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China Association for Promotion of Health Science and Technology Cellular Immune Therapy Committee, Chinese Medical Doctor Association for Ophthalmologist Branch Ophthalmology Committee, Imaging Medicine Branch of Chinese International Exchange and Promotion Association for Medical and Healthcare, Tumor and Microecology Professional Committee of China Anti-Cancer Association, Lymphoma Immunotherapy Committee of Beijing Cancer Prevention Society. [Chinese expert consensus on the diagnosis and management of ocular adnexal extranodal marginal zone mucosa-associated lymphoid tissue lymphoma (2023 edition)]. Zhonghua Zhong Liu Za Zhi 2024; 46:296-303. [PMID: 38303512 DOI: 10.3760/cma.j.cn112152-20230727-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (OAML) is a common malignant tumor that affects the ocular adnexal region. The incidence of OAML is increasing due to the aging population. The tumor invades the ocular adnexal region, which can result in abnormal ocular appearance and function, thereby reducing the quality of life. Currently, there is no standardized diagnosis and management guideline for OAML. To enhance the standardization of diagnosis and management in OAML, a collaborative effort was undertaken by esteemed organizations in China. The Cellular Immune Therapy Committee of China Association for Promotion of Health Science and Technology, the Ocular Tumor Committee of Chinese Medical Doctor Association for Ophthalmologist Branch, the Imaging Medicine Branch of Chinese International Exchange and Promotion Association for Medical and Healthcare, the Tumor and Microecology Professional Committee of China Anti-cancer Association, and the Lymphoma Immunotherapy Committee of Beijing Cancer Prevention Society jointly convened a panel of experts to develop the inaugural "Chinese Expert Consensus on the Diagnosis and Management of ocular adnexal extranodal marginal zone mucosa-associated lymphoid tissue lymphoma (2023 edition)"..
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Tinca AC, Szoke AR, Lazar BA, Szász EA, Tomuț AN, Sabău AH, Cocuz IG, Cotoi TC, Niculescu R, Chiorean DM, Ungureanu IA, Turdean SG, Cotoi OS. H-VISTA Immunohistochemistry Score Is Associated with Advanced Stages in Cutaneous and Ocular Melanoma. Int J Mol Sci 2024; 25:4335. [PMID: 38673920 PMCID: PMC11049914 DOI: 10.3390/ijms25084335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Melanoma represents a public health issue. One of the biggest goals of current research is to develop new therapeutic options for patients affected by this aggressive tumor. We conducted a retrospective study including 105 patients diagnosed with cutaneous and ocular melanoma, with stages varying from pT1a to pT4b and pT4e, respectively, and we performed immunohistochemistry reactions with the new potential prognostic marker, VISTA (V-domain Ig suppressor of T cell activation). We quantified the expression by applying the H-score adapted for VISTA and divided the patients, based on the median value, into groups that presented high, low, and negative expression. Therefore, we obtained 65 cases with positive expression for cutaneous melanoma and 8 cases with positive expression for ocular melanoma. Forty-one cases presented high expression in cutaneous melanoma and three cases presented high expression in ocular melanoma. In cutaneous melanoma, analytic statistics showed that VISTA expression was associated with a high Breslow index, high mitotic count, high Ki67 expression, and advanced clinicopathological stage. The majority of ocular melanoma cases demonstrating a positive reaction were classified as stage pT3, whereas earlier stages showed a negative reaction. Our findings underscore a significant correlation between VISTA expression and key prognostic factors in melanoma. Looking ahead, the prospect of future randomized studies holds promise in corroborating the clinical relevance of our findings. By further elucidating the intricate relationship between VISTA expression and melanoma progression, new treatment strategies could be found, improving patient outcomes in this challenging neoplasm.
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Affiliation(s)
- Andreea Cătălina Tinca
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Andreea Raluca Szoke
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Bianca Andreea Lazar
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
| | - Emőke Andrea Szász
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Alexandru Nicușor Tomuț
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Adrian Horațiu Sabău
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Iuliu-Gabriel Cocuz
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Titiana-Cornelia Cotoi
- Faculty of Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania;
| | - Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
| | - Diana Maria Chiorean
- Doctoral School of Medicine and Pharmacy, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.C.T.); (A.H.S.); (R.N.); (D.M.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
| | - Ioana Ancuța Ungureanu
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Sabin Gligore Turdean
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Faculty of Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania; (A.N.T.); (I.A.U.)
| | - Ovidiu Simion Cotoi
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania; (B.A.L.); (E.A.S.); (I.-G.C.); (S.G.T.); (O.S.C.)
- Pathophysiology Department, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Targu Mures, 540142 Targu Mures, Romania
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Jähnig A, Pfau K, Meyer P, Gatzioufas Z. [Severe Conjunctival and Corneal Epithelial Dysplasia: A Case Series]. Klin Monbl Augenheilkd 2024; 241:402-405. [PMID: 38653294 DOI: 10.1055/a-2202-3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND/OBJECTIVES Ocular surface squamous neoplasia (OSSN) are among the most frequent non-pigmented malignancies of the ocular surface. They have a wide range of histological characteristics - ranging from mild epithelial dysplasia to invasive carcinoma of the squamous cells of the cornea. They may be restricted to the conjunctiva or also involve the cornea. As there are no leading symptoms in the early stages, diagnosis may be very delayed in patients who do not receive regular ophthalmological treatment. The present case series describes clinical and histological data on OSSN and includes clinical and histological data on OSSN, including possible clinical presentations, important risk factors, special histological and cytological features and therapeutic options. METHODS Retrospective case series of patients with histologically confirmed severe epithelial dysplasia of the conjunctiva and cornea consistent with OSSN who presented to the Department of Ophthalmology in Basel University Hospital. The analysis covered demographic data, symptoms, diagnostic testing (photo documentation, brush biopsy), treatment and cytological and/or histological material and findings. RESULTS We report on five patients aged between 41 and 92 years at the time of diagnosis. The histological findings in all patients included severe epithelial dysplasia, but with a heterogenous clinical presentation. In all cases, the lesion started in the conjunctiva, but traversed the limbus and extended to the cornea. The primary treatment was always surgical removal. In one patient, this had to be repeated several times due to recurrent metaplasia and was complemented by subsequent mitomycin C therapy. The clinical outcome ranged between total restitution of the original state to inevitable enucleation. CONCLUSION The clinical presentation of OSSN is highly heterogenous, so that the initial diagnosis is difficult. There are no official guidelines for treatment, so that the treatment of choice varied between clinics. Regular ophthalmological follow-ups are recommended, even after complete surgical excision. Possible relevant concomitant diseases and risk factors must be identified before therapy.
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Affiliation(s)
| | | | - Peter Meyer
- Augenklinik, Universitätsspital Basel, Schweiz
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Yeager LB, Kassotis A, Frank T, Li CY, Marr BP. A Review of Pediatric Ophthalmic Tumors. Pediatr Rev 2024; 45:119-131. [PMID: 38425168 DOI: 10.1542/pir.2023-006163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tumors of the eye, orbit, and ocular adnexa can arise in the pediatric population. These entities can be both vision- and life-threatening and may be associated with systemic disease. Given their relative rarity, pediatricians must be aware of these conditions and understand what findings warrant immediate referral to an ophthalmologist for initiation of further testing. We aimed to review these conditions and highlight clinical features to promote awareness and expedite diagnosis. Tumors are subdivided into the following categories for review: anterior tumors of the eyelid and ocular surface, orbital tumors, and intraocular tumors.
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Affiliation(s)
- Lauren B Yeager
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Alexis Kassotis
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Tahvi Frank
- Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Chloe Y Li
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Brian P Marr
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
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Lee CH, Kim M, Shin SJ. 41 Gauge transvitreal fine-needle aspiration biopsy for intraocular tumors without vitrectomy. Asia Pac J Ophthalmol (Phila) 2024; 13:100056. [PMID: 38608820 DOI: 10.1097/apo.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/07/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Chul Hee Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Su-Jin Shin
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Xu Y, Luo L, Yang B, Xiao J. FIVE-YEAR FOLLOW-UP OF A SPONTANEOUSLY PROGRESSIVE RETINAL RACEMOSE HEMANGIOMA. Retin Cases Brief Rep 2024; 18:199-201. [PMID: 36730453 PMCID: PMC10885871 DOI: 10.1097/icb.0000000000001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To report the progression of a patient with retinal racemose hemangioma after 5 years of follow-up. METHODS Observational case report. RESULTS A 14-year-old girl was diagnosed with an isolated retinal racemose hemangioma with retinal arteriovenous malformation in the posterior pole of the left eye fundus. At the fifth year of follow-up, a spontaneous enlargement of the previously normal vessel was found above the original lesion. The patient's vision remained stable, and no complication was observed. CONCLUSION Retinal racemose hemangioma was once considered stable and nonprogressive, but progression and expansion of the lesion may also occur, so long-term follow-up is necessary.
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Affiliation(s)
- Yu Xu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Lifu Luo
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Bo Yang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Jun Xiao
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Roditi E, Panicker S, Fung AT. Intravascular large B-cell lymphoma of the eye: Literature review and new findings. Asia Pac J Ophthalmol (Phila) 2024; 13:100053. [PMID: 38556129 DOI: 10.1016/j.apjo.2024.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/21/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare, aggressive, multi-system disease that can affect the eye. We describe the ophthalmic presentation, multimodal imaging and treatment response of uveal IVLBCL. METHODS Review and case report. RESULTS Twenty-five published cases of IVLBCL involving the eye including our own were identified. Of these, 15 patients (60%) had clinically-detectable intraocular involvement, 6 (24%) had extraocular ophthalmic involvement only and 4 (16%) had subclinical, undiagnosed intraocular involvement that was retrospectively detected on post-mortem ocular histopathology. The male to female ratio was 1.08:1 with a mean presenting age of 65.1 ± 11.7 years (range 38-82 years). The majority of cases had bilateral involvement (21/25 patients, 84%). Extraocular manifestations included diplopia, ptosis and ophthalmoplegia. Intraocular manifestations included serous retinal detachment (13/28, 46%), retinal hemorrhages (9/28, 32%), vascular changes (9/28, 32%), retinal pigment epithelial changes (7/28, 25%), thickened choroid (6/28, 21%), vitritis (5/28, 17%), cotton-wool spots (3/28, 10%), and a subretinal lesion (1/28, 3%). Histopathological diagnosis was most commonly confirmed on post-mortem enucleation (8/25 patients, 32%), skin (6/25 patients, 24%) or brain biopsy (6/25 patients, 24%). CONCLUSION The presence of intra-retinal hemorrhages, cotton wool spots and/or Roth spots help differentiate IVLBCL from other similarly presenting diseases such as central serous chorioretinopathy and Vogt-Koyanagi-Harada disease. New signs not previously described in IVLBCL include macular bacillary layer detachment and hypo-cyanescent spots on ultra-wide field indocyanine green angiography. The diagnosis is elusive and requires tissue biopsy, but systemic chemotherapy and rituximab can lead to rapid improvement of the eye.
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Affiliation(s)
- Eduardo Roditi
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Department of Haematology, Blood Transplant and Cellular Therapies, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead and Central Clinical Schools, Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia.
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Sen M, Demirci H, Honavar SG. Targeted therapy in ophthalmic oncology: The current status. Asia Pac J Ophthalmol (Phila) 2024; 13:100062. [PMID: 38642707 DOI: 10.1016/j.apjo.2024.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024] Open
Abstract
There have been rapid advancements in the field of ocular oncology for the diagnosis and management of intraocular, adnexal, and orbital tumors. Targeted therapy is in the forefront of medical research in all fields including ocular oncology. Targeted therapy include drugs that target specific genetic mutations, pathways or proteins involved in the development of cancer. In contrast to traditionally used chemotherapy, drugs used in targeted therapy are highly specific for tumor cells and preserve the function of normal cells. This review aims to familiarize ophthalmologists with the drugs that are currently approved or undergoing clinical trials for use in ocular oncology. Targeted therapy is particularly useful for locally advanced or metastatic tumors, including but not limited to eyelid and periocular basal cell carcinoma, periocular cutaneous and conjunctival squamous cell carcinoma, ocular adnexal lymphoma, conjunctival melanoma, and uveal melanoma. The results are promising with improved survival outcomes and better tolerability than chemotherapeutic drugs.
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Affiliation(s)
- Mrittika Sen
- Ocular Oncology Service, Raghunath Netralaya, Mumbai, India
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight Eye Hospital, Hyderabad, India.
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Ge JY, Loo YH, Chan ASY. Metastatic renal cell carcinoma masquerading as an endogenous endophthalmitis: Role of vitreous cytology. Asia Pac J Ophthalmol (Phila) 2024; 13:100055. [PMID: 38583527 DOI: 10.1016/j.apjo.2024.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Jasmine Yaowei Ge
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Y H Loo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Anita S Y Chan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Duke-National University of Singapore Medical School, Singapore; Singapore General Hospital, Dept of Anatomical Pathology and Cytology, Singapore.
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Fan X, Jager MJ. Navigating the spectrum: A comprehensive exploration of diverse ocular and orbital tumor entities. Asia Pac J Ophthalmol (Phila) 2024; 13:100059. [PMID: 38621648 DOI: 10.1016/j.apjo.2024.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024] Open
Affiliation(s)
- Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, University of Cologne, Germany.
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Androudi S, Apivatthakakul A, Arevalo FJ, Berkenstock MK, Carreño E, Chee SP, Choovuthayakorn J, Cimino L, Cornish EE, Farrall AL, Gehl Z, Gentile P, Gerges TK, Gozzi F, Hernández-Pons A, Issa S, Kim HM, Kim M, Knickelbein JE, Kunavisarut P, Lee SM, Lim LL, Lin ML, Llorenç V, López-Sierra S, Martínez-Costa L, McCluskey P, Mochizuki M, O'Day RF, Pai AS, Palestine AG, Pathanapitoon K, Radford MH, Silpa-Archa S, Smith JR, Terada Y, Waduthantri S, Weaver TR, Williams KL, Woo SJ, Younan C. Presentation, Diagnostic Testing and Initial Treatment of Vitreoretinal Lymphoma. Ophthalmol Retina 2024; 8:72-80. [PMID: 37648063 DOI: 10.1016/j.oret.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Vitreoretinal lymphoma is a malignancy with high mortality. Incidence is rare, and there is a lack of medical evidence to direct management. This work describes presentation, diagnostic testing, and first treatment approaches in a recently diagnosed and treated patient cohort. DESIGN Clinical registry-based observational study. SUBJECTS Forty-eight women and 32 men (age range, 32-91 years; median age, 64 years) diagnosed with vitreoretinal lymphoma. METHODS An international network of ophthalmologists reported clinical features and management of patients presenting with vitreoretinal lymphoma between January 1, 2020 and December 31, 2022 via an electronic platform. MAIN OUTCOME MEASURES Visual acuity at presentation (logarithm of the minimum angle of resolution [logMAR]); basis for diagnosis; first treatment. RESULTS Vitreoretinal lymphoma was bilateral at presentation in 65% of patients (n = 52) and an initial site of lymphoma in 78% (n = 62). Of 127 eyes with lymphoma at presentation, vitreous was involved in 89% (n = 113) and was the only involved eye tissue in 40% (n = 51), and retina was involved in 46% (n = 59) and was the only involved eye tissue in 9% (n = 11). Median logMAR visual acuity of the worse-seeing eye was 0.50. The lymphoma was diagnosed from ocular specimens in 80% of patients (64/80), usually vitreous (57/64 patients [89%]), and on other clinical information in 20% of patients (16/80). Cellular studies were performed on ocular specimens from 59 of 64 patients (92%), most often cytology. Tumor gene analysis was used in 21 of 64 patients (33%), and cytokine assays were used in 13 of 64 patients (20%). For 76 patients (95%), treatment was initiated within 6 months of diagnosis and included ocular (38/76 [48%]), extraocular (17/76 [21%]), and ocular plus extraocular (21/76 [26%]) approaches. Intravitreal methotrexate was the most common ocular treatment (83/87 eyes [95%]). CONCLUSIONS Using data collected from 80 patients diagnosed with vitreoretinal lymphoma since 2020, we show that visual impairment is common, and that management often involves diagnosis by cellular tests and treatment with intravitreal chemotherapy. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Fellheimer HS, Card KR, Shields CL. Bilateral ocular tumors in a woman with cancer of the appendix and cervix. Indian J Ophthalmol 2024; 72:S2. [PMID: 38131533 PMCID: PMC10833152 DOI: 10.4103/ijo.ijo_1189_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Harrison S Fellheimer
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin R Card
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Stein M, Hämmerle M, Viestenz A, Wickenhauser C, Glien A, Struck HG, Heichel J. [Pleomorphic Adenoma of Ectopic Lacrimal Gland Tissue - Management of a Large Extraconal Retroaquaetorial Tumor via Anterior Transcutaneous Orbitotomy]. Klin Monbl Augenheilkd 2024; 241:10-14. [PMID: 37857327 DOI: 10.1055/a-2166-8334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Marlene Stein
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Monika Hämmerle
- Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Claudia Wickenhauser
- Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Halschirurgie Universitätsklinikum Halle (Saale), Deutschland
| | - Hans-Gert Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
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14
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Reilly S, Ellard R, O'Sullivan M, Khan R, Kennedy S. Recurrent lacrimal gland pleomorphic adenoma. Orbit 2023; 42:635-640. [PMID: 35546531 DOI: 10.1080/01676830.2022.2064515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Pleomorphic adenoma is the most common tumour of the lacrimal gland. Correct preoperative diagnosis is essential as the tumour should be removed en bloc. Incisional biopsy is contraindicated due to risk of recurrence and subsequent risk of malignancy. We identified 13 patients who were diagnosed with lacrimal gland pleomorphic adenoma in our institution over a 31-year period from 1990 to 2021. Of these, we describe four patients, three males and one female, who underwent incisional biopsy. One of these patients had a number of recurrences and required an orbital exenteration. The other two were treated with radiation to the orbit and experienced severe dry eye post-radiotherapy. All three patients are currently disease-free. The fourth patient underwent an incisional biopsy of his lacrimal gland pleomorphic adenoma (LGPA) within the last 6 months and has been referred for radiotherapy. The reasons for a lack of preoperative diagnosis of LGPA included clinical uncertainty and broad radiologic differential. None of the patients who had an en bloc resection experienced recurrence. We recommend that a fine needle aspirate (FNA) biopsy in lieu of a tissue biopsy should be performed where LGPA is included in the clinical and radiological differential diagnosis. If incisional biopsy is required, the suture track should be marked so that the entire biopsy track is removed with the specimen.
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Affiliation(s)
- Sinéad Reilly
- School of Biotechnology, Dublin City University, Dublin, Ireland
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
| | - Ruth Ellard
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Máire O'Sullivan
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
| | - Rizwana Khan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Susan Kennedy
- National Ophthalmic Pathology Laboratory, Royal Eye and Ear Hospital, Dublin, Ireland
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15
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Bonzheim I, Salmerón-Villalobos J, Süsskind D, Szurman P, Gekeler F, Spitzer MS, Salaverria I, Campo E, Coupland SE, Quintanilla-Martinez L, Fend F. [Molecular diagnostics for vitreoretinal lymphoma]. Pathologie (Heidelb) 2023; 44:150-154. [PMID: 37947807 DOI: 10.1007/s00292-023-01251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Primary vitreoretinal lymphoma (PVRL) represents a subtype of intraocular lymphomas, which are a subgroup of malignant lymphomas of the eye. PVRL is considered a special form of primary diffuse large cell lymphoma (DLBCL) of the CNS (central nervous system) (PCNSL) and arises primary or secondary to PCNSL. According to the cell of origin (COO) classification of DLBCL, PVRL largely belongs to the activated B‑cell (ABC) type of DLBCL. Based on a recently established genetic-biological classification of DLBCL, PCNSL and thus also PVRL belong to a group of DLBCL of the MYD88/CD79B-mutated (MCD) or cluster 5 subtype, which often shows extranodal manifestations and MYD88 and CD79A mutations as well as CDKN2A deletions.PVRL diagnostics is often complicated as it represents a classic masquerade syndrome. Due to the usually limited material with often large numbers of reactive lymphocytes and/or degenerative changes in the cells, the results of diagnostic tests are difficult to interpret. Classic diagnostic tests include cytology on vitreous aspirates, immunocytochemistry, and clonality analysis.New insights into the spectrum of genetic alterations of vitreoretinal lymphomas (VRL) confirm the close relationship to PCNSL and could significantly improve pathological diagnosis. Next-generation sequencing panel-based diagnostics allow VRL diagnosis confirmation with little DNA in almost 100% of patients in cases with insufficient cytological evidence or lack of clonality detection. PVRL, as well as secondary vitreoretinal lymphomas after PCNSL or extracerebral DLBCL, have high mutation frequencies in characteristically mutated genes in PCNSL or MCD/cluster 5 type DLBCL. Supporting diagnostics, mutation detection can also be performed on cell-free DNA from the vitreous supernatant.
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Affiliation(s)
- Irina Bonzheim
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland.
| | - Julia Salmerón-Villalobos
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Daniela Süsskind
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | | | - Florian Gekeler
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Augenklinik, Klinikum Stuttgart, Stuttgart, Deutschland
| | - Martin S Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Itziar Salaverria
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Elias Campo
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, Großbritannien
| | - Leticia Quintanilla-Martinez
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
| | - Falko Fend
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
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16
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Quhill H, Magan T, Thaung C, Sagoo MS. Prevalence of co-existent neoplasia in clinically diagnosed pterygia in a UK population. Eye (Lond) 2023; 37:3757-3761. [PMID: 37237231 PMCID: PMC10697954 DOI: 10.1038/s41433-023-02594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) and pterygia share risk factors and co-exist in only a minority of cases. Reported rates of OSSN in specimens sent as pterygium for histopathological analysis vary between 0% and nearly 10%, with the highest rates reported in countries with high levels of ultraviolet light exposure. As there is a paucity of data in European populations, the aim of this study was to report the prevalence of co-existent OSSN or other neoplastic disease in clinically suspected pterygium specimens sent to a specialist ophthalmic pathology service in London, United Kingdom. METHODS We performed a retrospective review of sequential histopathology records of patients with excised tissue submitted as suspected "pterygium" between 1997 and 2021. RESULTS In total, 2061 specimens of pterygia were received during the 24-year period, with a prevalence of neoplasia in those specimens of 0.6% (n = 12). On detailed review of the medical records of these patients, half (n = 6) had the pre-operative clinical suspicion of possible OSSN. Of those cases without clinical suspicion pre-operatively, one was diagnosed with invasive squamous cell carcinoma of the conjunctiva. CONCLUSION In this study, rates of unexpected diagnoses are reassuringly low. These results may challenge accepted dogma, and influence future guidance for the indications for submitting non-suspicious pterygia for histopathological analysis.
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Affiliation(s)
- Hibba Quhill
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Ocular Oncology Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Tejal Magan
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Thaung
- Department of Eye Pathology, UCL Institute of Ophthalmology, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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17
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Sáenz Decker E, García Fernández M, Gómez De la Torre R, Coto Hernández R, Santana García LI. Vitreoretinal lymphoma: a diagnostic challenge. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:718-722. [PMID: 37813184 DOI: 10.1016/j.oftale.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
A 66-year-old man with posterior uveitis and recurrent cystic macular edema related to possible previously treated Lyme disease is presented. Due to the recurrence of macular edema despite systemic and local corticosteroid treatment with intravitreal dexamethasone, biological treatment with Adalimumab was established. During follow-up, the patient developed bilateral subretinal lesions compatible with Vitreoretinal Lymphoma (VRL), so vitrectomy was performed, confirming the diagnosis of large B-cell lymphoma. Treatment with systemic chemotherapy with BRAM-Carmustine, Metrotexate, Ara C, and Rituximab was started with a good answer. Two years later, the patient remains without ocular or systemic recurrences. Vitreoretinal Lymphoma is a rare type of primary central nervous system lymphoma. The diagnosis is frequently delayed due to the nonspecific symptoms, which mimic chronic posterior uveitis, hence the importance with a diagnostic suspicion.
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Affiliation(s)
- E Sáenz Decker
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - M García Fernández
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - R Gómez De la Torre
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - R Coto Hernández
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L I Santana García
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain
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18
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Tuo YR, Zhang MF. [Research progress in the diagnosis of primary vitreoretinal lymphoma]. Zhonghua Yan Ke Za Zhi 2023; 59:954-959. [PMID: 37936364 DOI: 10.3760/cma.j.cn112142-20230717-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Primary vitreoretinal lymphoma (PVRL), the most prevalent intraocular lymphoma, is a subtype of primary central nervous system lymphoma (PCNSL) that often clinically mimics uveitis. It is a rare intraocular malignancy characterized by a dismal prognosis. The gold standard for PVRL diagnosis remains cytopathological examination. Additionally, auxiliary tests, such as clonal detection of tumor cells and cytokine analysis, have been employed. Moreover, recent years have witnessed the gradual development of novel molecular biomarkers and detection techniques. To optimize diagnostic strategies for PVRL patients, a comprehensive approach that integrates clinical manifestations, cytological examination, immunological assessment, and molecular biology analysis is indispensable. This article provides a comprehensive review of recent advancements in the diagnosis of primary vitreoretinal lymphoma.
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Affiliation(s)
- Y R Tuo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - M F Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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19
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Kongwattananon W, Pothikamjorn T, Somkijrungroj T. Posterior segment manifestations of ocular metastasis. Curr Opin Ophthalmol 2023; 34:522-528. [PMID: 37556166 DOI: 10.1097/icu.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis. RECENT FINDINGS Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases. SUMMARY Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.
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Affiliation(s)
- Wijak Kongwattananon
- Center of Excellence in Retina, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society
| | | | - Thanapong Somkijrungroj
- Center of Excellence in Retina, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society
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20
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Koenig LR, Biran N, Francis JH, Abramson DH. Localized Recurrence of Multiple Myeloma in the Lacrimal Gland. Ophthalmic Plast Reconstr Surg 2023; 39:e182-e183. [PMID: 37326495 DOI: 10.1097/iop.0000000000002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors report the case of a multiple myeloma recurrence isolated to the lacrimal gland. The patient is a 54-year-old man with a medical history of IgA kappa multiple myeloma status post multiple lines of chemotherapy and stem cell transplantation (×2) who was presumed to be without evidence of disease. Six years following the transplant, he presented with a lacrimal gland tumor with a biopsy consistent with multiple myeloma. Systemic disease evaluation at that time, including positron emission tomography scan, bone marrow biopsy, and serum analysis, were negative. To the best of the authors' knowledge, no prior reports exist describing an isolated lacrimal gland recurrence of multiple myeloma with ultrasound and MRI imaging.
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Affiliation(s)
- Lisa R Koenig
- Department of Ophthalmology, Weill Cornell Medicine, New York, U.S.A
| | - Noa Biran
- Multiple Myeloma Division, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, New Jersey, U.S.A
| | - Jasmine H Francis
- Department of Ophthalmology, Weill Cornell Medicine, New York, U.S.A
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - David H Abramson
- Department of Ophthalmology, Weill Cornell Medicine, New York, U.S.A
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
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21
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Giorgiutti S, Ballonzoli L, Michel G, Eischen A, Toussaint E, Nicolae A, Gaucher D, Poindron V. Masquerade syndrome: Retinal biopsy to diagnose primary intraocular lymphoma. J Fr Ophtalmol 2023; 46:996-997. [PMID: 37085372 DOI: 10.1016/j.jfo.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 04/23/2023]
Affiliation(s)
- S Giorgiutti
- Service d'immunologie clinique et médecine interne, centre de références des maladies auto-immunes et systémiques rares (CNR RESO), hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France.
| | - L Ballonzoli
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - G Michel
- Cabinet d'ophthalmologie, 6, rue de l'église, 67000 Strasbourg, France
| | - A Eischen
- Laboratoire d'hématologie, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - E Toussaint
- Service d'hématologie, institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - A Nicolae
- Laboratoire de pathologie, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - D Gaucher
- Service d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - V Poindron
- Service d'immunologie clinique et médecine interne, centre de références des maladies auto-immunes et systémiques rares (CNR RESO), hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
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22
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Jindal A, Kapatia G, Gupta G. Ocular metastasis from renal malignancies - A comprehensive review. Indian J Ophthalmol 2023; 71:3281-3289. [PMID: 37787223 PMCID: PMC10683680 DOI: 10.4103/ijo.ijo_3073_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 10/04/2023] Open
Abstract
The most common cause of intraocular mass is metastasis from other tumors. Renal malignancies, though rare, have a substantial number of cases with ocular metastasis, few of which were misdiagnosed. Many a times renal malignancies present with ocular manifestations before the primary diagnosis. Here in this article, we comprehensively reviewed 106 cases of ocular metastasis from renal malignancies published till date to the best of our knowledge. The eye is a rare site for distant metastasis because of the lack of a lymphatic system. The most common ocular structures to get involved in distant metastasis are the uveal tract, i.e., choroid, iris, and ciliary body. The most common renal tumor which metastasizes to eyes is renal cell carcinoma (RCC). RCC accounts for less than 2% of all ophthalmic metastases. Out of total 106 cases, the type of renal malignancy was known in 95 cases only, of which 92 had RCC, 1 Wilm's tumor, 1 rhabdoid tumor, and 1 medullary carcinoma. The age ranged widely from 2 weeks old to 81 years old. The male to female ratio was 3.4:1. In total, 67.4% of cases had a previous history of RCC, while the rest 32.6% primarily presented with ophthalmic manifestations first. Treatment modalities included enucleation of the eye, debulking surgery followed by radiotherapy and/or chemotherapy and/or immunotherapy.
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Affiliation(s)
- Akriti Jindal
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gaurav Gupta
- Department of Ophthalmology, Eye Sure Super-Speciality Eye Hospital, Bathinda, Punjab, India
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23
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Shi J, Zhu T, Zhou M, Zhou X, Song X, Wang Y, Jia R, Yu Z, Zhou Y, Fan X. Predicting the risk of distant and local recurrence for patients with ocular adnexal extranodal marginal zone lymphoma: a matched case-control study. Br J Ophthalmol 2023; 107:1560-1566. [PMID: 35914926 DOI: 10.1136/bjo-2022-321656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Extranodal marginal zone lymphoma of ocular adnexa (OA-EMZL) is the most frequent type of ocular adnexal lymphomas, with a high rate of disease recurrence. Precise patient stratification based on disease recurrence is understudied. This study aims to identify risk factors of distant recurrence (DR) and local recurrence (LR) to construct a prognostic model optimising rapid decision of therapeutic strategies. METHODS A total of 104 patients diagnosed with OA-EMZL between January 2011 and February 2020 were enrolled. Propensity score matching was performed for DR and LR groups. A nomogram was generated using a multivariate Cox proportional hazards model. RESULTS After matching, different independent risk factors of DR and LR were identified. Monocyte percentage (p=0.015) and M category >0 (p=0.043) were significant independent risk factors of DR. Epiphora (p<0.001) was the significant independent risk factor of LR. Three factors (monocyte percentage, M category >0, age >60) were integrated into the nomogram to predict the risk of DR. It had a relatively better discriminative ability for distant recurrence-free survival (C-index: 3-year, 0.784; 6-year, 0.801) than IPI score (C-index: 3-year, 0.663; 6-year, 0.673) in the cohort of all patients. CONCLUSION Our analyses suggested DR and LR as two distinct prognostic events, and additionally identified novel risk factors of them. The nomogram may serve as a practical tool for the prognostic estimation and rapid decision of therapeutic strategies for patients with OA-EMZL.
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Affiliation(s)
- Jiahao Shi
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Tianyu Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiaowen Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ziyao Yu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixiong Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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24
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Koseoglu ND, Corrêa ZM, Liu TA. Artificial intelligence for ocular oncology. Curr Opin Ophthalmol 2023; 34:437-440. [PMID: 37326226 PMCID: PMC10399931 DOI: 10.1097/icu.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW The aim of this article is to provide an update on the latest applications of deep learning (DL) and classical machine learning (ML) techniques to the detection and prognostication of intraocular and ocular surface malignancies. RECENT FINDINGS Most recent studies focused on using DL and classical ML techniques for prognostication purposes in patients with uveal melanoma (UM). SUMMARY DL has emerged as the leading ML technique for prognostication in ocular oncological conditions, particularly in UM. However, the application of DL may be limited by the relatively rarity of these conditions.
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Affiliation(s)
| | - Zélia Maria Corrêa
- Ocular Oncology, Bascom Palmer Eye Institute
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - T.Y. Alvin Liu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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25
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Spitznagel K, Sadar MJ, Terhaar H, Brandao J, Teixeira L, de Linde Henriksen M. Iridial melanocytoma in a ferruginous hawk (Buteo regalis): A case report and review of avian melanocytic neoplasia. Vet Ophthalmol 2023; 26:464-471. [PMID: 37581472 DOI: 10.1111/vop.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
A 21-year-old, suspected female captive ferruginous hawk (Buteo regalis) was followed for 3 years due to an iridial mass of the left eye (OS) that progressively increased in size. Enucleation of OS was eventually recommended due to the iridial mass taking up approximately 75% of the anterior chamber, and the bird seemed less active. A complete physical examination, complete blood cell count, biochemistry, and survey radiographs were performed pre-surgery with no findings indicating metastasis. A subconjunctival enucleation was performed and the globe was submitted for histopathology through the Comparative Ocular Pathology Lab of Wisconsin. The histopathologic evaluation determined the mass to be consistent with an iris melanocytoma, which has not been previously reported in this species. The patient recovered well from surgery and has remained comfortable and active for 117 days post-surgery. This case report aimed to review the current available information on avian ocular neoplasms as well as describe the clinical presentation, medical management and surgical procedure, and long-term follow-up for this patient to enhance clinical understanding of the behavior of iris melanocytic tumors in avian species.
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Affiliation(s)
- Katya Spitznagel
- College of Veterinary Medicine and Biomedical Sciences, James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA
| | - Miranda J Sadar
- Avian, Exotic, and Zoological Medicine Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Hannah Terhaar
- Comparative Ophthalmology Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Joao Brandao
- Zoological Medicine Service, Department of Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Leandro Teixeira
- Department of Pathobiological Sciences and Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Michala de Linde Henriksen
- Comparative Ophthalmology Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
- Comparative Ophthalmology, Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
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Choi JY, Jang YK, Han JC. Complication of Ectopic Lacrimal Gland Tumor on Long-term Follow-up: A Case Report. Korean J Ophthalmol 2023; 37:348-349. [PMID: 37336510 PMCID: PMC10427904 DOI: 10.3341/kjo.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- Ji Youn Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Kyung Jang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shahraki K, Shahraki K, Ghasemi Boroumand P, Sheervalilou R. Promotor methylation in ocular surface squamous neoplasia development: epigenetics implications in molecular diagnosis. Expert Rev Mol Diagn 2023; 23:753-769. [PMID: 37493058 DOI: 10.1080/14737159.2023.2240238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Cancer is heavily influenced by epigenetic mechanisms that include DNA methylation, histone modifications, and non-coding RNA. A considerable proportion of human malignancies are believed to be associated with global DNA hypomethylation, with localized hypermethylation at promoters of certain genes. AREA COVERED The present review aims to emphasize on recent investigations on the epigenetic landscape of ocular surface squamous neoplasia, that could be targeted/explored using novel approaches such as personalized medicine. EXPERT OPINION While the former is thought to contribute to genomic instability, promoter-specific hypermethylation might facilitate tumorigenesis by silencing tumor suppressor genes. Ocular surface squamous neoplasia, the most prevalent type of ocular surface malignancy, is suggested to be affected by epigenetic mechanisms, as well. Although the exact role of epigenetics in ocular surface squamous neoplasia has mostly been unexplored, recent findings have greatly contributed to our understanding regarding this pathology of the eye.
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Affiliation(s)
- Kourosh Shahraki
- Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Kianoush Shahraki
- Department of Ophthalmology, Zahedan University of Medical Sciences, Zahedan, Iran
- Cornea Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Paria Ghasemi Boroumand
- ENT, Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran
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Sripawadkul W, Reyes-Capo D, Zein M, Wylegala A, Albayyat G, Galor A, Karp CL. Long term study of topical interferon α-2b eye drops as primary treatment of ocular surface squamous neoplasia. Ocul Surf 2023; 28:108-114. [PMID: 36592780 PMCID: PMC10310888 DOI: 10.1016/j.jtos.2022.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the efficacy of topical interferon α-2β(IFN) eye drops as a primary treatment for ocular surface squamous neoplasia(OSSN) and evaluate factors that impact response to treatment and recurrence of OSSN. METHOD A retrospective study of 143 OSSN patients treated with topical IFN(1MIU/ml) from January 1998 to June 2021. The diagnosis was based on clinical examination and anterior segment optical coherence tomography, with histologic confirmation was present in 46.2% of patients. Data on demographic, tumor characteristics, treatment outcome, and side effects were collected. The primary outcomes were tumor resolution frequency and recurrence rate. Secondary outcomes were predictive factors for resolution and recurrence and side effects of treatment. RESULT Participants were mostly older (mean age, 69 years, SD 12.9, range 29-97), white(89%) males (74%). Complete tumor resolution was achieved in 80.4% of individuals with a mean time to resolution of 4.2 months (SD 2, range 0.5-12.3 months). On multivariable analysis, history of skin cancer (HR: 0.66, p = 0.05, 95%CI: 0.44-0.99) and immune system abnormalities (HR: 0.37, p = 0.009, 95%CI: 0.18-0.79) reduced the risk of tumor resolution, while a prior history of OSSN (HR: 3.49, p < 0.001, 95%CI: 1.76-6.93) increased the risk of resolution. With a mean follow-up time of 44.3 months (SD 50.9, 0-290 months), the recurrence rate was 0%, 2.3% and 3.1% at 1, 2, and 5 years respectively. Mild hyperemia(18.9%) and pain(10.6%) were the two most common side effects. CONCLUSION Topical IFN eye drops are a safe and effective primary treatment modality for OSSN with a reasonable side effect profile.
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Affiliation(s)
- Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA; Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Daniela Reyes-Capo
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Mike Zein
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Adam Wylegala
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Ghada Albayyat
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA.
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Kaliki S, Wagh RD, Vempuluru VS, Kapoor AG, Jakati S, Mishra DK, Mohamed A. Ocular surface squamous neoplasia with orbital tumour extension: risk factors and outcomes. Eye (Lond) 2023; 37:446-452. [PMID: 35115716 PMCID: PMC9905483 DOI: 10.1038/s41433-022-01955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the risk factors, clinical features, histopathology, treatment, and outcomes of patients with orbital tumour extension of ocular surface squamous neoplasia (OSSN). METHODS Retrospective study of 51 patients with orbital tumour extension (cases) and 360 patients without orbital extension (controls). RESULTS Of 1,653 patients with OSSN, orbital tumour extension was noted in 51 (3%) cases. The risk factors for orbital tumour extension included outdoor occupation (p < 0.03; Odds ratio (OR) = 1.96), Human Immunodeficiency Virus (HIV) infection (p < 0.0001; OR = 5.81), prolonged duration of symptoms (p = 0.01; OR = 1.02), tumour bilaterality (p = 0.02; OR = 2.92), forniceal and tarsal conjunctival involvement, diffuse tumour (p < 0.0001; OR = 9.13), inferior quadrantic location (p < 0.0001; OR = 7.51), increased tumour thickness (p = 0.04; OR = 1.59), higher % of ocular surface involvement (p = 0.002; OR = 1.12), nodular (p = 0.002; OR = 2.61) and nodulo-ulcerative (p < 0.0001; OR = 11.05) tumour morphology, poorly differentiated tumours (p = 0.006; OR = 4.23); invasive squamous cell carcinoma (SCC) (p < 0.0001; OR = 29.76), spindle cell and mucoepidermoid variant (p = 0.02; OR = 16.94) tumours. At a mean follow-up period of 27 months, tumour recurrence in the socket was noted in 1 (2%), locoregional lymph node metastasis (LNM) in 15 (29%) patients, and nine (18%) patients died due to systemic metastasis (SM). T4 tumour at presentation was a risk factor for LNM (p = 0.01; Hazard ratio (HR) = 5.60) and SM (p = 0.0003; HR = 5.09). CONCLUSION Orbital extension of OSSN is rare. Outdoor occupation, HIV infection, larger and thicker tumours in the inferior quadrant with forniceal and/or tarsal conjunctival involvement with nodular or noduloulcerative morphology, poor tumour differentiation, SCC, spindle cell and mucoepidermoid variants on histopathology are at increased risk for orbital tumour extension.
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Affiliation(s)
- Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer (SK, RDW, VSV), L V Prasad Eye Institute, Hyderabad, India.
| | - Richa Dharap Wagh
- Operation Eyesight Universal Institute for Eye Cancer (SK, RDW, VSV), L V Prasad Eye Institute, Hyderabad, India
| | - Vijitha S Vempuluru
- Operation Eyesight Universal Institute for Eye Cancer (SK, RDW, VSV), L V Prasad Eye Institute, Hyderabad, India
| | - Anasua Ganguly Kapoor
- Hima Bindu Yalamanchili Centre for Eye Cancer (AGK), L V Prasad Eye Institute, Vijayawada, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory (SJ, DKM), L V Prasad Eye Institute, Hyderabad, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory (SJ, DKM), L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics (AM), L V Prasad Eye Institute, Hyderabad, India
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Kumar SV, Kumar V, Mishra SK, Sati A. Clinicopathological profile, management and clinical outcomes in recurrent cases of ocular surface squamous neoplasia at a tertiary care centre. Int Ophthalmol 2023; 43:371-380. [PMID: 35857192 DOI: 10.1007/s10792-022-02432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was taken up to look into the various causes of recurrence, clinicopathological profile and final outcomes in recurrent cases of ocular surface squamous neoplasia (OSSN). METHODOLOGY A prospective cohort study was conducted and total 18 patients were recruited. All patients were subjected to detailed history, comprehensive eye examination and imaging studies. A treatment plan was formulated based on the size and extent of the lesion. The primary outcome measure was complete response to treatment with no evidence of recurrence after12 months and secondary outcome measure was complication associated with each treatment modality. RESULTS The common cause of recurrence in our study was misdiagnosis of the lesion as in 15 cases it was diagnosed as pterygium and in 03 cases it was actinic keratosis. Excision Biopsy with adjunctive cryotherapy was the preferred treatment modality followed by topical interferon-alpha 2b drop-in our study. We could achieve good outcomes in terms of complete response to the treatment in 16 cases. The complication associated with this treatment was minimal in our study as few patients complained redness and irritation which subsided after application of topical lubricants. There was no sign of recurrence even at 12 months of follow-up in all 18 cases. CONCLUSION The current study provided clinicopathological characteristics and treatment outcomes in recurrent cases of OSSN. In our study, adopting appropriate treatment strategy, regular follow-up to assess the response to treatment and change over to new treatment plan in cases with inadequate response helped in achieving good outcomes in recurrent cases of OSSN.
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Affiliation(s)
| | - Vinay Kumar
- Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India
| | | | - Alok Sati
- Army Hospital Research and Referral, Delhi, 110010, India
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31
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Rose GE, Vahdani K, Lewis J, Rose AM. Risk and Lag-time for Development of Lacrimal Gland Carcinoma Expleomorphic Adenoma: Observations and Conjectural Study. Ophthalmic Plast Reconstr Surg 2022; 38:563-566. [PMID: 35550483 DOI: 10.1097/iop.0000000000002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To estimate the proportion of de novo lacrimal gland pleomorphic adenomas (PAs) and carcinomas expleomorphic adenomas (CEPAs), together with age at presentation and first symptom. Conjectural models of tumor growth are considered. METHODS Retrospective review of patients with orbital lobe PA or CEPA. The presenting age was examined for conformation to a Gaussian distribution and the cumulative distribution function derived for both tumor types. The risk of CEPA with age was estimated by logistic regression. RESULTS About one-sixth (27/172; 16%) of these primary orbital lobe tumors were CEPAs, with 145 PAs (76/145 male; 52%) and 27 CEPAs (12/27 male; 44%). The mean presenting age for PAs was 48.3 years (median 47.7; range 11-84 years) and 57.7 years for CEPAs (median 61.2, range 27-91 years) ( p = 0.0062), and the standard deviations for each group are almost identical (16.3 for PAs, 15.9 for CEPAs; p = 0.92). Five (3.4%) PAs and 1 (3.7%) CEPA were asymptomatic: otherwise, the median symptom duration was 24 months for both PAs and CEPAs ( U test: p = 0.65). The odds of CEPA rises significantly with age, increasing 1.04-fold annually ( p = 0.0079). CONCLUSION The almost identical measures of dispersion for the presenting ages of PA and CEPA suggests that, once malignant transformation occurs, there might be a relatively constant period before it is evident. CEPAs present about a decade after PAs, this unexpectedly later presentation for the malignancy possibly being explained by a gradual replacement of the PA by the newly arising carcinoma within the preceding benign tumor.
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Affiliation(s)
- Geoffrey E Rose
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Joanna Lewis
- Freelance Medical Statistician, London, United Kingdom
| | - Anna M Rose
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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Watane A, Hansen ED, Vazquez LE, Karp CL. Ocular Surface Squamous Neoplasia Masquerading as Recalcitrant Epithelial Keratitis. Cornea 2022; 41:1185-1187. [PMID: 34907943 PMCID: PMC9192825 DOI: 10.1097/ico.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report a unique case of ocular surface squamous neoplasia that masqueraded as a nonresolving toxic epithelial keratitis. METHODS This was a case report and review of the literature. RESULTS A 79-year-old man presented with decreased vision, redness, and a foreign body sensation in his right eye that was refractory to treatment with lubrication and topical nonsteroidal antiinflammatory drops. Before presentation, the referring provider believed that he had medicamentosa-related keratitis and placed him on oral methazolamide. Slitlamp biomicroscopy of the right eye revealed diffuse epitheliopathy with punctate fluorescein staining and subtle underlying corneal epithelial opalescence. A mildly thickened and inflamed pinguecula was noted from 2 to 5 o'clock at the limbus of the right eye. An anterior segment high-resolution optical coherence tomography revealed thickened, hyperreflective epithelium with an abrupt transition. An incisional biopsy confirmed conjunctival and corneal intraepithelial neoplasia. The patient improved after 4 cycles of topical chemotherapy with 1% 5-fluorouracil eye drops with complete resolution of the corneal and conjunctival pathology. CONCLUSIONS Ocular surface squamous neoplasia can rarely masquerade as a recalcitrant medicamentosa and epithelial keratitis. In subtle cases or in cases with combined ocular surface morbidities, anterior segment high-resolution optical coherence tomography can be helpful to diagnose and direct therapy.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Eric D Hansen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Luis E Vazquez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
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Terán S, Ahumada F, Vergara F, Meza J, Zoroquiain P. OVOL1 immunohistochemical expression is a useful tool to diagnose invasion in ocular surface squamous neoplasms. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:504-509. [PMID: 35787378 DOI: 10.1016/j.oftale.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES OVOL1 is a gene that negatively regulates mesenchymal transformation, which allows epithelial cells to invade the stroma. On the other hand, it negatively regulates c-Myc, which has a positive effect on cell proliferation. The aim of this study is to evaluate the expression of OVOL1 and c-Myc in ocular surface squamous neoplasia (OSSN). PATIENTS AND METHODS Cross-sectional cohort study of 36 samples including 6 squamous papillomas, 19 conjunctival intraepithelial neoplasms, 6 squamous carcinomas and 7 normal conjunctivae were evaluated using immunohistochemistry against OVOL1 and c-Myc. The expression of both markers was analysed using the H-score (intensity 1-3 multiplied by the percentage of positive cells). RESULTS Percentages of 98 and 100 of the OSSN, and 57 and 71% of the normal conjunctivae expressed OVOL1 and c-Myc respectively, however, the mean H-score of OVOL1 and c-Myc was higher in the OSSN than in normal conjunctivae group (P=0.0001 in both). Within the OSSN, OVOL1 demonstrated a higher H-score in the conjunctival intraepithelial neoplasms and papilloma, compared to the squamous carcinoma (P<0.01) group. c-Myc did not show differences between the OSSN groups. An H-score lower than 35 differentiates a squamous cell carcinoma from other OSSN lesions with a sensitivity of 83.3% and a specificity of 100%. CONCLUSIONS The expression of OVOL1 is a useful tool to differentiate between a squamous carcinoma of conjunctival intraepithelial neoplasms and papilloma. OVOL1 could play a role in the invasiveness of squamous neoplasms and places it as a potential therapeutic target.
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Affiliation(s)
- S Terán
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Ahumada
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Vergara
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Meza
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Zoroquiain
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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34
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Fend F, Bonzheim I, Kakkassery V, Heindl LM, Illerhaus G. [Lymphoma of the eye and its adnexa : Modern pathological diagnostics and systemic treatment]. Ophthalmologie 2022; 119:664-674. [PMID: 35925409 DOI: 10.1007/s00347-022-01650-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Malignant lymphomas of the eye and its adnexal structures account for approximately 5-15% of extranodal lymphomas. According to anatomic and biological criteria, two large groups of lymphomas in and around the eye need to be distinguished: (1) primary lymphomas of intraocular structures and (2) primary lymphomas of ocular adnexa. Furthermore, there is a large spectrum of secondary manifestations of malignant lymphomas in ocular and periocular structures. OBJECTIVE This article gives a summary of the classification and molecular pathology of various intraocular and periocular lymphomas as well as oncological systemic treatment with a focus on primary vitreoretinal lymphomas. METHODS A selective literature search was carried out in PubMed on the topic of intraocular and periocular lymphomas and own experiences are presented. RESULTS The treatment of primary vitreoretinal lymphomas (PVRL) is an interdisciplinary challenge and despite the apparently localized disease, systemic treatment concepts are necessary to reduce the high risk of secondary involvement of the central nervous system (CNS). Therefore, it is crucial that the substances used can penetrate the CNS, and protocols should be chosen in accordance with the treatment concepts for primary CNS lymphomas. The knowledge on the genetics and biology of ocular lymphomas generated by modern high throughput methods enable not only improved diagnostics using molecular methods but also provide rationales for targeted therapeutic approaches. CONCLUSION A deep understanding of the biological and molecular principles of intraocular and periocular lymphomas forms a basic prerequisite for precise diagnostics and the use of targeted systemic treatment.
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Affiliation(s)
- Falko Fend
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland.
- Comprehensive Cancer Center Tübingen-Stuttgart, Tübingen-Stuttgart, Deutschland.
| | - Irina Bonzheim
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
- Comprehensive Cancer Center Tübingen-Stuttgart, Tübingen-Stuttgart, Deutschland
| | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Gerald Illerhaus
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Klinikum der Landeshauptstadt Stuttgart gKAöR | Standort Mitte, Katharinenhospital, Kriegsbergstr. 60, 70174, Stuttgart, Deutschland.
- Stuttgart Cancer Center/Tumorzentrum Eva Mayr-Stihl, Stuttgart, Deutschland.
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35
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Schiemenz C, Lüken S, Klassen AM, Ranjbar M, Illerhaus G, Fend F, Heindl LM, Chronopoulos A, Grisanti S, Kakkassery V. [Clinical procedures for intraocular lymphomas]. Ophthalmologie 2022; 119:675-685. [PMID: 35925411 DOI: 10.1007/s00347-022-01651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The classification of intraocular lymphomas is based on their anatomical location. They are divided into uveal lymphomas with involvement of the choroid, ciliary body or iris and vitreoretinal lymphomas with isolated or combined involvement of the vitreous body and/or retina. Over the last decades it has become increasingly possible to work out the clinical and pathobiological features of the various subtypes, thereby reducing the diagnostic hurdles and creating improved treatment options. OBJECTIVE A summary of the various types of intraocular lymphoma in terms of clinical features, diagnostics, treatment and prognosis is given as well as recommendations for follow-up care. METHODS A selective literature search was carried out on the subject of intraocular lymphomas using PubMed and Google Scholar. RESULTS Intraocular lymphomas affect different structures, so that the symptoms can also be very different. The diagnostic spectrum ranges from typical ocular examination methods to sample biopsies with subsequent cytological, histological and molecular pathological processing. The treatment pillars available are percutaneous irradiation and intravitreal drug administration as local treatment and systemic treatment or a combination of systemic and local treatment. The prognosis depends mainly on the subtype of the lymphoma and the extent of the infestation when the diagnosis is confirmed. Even though some effective treatment options are now available, it has not yet been possible to significantly reduce the mortality rate. CONCLUSION Many different options are available for the diagnostics and treatment of intraocular lymphomas, which require close interdisciplinary cooperation. The further developments in the field of molecular pathology allow a faster and more accurate diagnosis and could open up new treatment options in the future.
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Affiliation(s)
- C Schiemenz
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - S Lüken
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - A M Klassen
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Ranjbar
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - G Illerhaus
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Klinikum der Landeshauptstadt Stuttgart gKAöR | Standort Mitte, Katharinenhospital, Stuttgart, Deutschland
- Stuttgart Cancer Center, Tumorzentrum Eva Mayr-Stihl, Stuttgart, Deutschland
| | - F Fend
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Comprehensive Cancer Center, Tübingen-Stuttgart, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - A Chronopoulos
- Augenklinik, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - S Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Sun H, Cai R, Zhai C, Song W, Sun J, Bi Y. Primary Mucoepidermoid Carcinoma of the Lacrimal Apparatus. Am J Ophthalmol 2022; 239:170-179. [PMID: 35288069 DOI: 10.1016/j.ajo.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE In this study, we evaluated the clinicopathologic and molecular characteristics of lacrimal apparatus mucoepidermoid carcinoma (MEC) to define its typical diagnostic features. DESIGN Retrospective observational case series. METHODS Institutional pathology records between 2011 and 2021 were searched for all cases of lacrimal apparatus MEC. RESULTS A total of 2 male and 6 female patients ranging in age from 18 to 83 years (median 56, mean 54) were included. Six lacrimal apparatus MECs were found in the lacrimal gland, and 2 cases occurred in the lacrimal sac and nasolacrimal duct. Histologically, there were 6 cases of conventional MEC, 1 clear-cell variant of MEC, and 1 oncocytic variant of MEC for a total of 8 cases. There were 3 low-grade cases and 5 high-grade cases. All 8 cases were evaluated via immunohistochemistry, and the results were positive (scores 1-4) for pankeratin, 34betaE12, p63, p40, CK7, CK8, and CK19, with a relatively higher expression of p63 observed in high-grade MEC. The presence of human papillomavirus (HPV) type 6 DNA was found in 4 patients. MAML2 fluorescence in situ hybridization was positive for MAML2 rearrangement in 3 lacrimal gland tumors (2 low-grade and 1 high-grade). Six tumors were managed with radical resection, and 2 patients underwent orbital exenteration. Postoperative radiation therapy was delivered to 6 patients, and chemotherapy was administered to 1 patient. CONCLUSIONS MECs of the lacrimal apparatus are rare tumors, and the rate of MAML2 translocations is lower than that in salivary MECs. Lacrimal gland and lacrimal sac MECs may not be of the same subtypes intrinsically because of the difference in MAML2 translocation, anatomy, and clinical course. The etiologic function of HPV type 6 infection should be explored in lacrimal apparatus MECs. Radical surgery is the treatment of choice. The description of these unique findings may assist in the definitive diagnosis of and improve our understanding of lacrimal apparatus MEC.
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Affiliation(s)
- Hui Sun
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.); Department of Pathology, Fudan University Shanghai Cancer Center (H.S.), Shanghai, China
| | - Rongrong Cai
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Changwen Zhai
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Wanjing Song
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Ji Sun
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.)
| | - Yingwen Bi
- From the Department of Pathology, Eye and ENT Hospital, Fudan University (H.S., R.C., C.Z., W.S., J.S., Y.B.).
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Neerukonda VK, Kim IK, Stagner AM. Primary vitreoretinal involvement and immunopositivity for BRAFV600E help distinguish metastatic from primary intraocular melanoma: a detailed histopathologic study of metastatic cutaneous melanoma to the eye. Histopathology 2022; 80:1061-1070. [PMID: 35275414 DOI: 10.1111/his.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic characteristics of metastatic cutaneous melanoma to the eye and identify potential distinguishing characteristics from the more common primary uveal melanoma; particularly, tumour location within the eye, cytomorphology and immunohistochemical/specific molecular genetic features. METHODS A retrospective observational case series using surgical enucleation and diagnostic vitrectomy cytologic specimens from seven patients with suspected intraocular melanoma, eventually diagnosed as metastatic melanoma, was conducted. Haematoxylin and eosin-stained sections of tumour and immunohistochemical (IHC) stains for BRAFV600E and Ki-67 were critically reviewed; BAP1 IHC was also evaluated in cases where additional tissue was available. Clinical imaging studies and medical records were reviewed. RESULTS The majority of patients (86%) with metastatic melanoma have primary vitreoretinal (not uveal) involvement and epithelioid, highly malignant cytomorphology (100%); many (50%) harbour BRAFV600E mutations, a finding not seen in large cohorts of primary uveal melanoma. CONCLUSIONS Characteristics favouring or defining metastatic intraocular melanoma over primary uveal melanoma include high-grade epithelioid cytology, predominant involvement of the vitreous cavity and/or retina, and presence of positive immunostaining for BRAFV600E.
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Affiliation(s)
- Vamsee K Neerukonda
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ivana K Kim
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Vitreoretinal Surgery Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Theotoka D, Wall S, Galor A, Sripawadkul W, Khzam RA, Tang V, Sander DL, Karp CL. The use of high resolution optical coherence tomography (HR-OCT) in the diagnosis of ocular surface masqueraders. Ocul Surf 2022; 24:74-82. [PMID: 35231640 PMCID: PMC9058205 DOI: 10.1016/j.jtos.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ocular surface masqueraders encompass any ocular surface lesion masquerading as another ocular surface lesion. High resolution optical coherence tomography (HR-OCT) has emerged as an adjunctive tool to clinical acumen. This study's purpose is to evaluate the utility of HR-OCT images in guiding the diagnosis and management of those lesions. MATERIAL AND METHODS 22 individuals with a clinically ambiguous ocular surface lesion with slit lamp photographs (SLP), HR-OCT images, and histopathological examination were included in the study. The presumptive clinical diagnosis based on SLP was compared to the diagnosis suggested by HR-OCT findings and to definitive diagnosis by histopathology. The main outcome of this study was the frequency in which HR-OCT findings guided the clinician to the correct diagnosis. RESULTS 7 lesions were epithelial, 3 had an epithelial and a subepithelial component, and 12 were subepithelial. HR-OCT was most effective in discerning lesion location, successfully identifying the location in 100% of cases. Classic HR-OCT findings were detected in 68.2% of cases while suggestive features were detected in 31.8% of cases. The epithelial lesions' mean epithelial thickness was 265.4 ± 140.6 μm, the subepithelial lesions' mean was 58.0 ± 25.0 μm, and the combined lesions' mean was 140.0 ± 70.0 μm. The epithelium was significantly thicker in epithelial lesions compared to subepithelial and combined lesions. By ROC analysis we identified that using a cut off of 156 μm, the sensitivity was 86% and the specificity was 93%. DISCUSSION HR-OCT can be a valuable diagnostic tool, assisting in the differentiation of ambiguous ocular surface pathologies by providing a cross-sectional, morphological image of the lesion.
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Affiliation(s)
- Despoina Theotoka
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vincent Tang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dubovy L Sander
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
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Yu MD, Men CJ, Do H, Colevas AD, Lin JH, Egbert PR, Tse DT, Kossler AL. Genome Sequencing and Apoptotic Markers to Assess Treatment Response of Lacrimal Gland Adenoid Cystic Carcinoma to Intra-Arterial Cytoreductive Chemotherapy. Ophthalmic Plast Reconstr Surg 2022; 38:e44-e47. [PMID: 34798653 PMCID: PMC10838401 DOI: 10.1097/iop.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adenoid cystic carcinoma of the lacrimal gland is an aggressive, malignant epithelial neoplasm. We report the case of a 30-year-old male with lacrimal gland adenoid cystic carcinoma treated with neoadjuvant intra-arterial chemotherapy through the internal carotid artery, followed by orbital exenteration and chemoradiation. Treatment response was evaluated using a novel combination of pre- and posttreatment genome sequencing coupled with immunohistochemical evaluation, which showed diffuse tumor apoptosis. A posttreatment decrease in variant allele frequency of the NOTCH1 mutation, and robust tumor cytoreduction on imaging, supports exploration of NOTCH1 analysis as a potential marker of cisplatin sensitivity. The use of genome sequencing and immunohistochemical evaluation could provide a more targeted therapeutic assessment of neoadjuvant intra-arterial chemotherapy in the management of lacrimal gland adenoid cystic carcinoma.
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Affiliation(s)
- Michael D. Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
| | - Clara J. Men
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
| | - Huy Do
- Department of Interventional Neuroradiology, Stanford University, Stanford, California, U.S.A
| | - A. Dimitrios Colevas
- Department of Medicine (Oncology), Stanford University, Stanford, California, U.S.A
| | - Jonathan H. Lin
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
- Department of Pathology, Stanford University, Stanford, California, U.S.A
| | - Peter R. Egbert
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
- Department of Pathology, Stanford University, Stanford, California, U.S.A
| | - David T. Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, U.S.A
| | - Andrea L. Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
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Liu S, Gu J, Zhang T, Ping B, Zhou M, Huang X, Jiang R, Xu G, Chang Q. CLINICAL FEATURES, DIAGNOSTIC SIGNIFICANCE, AND PROGNOSIS OF VITREORETINAL LYMPHOMA IN YOUNG PATIENTS. Retina 2021; 41:2596-2604. [PMID: 34173362 DOI: 10.1097/iae.0000000000003241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the clinical features, diagnostic approaches, and outcomes of young patients with vitreoretinal lymphoma. METHODS Fifty-one vitreoretinal lymphoma patients (97 eyes) referred to the Eye and ENT Hospital of the Fudan University from 2011 to 2020 were grouped based on their onset age (age ≤50 years and age >50 years). Complete eye examinations, evaluation of systemic conditions, and biological analysis of intraocular fluids were performed. RESULTS Young patients accounted for 31.4% (n = 16) of the cohort. More eyes had retinal/subretinal pigment epithelial infiltration (20 [64.5%] vs. 23 [34.8%]; P = 0.018) in young patients than in elderly ones. The mutation rate of Myeloid Differentiation Factor 88 gene (MYD88) was significantly lower in young patients than in elderly ones (5 [50%] vs. 21 [91.3%]; P = 0.016). The median time to new onset of central nervous system lymphoma was significantly shorter in young patients (11.7 vs. 36.2 months; P = 0.012). However, mean overall survival did not differ between the 2 groups (64.9 vs. 57.5 months; P = 0.871). CONCLUSION Early diagnosis and central nervous system evaluation are crucial for young vitreoretinal lymphoma patients with rapid central nervous system involvement. Meanwhile, young vitreoretinal lymphoma patients have some unique features, including more retinal/subretinal pigment epithelial infiltrations and lower MYD88 mutation rates.
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Affiliation(s)
- Shixue Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Junxiang Gu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Bo Ping
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Xin Huang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; and
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Abstract
PURPOSE Retention mucoceles of the lacrimal sac almost always expand below the medial canthal tendon (MCT), whereas the very much rarer malignancies involving the lacrimal sac may progress to form a mass above the tendon. In this study, the incidence of malignancy was determined for patients with a preoperative decision to undergo biopsy for a clinically suspect, hard lacrimal sac mass, together with the proportion having a tumor extending above the MCT. METHODS Patients thought-on the basis of having a firm, immobile mass centered on the lacrimal sac fossa-to possibly have lacrimal sac malignancy were identified from a database of biopsies between 1989 and 2020. A retrospective review of their clinical, radiologic, and pathologic records was undertaken. RESULTS Fifty-three patients (24 male; 45%) underwent biopsy of atypical masses of the lacrimal sac, of which 47 of 53 (89%) extended above the MCT. Seventy-seven percent (41/53) patients had malignancy-26 primary carcinomas and 15 secondary tumors (14 lymphomas or hematopoietic and 1 neuroendocrine)-and 12 had benign conditions (6 transitional cell papillomatosis, 5 chronic inflammation, and 1 solitary fibrous tumor); all the benign pathologies extended above the MCT. The age at presentation and duration of symptoms was similar in patients with benign or malignant pathology. One-fifth of malignant lesions had pain, whereas all the benign conditions were painless, and acute dacryocystitis was relatively uncommon-occurring in only 13% of patients. CONCLUSIONS If a firm and immobile lacrimal sac mass extends above the MCT, it has about a 74% chance of being malignant and, if pain is present, the lesion is more likely to be so. Clinically suspicious masses in the lacrimal sac fossa, whether benign or malignant, appear to present at the same age and with a similar duration of symptoms.
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Affiliation(s)
- Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
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Rothova A, Groen F, Ten Berge JCEM, Lubbers SM, Vingerling JR, Thiadens AAHJ. CAUSES AND CLINICAL MANIFESTATIONS OF MASQUERADE SYNDROMES IN INTRAOCULAR INFLAMMATORY DISEASES. Retina 2021; 41:2318-2324. [PMID: 33814536 DOI: 10.1097/iae.0000000000003171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the clinical characteristics and prevalence of neoplastic and nonneoplastic inflammatory masquerade syndromes (IMSs) in a tertiary center and determine the useful diagnostic tests. METHODS A retrospective cohort study of consecutive 1906 patients diagnosed with intraocular inflammatory disease. RESULTS Of all patients initially diagnosed with intraocular inflammatory disease, we identified 116 (6%) patients with noninflammatory causes (neoplastic IMSs in 36/116; 31% and nonneoplastic IMSs in 52/116; 45%). In addition, 26 patients (22%, 1.4% of all) had drug-induced uveitis and 2 (2%, 0.1% of all) had paraneoplastic uveitis. The large B-cell lymphoma was the most common neoplastic IMS (78%), and the major clinical features were presence of cells and floaters in the vitreous (69%) and chorioretinal lesions (33%). The causes of nonneoplastic IMSs included retinal vascular disorders (38%), hereditary retinal diseases (31%), and degenerative ocular disorders (19%). The common clinical manifestations consisted of chorioretinal scars (27%), small white-yellow retinal lesions (17%), and leaking vessels on fluorescein angiography (14%). CONCLUSION Noninflammatory causes were determined in 6% of a large population with initial diagnosis of intraocular inflammatory disease. Although neoplastic IMS was commonly characterized by vitreous cells and opacities, most common definitive diagnoses in nonneoplastic IMS encompassed diverse retinal disorders.
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Affiliation(s)
- Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Anjum S, Sen S, Chosdol K, Bakhshi S, Kashyap S, Pushker N, Bajaj MS, Meel R, Sharma MC. Vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1 alpha (HIF-1ɑ) in lacrimal gland Adenoid cystic carcinoma: Correlation with clinical outcome. Ann Diagn Pathol 2021; 56:151846. [PMID: 34749048 DOI: 10.1016/j.anndiagpath.2021.151846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/19/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE VEGF and HIF-1α are important regulators of angiogenesis, overexpressed in various tumors. Lacrimal gland Adenoid cystic carcinoma (ACC) is a malignant tumor whose angiogenic properties remain unexplored. This study was designed to evaluate the expression of HIF-1α and VEGF in lacrimal gland ACC. METHODS VEGF and HIF-1α immunoexpression was undertaken in 30 lacrimal gland ACC cases. mRNA expression of VEGF and HIF-1α was analysed in 17 cases by quantitative real time PCR. The results obtained were correlated with clinicopathological features and survival of the patients to determine the prognostic significance. RESULTS Immunoexpression of HIF-1α and VEGF was seen in 36.6% and 46.6% ACC cases. HIF-1α expression showed significant association with advanced T-stage (P = 0.001) and VEGF with intracranial extension (P = 0.014) and solid histological pattern (P = 0.045). HIF-1α mRNA expression was seen in 29.4% cases and showed significant association with perineural invasion (P = 0.027). Recurrence occurred in 60%, distant metastasis in 20% and death in 20% cases. Survival analysis revealed that patients with HIF-1α, VEGF immunoexpression, solid histological pattern, perineural invasion, bone erosion, intracranial extension, metastasis, advanced T-stage, and exenteration had poor survival. On multivariate analysis VEGF immunoexpression (hazard ratio, 16.785; 95% confidence interval, 1.872-150.495; P = 0.012) was the most significant poor prognostic factor. CONCLUSIONS This study demonstrates that VEGF is a potential predictor for poor clinical outcome in lacrimal gland Adenoid cystic carcinoma.
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Affiliation(s)
- Shahzan Anjum
- Ocular Pathology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Ocular Pathology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Kunzang Chosdol
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Ocular Pathology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep Singh Bajaj
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Chaurasia S, Mishra DK. Clinical clues to the early diagnosis and management of ocular surface neoplasia following keratoplasty in xeroderma pigmentosa. BMJ Case Rep 2021; 14:e244322. [PMID: 34380687 PMCID: PMC8359515 DOI: 10.1136/bcr-2021-244322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
The purpose of this report is to highlight the early clinical signs and management of ocular surface neoplasia following penetrating keratoplasty in xeroderma pigmentosa. A 14-year-old girl reported increased conjunctival hyperemia, tearing, photophobia in the right eye at 6 months after penetrating keratoplasty that worsened rapidly over the subsequent 2 weeks. Slit lamp examination showed increased vascularity, epithelial haze and raised whitish lesions at the graft-host junction. Alcohol keratoepithelectomy was performed for confirming the diagnosis. Histology of the sample revealed severe dysplasia. The lesion resolved after surface plaque brachytherapy. The graft clarity was restored and maintained until the last follow-up of 15 months following brachytherapy. Exacerbated symptoms and clinical signs of increased vascularisation and epithelial lesions should arouse the suspicion of ocular surface neoplasia in grafted eyes. Early diagnosis and management can salvage the graft clarity.
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Affiliation(s)
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Vempuluru VS, Jakati S, Godbole A, Mishra DK, Mohamed A, Kaliki S. Spectrum of AS-OCT features of ocular surface tumors and correlation of clinico-tomographic features with histopathology: a study of 70 lesions. Int Ophthalmol 2021; 41:3571-3586. [PMID: 34241759 DOI: 10.1007/s10792-021-01939-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the correlation between clinical and anterior segment optical coherence tomographic (AS-OCT) details and histopathological changes in various ocular surface lesions. METHODS Prospective case series of 70 lesions in 65 patients. RESULTS AS-OCT revealed epithelial changes in OSSN (n = 19; 44%), squamous papilloma (n = 3; 60%), nevus (n = 1; 33%), epithelial hyperplasia (n = 1; 33%), granular dystrophy (n = 1; 100%) and granulation tissue (n = 1; 100%); subepithelial changes in chronic inflammation (n = 4, 100%), lymphoma (n = 3; 100%) and arteriovenous malformation (n = 1; 100%); combined epithelial and subepithelial changes in OSSN (n = 24; 56%), squamous papilloma (n = 2; 40%), PEH (n = 3; 100%), nevus (n = 2; 67%), epithelial hyperplasia (n = 2; 67%), solar elastosis (n = 1; 100%), lobular capillary hemangioma (n = 1; 100%) and sebaceous carcinoma (n = 1; 100%). Epithelial involvement on AS-OCT paralleled the histopathological findings in 98% (n = 69) and subepithelial involvement in 83% (n = 58). The correlation of clinico-tomographic diagnosis with histopathology diagnosis was seen in 77% (n = 54) lesions. Sensitivity and specificity of AS-OCT as a diagnostic tool for detection of epithelial involvement were 100% and 92% and for subepithelial involvement was 98% and 100%, respectively. CONCLUSION The correlation between AS-OCT and histopathology features determining epithelial and subepithelial involvement is excellent. It is a useful adjunctive tool for the diagnosis of ocular surface lesions.
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Affiliation(s)
- Vijitha S Vempuluru
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Anushri Godbole
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India.
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Al-Ghadeer H, Khandekar R. Bilateral Limbal Dermoid as an Isolated Finding in a Child. J Pediatr Ophthalmol Strabismus 2021; 58:e27-e29. [PMID: 34288763 DOI: 10.3928/01913913-20210506-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors report a case of a bilateral limbal dermoid in a 4-year-old girl with no extraocular anomalies or systemic associations. The child's best corrected visual acuity was 20/50 in the right eye and 20/40 in the left eye. There was a small limbal dermoid located on the inferotemporal side in the right eye and a large elevated limbal lesion that extended over the visual axis in the left eye. Limbal dermoid excision and lamellar keratoplasty were performed in the left eye and followed by a simple excision of the limbal dermoid in the right eye. Histopathological examination confirmed the clinical diagnosis of a dermoid. At the 2-year follow-up visit, the child's best corrected visual acuity had improved to 20/30 in both eyes. Tumors of the corneal limbus are extremely rare. Simple excision is a viable method of treatment for smaller, superficial lesions, although larger lesions can obstruct the visual axis and produce irregular astigmatism and amblyopia. In this patient, surgical intervention resulted in a reasonable cosmetic and final visual outcome. [J Pediatr Ophthalmol Strabismus. 2021;58(4):e27-e29.].
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Kakkassery V, Grajewski RS, Heindl LM. [Diagnostics and grading of intraocular lymphoma]. Ophthalmologe 2021; 118:494-495. [PMID: 32945914 DOI: 10.1007/s00347-020-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Rafael S Grajewski
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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Abstract
Several neoplastic processes can involve the eye, either primarily or secondary to a systemic malignancy. The most common primary tumors of the eye include conjunctival and uveal melanoma, retinoblastoma, conjunctival and intraocular lymphoma, and ocular surface squamous neoplasia. Metastatic spread from systemic malignancies, especially of the breast and lung, also can involve the eye. A combination of ophthalmologic examination, ancillary testing, and cytologic/histopathologic evaluation leads to accurate diagnosis. Management consists of surgery, radiotherapy, chemotherapy, and immunotherapy delivered in various forms.
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Affiliation(s)
- Basil K Williams
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Suite 5415, Cincinnati, OH 45267-0567, USA.
| | - Maura Di Nicola
- Medicine, 231 Albert Sabin Way, Suite 5412, Cincinnati, OH 45267-0567, USA. https://twitter.com/mauradinicola
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Abstract
PURPOSE To describe the risk factors, clinical presentation, management, and outcomes of patients with bilateral ocular surface squamous neoplasia (OSSN). METHODS Retrospective case series. RESULTS Of the 25 patients with bilateral OSSN, the mean age at diagnosis of OSSN was 31 years (median, 24 years; range, 2-60 years). Risk factors for bilateral OSSN included xeroderma pigmentosum (n = 15, 60%), human immunodeficiency virus infection (n = 3, 12%), conjunctival xerosis (n = 1, 4%), and topical steroid use (n = 1, 4%). There were no identifiable ocular or systemic risk factors in 7 (28%) patients. Presentation was synchronous in 14 (56%) and metachronous in 11 (44%) patients. Tumor morphology was bilaterally similar in 12 (48%) patients. Histopathological examination (n = 36) revealed conjunctival intraepithelial neoplasia (CIN) grade 1 in 4 (8%); grade 2 in 7 (14%); carcinoma in situ in 5 (10%), and invasive carcinoma in 20 (40%). Primary management of OSSN (n = 49) included excisional biopsy (n = 31, 62%), topical immunotherapy (IFN α2B) (n = 11; 22%), topical Mitomycin C (MMC) (n = 3, 6%), enucleation (n = 1, 2%), orbital exenteration (n = 2, 4%), and plaque brachytherapy (PBT) (n = 1, 2%). One patient was lost to follow-up after detection of tumor in the second eye. Recurrent tumors were noted in 16 (32%) eyes and binocular globe salvage was achieved in 16 (64%) patients at a mean follow up of 41 months (median 30 months; range, 1-164 months). CONCLUSION OSSN occurrence can be synchronous or metachronous. Meticulous examination of the fellow eye is important for an early diagnosis of OSSN.
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Affiliation(s)
- Vijitha S Vempuluru
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Monalisha Pattnaik
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Neha Ghose
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
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Nguyen QL, Reynolds SB, Piri N, Rivas Perez HL. Ophthalmic anterior segment metastasis masquerading as uveitis. BMJ Case Rep 2021; 14:e236405. [PMID: 33653830 PMCID: PMC7929850 DOI: 10.1136/bcr-2020-236405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/03/2022] Open
Abstract
Ocular malignancies are rare, with many cancers of the eye being the result of metastases, the most common of which result from primary tumours of breast, lung and gastrointestinal tract. Diagnosis is often made at a late stage in the disease course, leading to poorer outcomes. Disease-directed therapy in the presence of ocular metastases varies based on the primary tumour and patient performance status but generally involves systemic treatment, either with chemotherapy or involved-field radiation. We herein present an interesting case of ocular malignancy with neuroendocrine small cell features of pulmonary origin in a patient with no prior oncological history. Meticulous ophthalmic examination led to the diagnosis of small cell lung carcinoma with anterior segment metastasis. The patient underwent six cycles of systemic chemotherapy with a favourable response, resulting in improvement in vision and regression of the ocular lesion.
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Affiliation(s)
- Quang Le Nguyen
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Samuel Benjamin Reynolds
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Niloofar Piri
- Ophthalmology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Hiram L Rivas Perez
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
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