Apropos of clinical case]

The clinicopathologic case of a 69-year-old-female patient with a big caruncular melanoma is reported. Tumor was excised surgically and underwent external conventional radiation therapy with no recurrence two years later. Histopathology endorsed the clinical diagnosis and thickness of the tumor measured 5.5 mm. The bad prognosis of the caruncular location was reinforced by the tumor thickness. A better knowledge of conjunctival melanomas characteristics might allow an earlier diagnosis and a better prognosis as irradiation following surgical treatment appears efficient on unifocal limited melanomas.

[Pigmented basal cell carcinoma of the eyelid. Apropos of a clinical case]

A clinico-pathologic case of a 83-year-old female patient with a deeply pigmented inferior lid tumor is reported. The histopathological study of the tumor demonstrated a pigmented basal cell carcinoma. Numerous different tumors may affect the eyelids, melanocytic or not in nature. True melanomas are infrequent compared with the numerous other pigmented tumors, which always need a histological analysis.

[Differential diagnosis of conjunctival melanoma: exteriorized uveal melanoma]

Four years after unexplained left eye visual loss and 15 days after surgical procedure on the other eye, a 93-year-old female developed a pigmented left conjunctival lesion. Ultrasound examination demonstrated this lesion to be in fact an extraocular extension of uveal melanoma. The patient was treated by external radiotherapy after expanded enucleation.

[Ring recurrence of ciliary body melanoma after proton-beam therapy]

A malignant ciliary body melanoma was treated by proton-beam irradiation. Ring-shaped recurrence with extraocular extension appeared thirty-six months later and required enucleation. Histologic study revealed a predominant epithelioid cell type tumor, flattened in previously treated area. Proton-beam irradiation efficiency depends on clinical evaluation, which remains questioned in ciliary body locations where circumferential extension could be misevaluated.

[Meibomian adenocarcinoma in its blepharo-conjunctival form. Apropos of a case]

A case of Meibomian carcinoma of the left eyelid was observed in a 53-year-old-female patient. SHe had been previously treated for chronic unilateral blepharoconjunctivitis; an excisional biopsy disclosed a Meibomian carcinoma. First a total resection of both left eyelids was performed with plastic reconstructive surgery, three months later a recurrence required an orbital exenteration. This case underlines the interest of an early diagnosis which allows a more conservative treatment. The diagnosis must be kept in mind in any case of chronic unilateral blepharoconjunctivitis; histopathology has a key role in the diagnosis of Meibomian carcinoma.

Retinal arterial occlusion associated with resistance to activated protein C

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Prognosis and treatment of retinoblastoma. 105 cases treated at Institut Curie

In a retrospective study of 105 retinoblastoma cases, the authors studied the clinical symptoms, survival and ocular conservations. The results are much better in case of early diagnosis. They discuss the therapeutic modalities in their institute and elsewhere.

[Prognosis and treatment of retinoblastoma. 105 cases treated at the Curie Institute]

We reviewed 105 cases of retinoblastoma treated in our institution between 1977 et 1981. We statistically analyse the prognosis according to various factors and we compare our results with the results of the other authors. We discuss the therapeutic modalities and the results.