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Lavacchi D, Nobili S, Brugia M, Paderi A, Fancelli S, Caliman E, Vergoni F, Mini E. A case report of eyelid Merkel cell carcinoma occurring under treatment with nivolumab for a lung adenocarcinoma. BMC Cancer 2018; 18:1024. [PMID: 30348121 PMCID: PMC6198491 DOI: 10.1186/s12885-018-4919-z] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin characterized by high aggressiveness. Four main factors are implicated in its development: immunosuppression, ultraviolet radiation, age and the Merkel cell polyomavirus (MCPyV). In recent years, immune checkpoint inhibitors have shown clinical activity in MCC treatment. CASE PRESENTATION We report the case of an 82-year-old man with a lung adenocarcinoma diagnosis, who underwent immunotherapy with nivolumab as second-line treatment. Seven months after the diagnosis of lung cancer during the nivolumab treatment, the patient developed an eyelid MCC, initially misdiagnosed as a chalazion. A palliative radiotherapy was performed with clinical benefit. After a total of seven cycles of nivolumab, computed tomography showed a lung and cerebral disease progression. In addition, clinical conditions worsened leading to the patient's death 13 months after the initial lung cancer diagnosis. CONCLUSIONS Cases of co-occurrence of MCC and non-small cell lung cancer (NSCLC) have rarely been reported. Interestingly, common risk factors may be postulated for both cancers. Considering the rarity of this adverse event, its short-term temporal relation with the administration of the drug, which makes a relation improbable, and the coexistence of other risk factors, which may provide plausible explanations, it is possible to conclude according to the WHO Adverse Reaction Terminology that a causal relation between the occurrence of this serious adverse event and the exposure to the drug is unlikely. However, the case deserves to be reported in the literature.
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Affiliation(s)
- Daniele Lavacchi
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Stefania Nobili
- Department of Health Sciences, University of Florence, viale Pieraccini, 6, 50139 Florence, Italy
| | - Marco Brugia
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Agnese Paderi
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Sara Fancelli
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Enrico Caliman
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Federica Vergoni
- Pathological Anatomy Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence, viale Pieraccini, 6, 50139 Florence, Italy
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Teixeira AI, Neno M, Badura R, Borges-Costa J, Filipe PL. Kaposi Sarcoma of the eyelid as an initial manifestation of AIDS. Dermatol Online J 2016; 22:13030/qt2jw6t7cs. [PMID: 27617725] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023] Open
Abstract
Kaposi sarcoma (KS) is a multifocal systemic disease that originates in the vascular endothelium related to Human Herpes Virus 8 (HHV-8). In the early 1980s the first series of cases of disseminated Kaposi Sarcoma in HIV infected patients were reported. However, with the advent of highly active antiretroviral therapy (HAART) since 1997, these cases are less frequently observed by clinicians. We report the case of a 40-year-old woman, presenting with two asymptomatic purpuric nodules localized in the superior and inferior left eyelids, occluding the palpebral fissure, which were present for 4 months prior to presentation. The eyelid nodules were determined to represent KS, but there were no additional cutaneous lesions. Pulmonary and gastric KS involvement was documented. Antiretroviral therapy was initiated along with pegylated liposomal doxorubicin. The nodules gradually disappeared and her immune status eventually improved. Ocular and periorbital involvement of KS associated with HIV-1 infection as the initial clinical manifestations is a rare advent. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the extension of cutaneous lesions.
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Affiliation(s)
- Ana Isabel Teixeira
- Department of Dermatovenereology of Centro Hospitalar de Lisboa Norte, Lisboa, Portugal.
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Sánchez Cañal B, Monts Cambero NE, Carrión Campo R, Saldaña Garrido JD. Eyelid reconstruction in a child with xeroderma pigmentosum. ACTA ACUST UNITED AC 2016; 91:439-41. [PMID: 27036528 DOI: 10.1016/j.oftal.2016.02.021] [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: 08/10/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/19/2022]
Abstract
CLINICAL CASE Seven-year-old male patient, affected by xeroderma pigmentosum (XP) who was referred to ophthalmology due to the presence of numerous tumours in his left eye that affected the eyelids and conjunctiva. He had a tumour in his lower eyelid that affected the free edge, creating a secondary ectropion, and several lesions with a melanocytic appearance in conjunctiva. A resection of the eyelid tumour and the conjunctival lesions were performed by placing a skin graft and amniotic membrane, respectively, as covering. DISCUSSION XP patients have high probability of developing eye tumours. A thorough ophthalmic examination is necessary to establish an early diagnosis.
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Affiliation(s)
- B Sánchez Cañal
- Unidad de Oculoplastia, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| | - N E Monts Cambero
- Unidad de Oculoplastia, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España.
| | - R Carrión Campo
- Unidad de Oculoplastia, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| | - J D Saldaña Garrido
- Unidad de Oculoplastia, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
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Bellazreg F, Knani L, Ben Abdelkarim S, Hattab Z, Hachfi W, Ben Hadj Hamida F, Letaief A. [HIV-associated conjunctivo-palpebral Kaposi's sarcoma: A case report]. J Fr Ophtalmol 2016; 39:e93-5. [PMID: 26947324 DOI: 10.1016/j.jfo.2014.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/28/2014] [Indexed: 11/18/2022]
Affiliation(s)
- F Bellazreg
- Service de maladies infectieuses, CHU Farhat Hached, 4000 Sousse, Tunisie.
| | - L Knani
- Service d'ophtalmologie, CHU Farhat Hached, 4000 Sousse, Tunisie
| | - S Ben Abdelkarim
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached, 4000 Sousse, Tunisie
| | - Z Hattab
- Service de maladies infectieuses, CHU Farhat Hached, 4000 Sousse, Tunisie
| | - W Hachfi
- Service de maladies infectieuses, CHU Farhat Hached, 4000 Sousse, Tunisie
| | | | - A Letaief
- Service de maladies infectieuses, CHU Farhat Hached, 4000 Sousse, Tunisie
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Abstract
BACKGROUND Collateral damage to upper eyelid margin during proton beam radiotherapy (PBR) for choroidal melanoma may cause squamous metaplasia of the tarsal conjunctiva with keratinisation, corneal irritation, discomfort and, rarely, corneal perforation. We evaluated transpalpebral PBR as a means of avoiding collateral damage to the upper eyelid margin without increasing the risk of failure of local tumour control. METHODS Retrospective study of consecutive patients who underwent PBR for choroidal melanoma between 1992 and 2007 at the Royal Liverpool University Hospital and the Douglas Cyclotron at Clatterbridge Cancer Centre, UK. RESULTS Sixty-three patients were included in this study. Mean basal tumour diameter and tumour thickness were 11.8 mm and 3.6 mm, respectively. PBR mean beam range and modulation were 26.5 mm and 16.9 mm respectively. The eyelid margin was included in the radiation field in 15 (24%) eyes. The median follow-up was 2.5 years. Local tumour recurrence developed in 2 (3.2%) patients. In these two cases that developed tumour recurrence the transpalpebral treatment did not involve the eyelid margin. Six (9.5%) patients died of metastatic disease. No eyelid or ocular surface problems developed in any of the 48 patients who were treated without eyelid rim involvement, while 7 of the 15 patients with unavoidable irradiation of the eyelid rim developed some degree of madarosis. These seven patients all received more than 26.55 proton Gy to the eyelid margin. Symptoms, such as grittiness occurred in 12% of 48 patients without eyelid margin irradiation as compared with 53% of 15 patients whose lid margin was irradiated. CONCLUSIONS Transpalpebral PBR of choroidal melanoma avoids eyelid and ocular surface complications without increasing failure of local tumour control.
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Affiliation(s)
- Lazaros Konstantinidis
- Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Dawn Roberts
- Liverpool Ocular Oncology Research Group, Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | | | - Heinrich Heimann
- Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Bertil Damato
- Ocular Oncology Service, Departments of Ophthalmology and Radiation Oncology, University of California, San Francisco, USA
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Abstract
The objective of this study is to review the association between ultraviolet (UV) light and ocular diseases. The data are sourced from the literature search of Medline up to Nov 2012, and the extracted data from original articles, review papers, and book chapters were reviewed. There is a strong evidence that ultraviolet radiation (UVR) exposure is associated with the formation of eyelid malignancies [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)], photokeratitis, climatic droplet keratopathy (CDK), pterygium, and cortical cataract. However, the evidence of the association between UV exposure and development of pinguecula, nuclear and posterior subcapsular cataract, ocular surface squamous neoplasia (OSSN), and ocular melanoma remained limited. There is insufficient evidence to determine whether age-related macular degeneration (AMD) is related to UV exposure. It is now suggested that AMD is probably related to visible radiation especially blue light, rather than UV exposure. From the results, it was concluded that eyelid malignancies (BCC and SCC), photokeratitis, CDK, pterygium, and cortical cataract are strongly associated with UVR exposure. Evidence of the association between UV exposure and development of pinguecula, nuclear and posterior subcapsular cataract, OSSN, and ocular melanoma remained limited. There is insufficient evidence to determine whether AMD is related to UV exposure. Simple behaviural changes, appropriate clothing, wearing hats, and UV blocking spectacles, sunglasses or contact lens are effective measures for UV protection.
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Affiliation(s)
- Jason C S Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 4/F, Hong Kong Eye Hospital, 147 K Argyle Street, Kowloon, Hong Kong, People's Republic of China,
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Bogdănici C, Tone S, Bogdănici T. [Ocular changes in ophthalmo-heliosis]. Oftalmologia 2013; 57:9-18. [PMID: 24701809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ophthalmoheliosis are a class of diseases in which acute or chronic exposure to UV radiation is crucial. Pathology is different, depending on the duration, wave-lenghth, size and intensity of exposure. The aim of this paper is to highlight the mechanisms by which UVR absorption occurs in the eye and patho-physiological changes with many types of pathology. There are also presented categories risk factors and preventive measures of the disease.
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Hu D, McCormick SA. Progress in the studies of etiology, epidemiology and pathogenesis of ocular melanomas. Eye Sci 2011; 26:18-22. [PMID: 21425491 DOI: 10.3969/j.issn.1000-4432.2011.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 02/16/2011] [Indexed: 11/18/2022]
Abstract
Our population-based epidemiological studies demonstrated that the epidemiological aspects of ocular melanomas are different from those in cutaneous melanoma. The incidences of conjunctival melanoma increased in the past decades and was higher in the South (greater sun exposure), which is consistent with the occurrence of cutaneous melanoma. On the contrary, incidences of uveal melanoma are in the opposite direction of cutaneous melanomas. This indicates that solar radiation does not cause an increase of incidences of melanoma in ocular tissues (uveal melanoma) that are not exposed to solar radiation. Solar radiation increases the incidence of melanoma only in tissues exposed to said radiation, such as in conjunctival and eyelid melanomas. Uveal melanoma incidences in light-pigmented individuals are much greater than in dark-pigmented individuals. This result cannot be attributed to a melanin photo-screening effect, and is possibly related to melanin's biophysical and biochemical effects. The difference in incidences between light- and dark-pigmented individuals in conjunctival melanomas, as well as in vulvar and vaginal melanomas, are much lower than that in the uveal and cutaneous melanomas. This difference may be related to the different histological structures in these melanomas; conjunctival and vaginal melanomas occur in the mucous membrane, whereas cutaneous melanomas occur in the skin. Recent molecular biological studies indicate that each type of melanoma has its own molecular changes which are different from the others. Therefore, independent studies are required for each type of melanoma to discover their own etiology and pathogenesis, and to develop relevant novel prevention and treatment procedures.
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Affiliation(s)
- Danning Hu
- Department of Pathology and Ophthalmology, New York Medical College, New York, NY, USA.
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Yeung JCC, Chung CF, Lai JSM. Orbital myiasis complicating squamous cell carcinoma of eyelid. Hong Kong Med J 2010; 16:63-65. [PMID: 20124577] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Myiasis is infestation of the body by fly maggots. Immobile patients with skin wounds in exposed areas are at high risk of developing myiasis. We report a case of orbital myiasis from the species Chrysomya bezziana complicating squamous cell carcinoma of the eyelid. Magnetic resonance imaging of the orbit is useful for delineating the extent of the infestation and identifying residual maggots. In extensive orbital myiasis, exenteration is needed to prevent intracranial extension of tissue destruction.
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Affiliation(s)
- J C C Yeung
- Department of Ophthalmology, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Kapoor S. Cutaneous and systemic malignancies in patients with sarcoidosis: a close association. Ann Acad Med Singap 2009; 38:179. [PMID: 19271055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Kau HC, Yang CF, Liu IT, Kao SC, Hsu WM, Teng MMH, Tsai CC. Benign fibrous histiocytoma associated with a frontoethmoidal mucopyocele and orbital abscess. Ophthalmic Plast Reconstr Surg 2007; 23:236-8. [PMID: 17519668 DOI: 10.1097/iop.0b013e31803ecf24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/25/2022]
Abstract
A 74-year-old man sought treatment for painful swelling in the right upper eyelid. CT demonstrated a frontoethmoidal mucocele extending in the right orbit with abscess formation. Following functional endoscopic sinus surgery, the inflammatory symptoms in the right eye nearly resolved. However, a firm mass was still noted in the same location. Histopathologic examination proved it to be a benign fibrous histiocytoma. Benign fibrous histiocytoma may occur in association with an orbital abscess secondary to mucocele.
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Affiliation(s)
- Hui-Chuan Kau
- Department of Ophthalmology, Taoyuan Veterans Hospital, Taiwan
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Schrack KE, Youssef OH. Laterality of Periocular Basal Cell Carcinomas in Relation to Driving Practices in Philadelphia, PA, U.S.A. Ophthalmic Plast Reconstr Surg 2007; 23:252. [PMID: 17519678 DOI: 10.1097/iop.0b013e31804ca128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A 12-year-old girl with neurofibromatosis type 1 underwent subtotal anterior exenteration of a blind, unsightly, buphthalmic eye and orbital/eyelid plexiform neurofibroma. Simultaneously, a channeled Medpor orbital implant was positioned to reduce a meningoencephalocele resulting from severe sphenoid wing dysgenesis. Two-stage osseointegration was subsequently performed to permit secure fitting of an orbital prosthesis. This patient's cosmesis and social interaction were improved markedly with this surgical approach for disfiguring ocular, eyelid, and orbital disease due to neurofibromatosis type 1.
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Affiliation(s)
- Karen E Madill
- Manchester Royal Eye Hospital, Manchester, United Kingdom
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Jones CA, Adams M. Re: “Laterality of Periocular Basal Cell Carcinomas in Relation to Driving Practices in Philadelphia, PA, U.S.A.”. Ophthalmic Plast Reconstr Surg 2007; 23:252-3. [PMID: 17519677 DOI: 10.1097/iop.0b013e31804ca139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Procianoy F, Cruz AAV, Baccega A, Ferraz V, Chahud F. Aggravation of Eyelid and Conjunctival Malignancies Following Photodynamic Therapy in DeSanctis-Cacchione Syndrome. Ophthalmic Plast Reconstr Surg 2006; 22:498-9. [PMID: 17117119 DOI: 10.1097/01.iop.0000246600.80517.d3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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
A 5-year-old girl with DeSanctis-Cacchione syndrome (a severe variant of xeroderma pigmentosum) was referred for evaluation of multiple eyelid and bulbar conjunctival squamous cell carcinomas. Examination evidenced multiple vegetating lesions on the eyelid, bulbar conjunctiva, and cornea of both eyes. As the lesions were considered not to be manageable by surgical excision and would have required exenteration, photodynamic therapy was performed on the patient's left eye. Three months after photodynamic therapy, the patient presented with a dramatic increase in the extension of the tumors. Since xeroderma pigmentosum is a DNA repair disorder, the radiation involved in photodynamic therapy probably played an iatrogenic role in the evolution of the case. We believe that photodynamic therapy may be harmful to patients with DNA repair disorders.
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Affiliation(s)
- Fernando Procianoy
- Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, the School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Pascual-Castroviejo I, Pascual-Pascual SI, Burgueno M, Martin-Perez M, Palencia R, Garcia-Segura JM, Valero C. [Unilateral facial and cerebral hyperplasia associated with neurofibromatosis type 1. Report of four patients]. Rev Neurol 2006; 43:346-52. [PMID: 16981165] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Plexiform neurofibroma in any location is one of the commonest complications associated with neurofibromatosis type 1 (NF1). Plexiform neurofibroma of the upper eyelid and orbit is usually associated with ipsilateral hemifacial hyperplasia. We present four patients with NF1 and plexiform neurofibroma of the eyelid and orbit associated with hemifacial hyperplasia, who also showed hyperplasia of the unilateral cerebral hemisphere. CASE REPORTS There are four patients, three females and one male, who consulted because of NF1 with plexiform neurofibroma of upper eyelid and hemifacial hyperplasia. Upper eyelid involvement was observed since birth and progressed during the first years of life. The patients showed normal neurological and mental development without motor or cerebellar disorders. Magnetic resonance studies demonstrated the asymmetric hyperplasia of the ipsilateral hemisphere in all four cases and of the cerebellar hemisphere in one case. The degree of hemispheric hyperplasia was related to the size and extension of the plexiform neurofibroma, as well as to the severity of the hemifacial hyperplasia. In our case which had the plexiform neurofibroma extended to the neck and the upper thorax, the hyperplasia not only affected the cerebral hemisphere but also the ipsilateral cerebellar hemisphere. All parts of the hemisphere showed increased size. The cortex of the entire hemisphere showed normal differentiation of the subcortical white matter. CONCLUSION NF1 appears to be related with facial and cerebral ipsilateral hemihyperplasia. The relation between the size and extension of the orbital, eyelid and facial plexiform neurofibroma and the degree of asymmetry of the hemispheric hyperplasia suggest that different influences of a still unknown agent, possibly a gene, obviously related to NF1, causes both the intracranial and extracranial abnormalities.
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Espana.
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Abstract
AIM The prevalence of thyroid orbitopathy, compared with an estimate for the United Kingdom population, is examined in a large cohort of patients treated for periocular lymphoma. PATIENTS AND METHODS Clinical details were reviewed for patients presenting to the Orbital Clinic at Moorfields Eye Hospital with biopsy-proven periocular lymphoma. Recorded evidence of prior thyroid gland abnormality or thyroid eye disease was sought and treatment details recorded, together with that of the subsequent periocular lymphoma. The calculated prevalence of thyroid orbitopathy in our patients with periocular lymphoma was compared with an estimate based upon published figures for a United Kingdom population. RESULTS Of 369 patients with periocular lymphoma, 20 (5%) had a history of thyroid disease and adequate notes were available in 10 cases: All had autoimmune thyrotoxicosis between 11 and 27 years (median 17.5) before diagnosis of periocular lymphoma and 6/10 had thyroid orbitopathy-none receiving orbital radiotherapy for treatment of their thyroid eye disease. Using a calculated estimate for the UK prevalence of thyroid orbitopathy, the probability of even these six cases of ophthalmopathy among 369 patients with periocular lymphoma is very low (P=0.007). CONCLUSION Compared with a population estimate, patients with periocular lymphoma had a significantly greater prevalence of preceding thyroid orbitopathy, with a median latency of 17 years. Thyroid orbitopathy possibly predisposes to later local lymphoma in a manner similar to the late emergence of lymphoma with other chronic inflammatory diseases-such as Sjögren's syndrome, Hashimoto's thyroiditis, coeliac disease, or Helicobactergastritis.
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Abstract
The objective of this retrospective study was to describe signalment, clinical presentation, surgical treatment, outcome, histopathologic, and immunohistochemical characteristics of periocular peripheral nerve sheath tumor in a series of cats. Six cats with a histologic diagnosis of peripheral nerve sheath tumor of the eyelid and/or conjunctiva were identified from 3997 feline ocular histopathologic submissions to the Comparative Ocular Pathology Laboratory of Wisconsin between 1976 and 2002. Medical records were reviewed and data were collected for signalment, eye affected, location, duration, and history of tumor recurrence. Ancillary diagnostic tests, surgical approach, and histopathology were also described. Special stains and immunohistochemistry panels were performed on the tissue. Follow-up information was obtained through telecommunications with the owner and local veterinarian. The mean age of the cats was 8 years (range: 5-15 years). There was an equal distribution of males and females. Breeds represented were two Domestic Long-haired (DLH) cats, three Domestic Short-haired (DSH) cats, and one Manx. The right eye was affected in four cats and the left eye in two cats. The superior eyelid was affected in four cats, the superior conjunctiva in two cats, and the inferior eyelid in one cat. All of the cats that underwent surgical excision, cryoablation, or laser ablation had an average of three recurrences of the tumor. Four of six cats undergoing wide excision with enucleation, exenteration or rhomboid flap had no recurrence of the tumor. Histomorphologically, all of the tumors were of spindle cell type with five of six tumors showing histologic features of Antoni type B tissue. All six tumors stained positive for vimentin. Five of six tumors stained positive for S-100 and laminin. All six tumors were negative for smooth muscle actin. Definitive histologic diagnoses of spindle cell tumors can be difficult. The presence of Antoni A and B histologic patterns as well as immunohistochemical reactivity for vimentin, S-100, and laminin suggest a diagnosis of peripheral nerve sheath tumor. Our findings suggest that local aggressive recurrence is common and that wide surgical excision combined with enucleation or exenteration may be indicated.
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Mencía-Gutiérrez E, Gutiérrez-Díaz E, Redondo-Marcos I, Ricoy JR, García-Torre JP. Cutaneous horns of the eyelid: a clinicopathological study of 48 cases. J Cutan Pathol 2005; 31:539-43. [PMID: 15268708 DOI: 10.1111/j.0303-6987.2004.00226.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [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: 11/29/2022]
Abstract
BACKGROUND Cutaneous horn (cornu cutaneum) is a morphological designation for a protuberant mass of keratin that resembles the horn of an animal. It results from unusual cohesiveness of keratinized material from the superficial layers of the skin or implanted deeply in the cutis. This lesion may be associated with a benign, premalignant, or malignant lesion at the base, masking numerous conditions. METHODS A retrospective analysis of 48 cases of cutaneous horns of the eyelid treated between 1992 and 2002 has been performed. RESULTS Twenty-four men and 19 women, with a mean age of 62 years (range 16-90), were treated by surgery. Histologically, 77.1% were associated with benign specimens at the base pathology, 14.6% were premalignant, and finally, 8.3% were caused by malignant skin tumors. The most common lesion was seborrheic keratosis among the benign lesions, actinic keratosis among the premalignant ones, and basal cell carcinoma and squamous cell carcinoma among the malignant ones. CONCLUSION Cutaneous horns usually appear on exposed skin areas in elderly men. The important issue in this condition is not the horn itself, which is just dead keratin, but rather the nature of the underlying disease, although the horns are usually benign.
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Affiliation(s)
- Enrique Mencía-Gutiérrez
- Department of Ophthalmology, 12 de Octubre Hospital, Complutense University, Cedro 23, E28250 Torrelodones, Madrid, Spain.
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Abstract
Basal cell carcinoma is the most common eyelid malignancy, accounting for approximately 90% of malignant eyelid tumours. Despite its prevalence in adults, it is extremely rare in children, and usually occurs in the setting of a known genetic defect or following radiotherapy treatment. We report three cases of de novo basal cell carcinoma in children. These children had no known genetic syndromes and had not undergone radiotherapy.
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Affiliation(s)
- A Al-Buloushi
- Department of Ophthalmology, McGill University Health Center, Montreal General Hospital, 3775 University St, Room 216, Montreal, Canada
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Szabo B, Szabo I, Mera M, Fripcea AM. [Keratotic basal cell carcinoma with orbital extension--case report]. Oftalmologia 2005; 49:43-9. [PMID: 16245743] [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: 05/05/2023]
Abstract
This is a description of a case of a 72-year-old female who developed a basal cell carcinoma of the external angle of the eyelid, with intraorbital extension. This type of cancer of the eyelid developed on keratotic skin lesions of the face; the invasion of the orbit occurred only for two years. The tumour of the eyelid and orbit was completely removed with good postoperative course and a good outcome without recurrence in the past 3 years.
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Abstract
BACKGROUND Sebaceous carcinoma of the eyelid is a rare tumor. Treatment can be complicated by noncontiguous spread of the tumor. OBJECTIVE Review a series of patients with sebaceous carcinoma to illustrate clinical presentations, treatments, and outcomes. METHODS We retrospectively reviewed medical records of patients with sebaceous carcinoma treated at Mayo Clinic (Rochester, MN). RESULTS Fourteen patients had sufficient follow-up data available for review. Mean follow-up was 57 months (range 18-134 months). Treatment included wide local excision with frozen and permanent section control (9 patients, 64%), Mohs micrographic surgery (2 patients, 14%), external beam radiation (2 patients, 14%), and exenteration and total parotidectomy with cervical lymph node dissection (1 patient, 7%). Two patients (14%) had local recurrence of the tumor after wide local excision, and 1 patient (7%) had tumor recurrence after Mohs micrographic surgery. CONCLUSION Treatment should be chosen on the basis of the extent of the tumor and the specific needs of the patient. The mainstay of treatment of tumors without orbital involvement has been wide local excision, with the margins checked in both permanent and frozen sections, in combination with conjunctival map biopsies when warranted. Mohs micrographic surgery is an alternative that may provide tissue conservation and lower recurrence rates. Recurrence rates between treatments are difficult to assess because of the small number of cases reported in the literature. In cases with orbital involvement, exenteration may be warranted. Radiation may be useful when surgery cannot be tolerated.
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Abstract
BACKGROUND Although UV radiation is the major cause of basal cell carcinoma (BCC), local factors, such as chronic trauma, irritation, or inflammation, may also have some role in its etiopathogenesis. The pilosebaceous follicle mites, Demodex folliculorum and D. brevis, inhabit most commonly and densely certain facial skin areas, including the nose and periorbital regions, where BCC also develops most frequently. AIM To investigate, in a retrospective histopathologic study, whether a possible etiopathogenetic relationship exists between demodicidosis and eyelid BCCs. METHODS We examined 32 eyelid BCC specimens that contained at least five eyelashes or five hair follicles with respect to the presence and density of Demodex mites. As controls, we evaluated 34 matched specimens consisting of benign eyelid skin lesions. RESULTS Twenty-one of 32 BCC cases (65.6%) and eight of 34 control cases (23.33%) had demodicidosis. Mean mite counts were 1.31 +/- 1.57 and 0.47 +/- 0.99 in BCC cases and controls, respectively. The differences were significant for both prevalence (P < 0.001) and density (P = 0.0052). Although there was a significant positive correlation between increasing mite number and patient age in the control group (r = 0.47, P < 0.05), no significant correlation was found between these two factors in BCC cases (r = -0.102, P > 0.05). CONCLUSIONS Demodicidosis may be one of the triggering factors of carcinogenesis in eyelid BCCs in otherwise predisposed people due to its traumatic/irritating effect or chronic inflammation.
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Affiliation(s)
- Zülal Erbagci
- Department of Dermatology, Gaziantep University Medical Faculty Gaziantep, Turkey.
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27
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Abstract
OBJECTIVE To analyze the association between retinoblastoma (Rb) and sebaceous carcinoma (SC) of the eyelid to improve surveillance of survivors of RB: DESIGN Case report and systematic literature review. METHODS Ten patients who had SC develop after Rb were identified by systematic literature review, and a child who died with lymph node, lung, and liver metastases 7 years after irradiation for Rb is described. The data were analyzed by univariate statistics, including cumulative frequency distribution plots and Kaplan-Meier analysis. RESULTS Of 11 children with SC of the eyelid who all had hereditary RB, 9 (82%; 95% confidence interval, 48-98) received a median of 46 Gy (range, 21-89) of radiotherapy at a median age of 16 months (range, 0.5-15 years) and had SC develop within the field of radiation. Their median age at diagnosis of SC was 14 years (range, 8-30 years), median diagnostic delay 12 months (range, 6 months-3 years), and median interval from irradiation 11 years (range, 5-26 years); 7 of them (78%; 95% confidence interval, 40-97) were diagnosed between 5 and 15 years after radiotherapy. SC also developed at the age of 32 and 54 years in two nonirradiated Rb patients. Five patients had regional lymph node metastases after a median time of 12 months (range, 1 month-24 years). The 5-year cumulative probability of survival was 87%. CONCLUSIONS SC of the eyelid may occur in patients with hereditary Rb regardless of primary treatment, especially within the field 5 to 15 years after radiotherapy.
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Affiliation(s)
- T Kivelä
- Oncology Service and Ophthalmic Pathology Laboratory, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
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28
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Abstract
Sjögren's syndrome (SS) is an autoimmune disease characterized by a lymphocytic infiltration of the salivary and lacrimal glands leading to a progressive destruction of these glands due to the production of autoantibodies. This disorder is either isolated (primary SS) or associated with other systemic diseases (secondary SS). The occurrence of B-cell non-Hodgkin's lymphoma (NHL) represents the major complication in the evolution of SS patients. The risk of developing NHL, which is equivalent for both primary and secondary SS, was estimated to be 44 times greater than that observed in a comparable normal population. NHLs in SS patients occur preferentially in the salivary glands and in other mucosa-associated lymphoid tissues (MALT). However, it can also occur in the lymph nodes or bone marrow. We documented a case of low-grade B-cell lymphoma of MALT in the right eyelid and primary biliary cirrhosis (PBC) of a patient with SS. To the best of our knowledge, this is the first case reported in Korea.
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Affiliation(s)
- J S Hahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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29
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Rundle P, Shields JA, Shields CL, Eagle RC, Singh AD. Sebaceous gland carcinoma of the eyelid seventeen years after irradiation for bilateral retinoblastoma. Eye (Lond) 2001; 13 ( Pt 1):109-10. [PMID: 10396394 DOI: 10.1038/eye.1999.20] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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30
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Wenzel CT, Halperin EC, Fisher SR. Second malignant neoplasms of the head and neck in survivors of retinoblastoma. Ear Nose Throat J 2001; 80:106, 109-12. [PMID: 11233341] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Retinoblastoma is a malignant tumor of the embryonic retina. Although it is rare, it is the most common primary eye tumor of childhood. Life expectancy following treatment is now excellent, but survivors who have heritable retinoblastoma face an increased risk of a second malignant head or neck neoplasm. A second neoplasm, which often occurs in the irradiated field of the original tumor, has become the most significant threat to the survival of these patients. We report the case of a young girl who was cured of her retinoblastoma only to later develop a second nonocular tumor that metastasized to the superficial parotid gland. She underwent a superficial parotidectomy and neck dissection, but the malignancy eventually recurred and required further surgery and radiation therapy. In this article, we discuss the etiology, incidence, sites of occurrence, and management options for a second malignant neoplasm in retinoblastoma survivors. The head and neck surgeon must be vigilant in the diagnosis and management of second neoplasms in this patient population because they often occur in irradiated fields; surgical management is important to patient survival.
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Affiliation(s)
- C T Wenzel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, N.C., USA
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31
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Abstract
BACKGROUND The study evaluates the incidence of ocular compromise in the Kaposi's sarcoma associated with AIDS. METHODS We revised the clinical histories of HIV seropositives patients seen in the ophthalmology department from January, 1994 to December, 1998. All patients were examined by direct visually and dilated fundus examination with the use of either a direct or an indirect ophthalmoscope. RESULTS In 6,552 patients, ocular Kaposi's sarcoma was diagnosed in 17 (0.25%), predominantly in male sex (88.23%). The lesions predominated in eyelids, and the inferior has been the most affected. In only one female, the ocular compromise was the first neoplastic manifestation. CONCLUSIONS The ocular compromise in the Kaposi's sarcoma is an alternative to be considered in AIDS patients with previous or simultaneous cutaneous or visceral involvement. Due to the few clinical signs of these lesions, a thorough ocular study is recommended in these patients.
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Affiliation(s)
- M Corti
- Unidades 10-11 y Servicio de Oftalmología, Hospital de Infecciosas, F. J. Muñiz Buenos Aires, Argentina.
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32
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Abstract
PURPOSE To study the clinicopathologic characteristics and treatment of eyelid carcinomas developing in thermal burn scars. METHODS A review of eight cases of eyelid burn scar malignancies: two from our own experience and six from published reports. RESULTS Reported cases of burn scar malignancy of the eyelid are short-latency basal cell carcinomas. All carcinomas arose from small superficial burns. These potentially aggressive tumors respond well to local excision. CONCLUSION As with other areas of the body, eyelid burn scars may undergo neoplastic degeneration. These carcinomas are predominately short latency basal cell carcinomas, rather than long-latency squamous cell carcinomas that are more common elsewhere in the body, including the head and neck region. Clinicians should be diligent in the long-term surveillance of all eyelid burns.
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Affiliation(s)
- D V Pratt
- Cedar Medical Center, Tacoma, Washington, USA
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33
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Abstract
After a short description of the history of eyelid reconstruction, the causes of defects are discussed. For the primary and secondary treatment of thermic injuries, a full-skin graft is recommended and the indication of combined skin-cartilage transplants is mentioned. For deep defects, numerous methods of eyelid reconstruction are available. The differentiated indication for manifold initial situations is discussed in detail. The most important techniques are described on the basis of various examples.
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Affiliation(s)
- J Lentrodt
- Klinik für Kiefer- und Plastische Gesichtschirurgie der Universität Düsseldorf
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34
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Garber N. Ocular risks from sunlight exposure. J Ophthalmic Nurs Technol 2000; 19:13-21; quiz 22-5. [PMID: 11033664] [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: 02/18/2023]
Abstract
Relinquishing the desire to acquire a tan will be difficult for many people. To many individuals, a tan is a symbol of health, fashion and attractiveness. Even when informed about the risks of sunlight exposure, many people ignore the advice to change their behaviors and decrease their risks. Adoption of safe sunlight precautions depends on individual preference, age, work requirements, gender, and perception of personal risk. Many people selectively adhere to certain protective behaviors which do not conflict with social norms. Reinforcement of how sunlight can damage the eyes and skin needs to be continually provided so that public attitudes can adapt to all the necessary appropriate behaviors. Ophthalmic health care professionals have an important part in public education. They can customize their patient's personal protective requirements to match the type of risks uncovered in the clinical work up. The ocular and social history should include the patient's sunlight exposure risk profile and document pre-existing sunlight damage to the eyes and facial areas. All follow-up visits should reinforce sunlight exposure information and document compliance or non-compliance. Only in this way can the eye care delivery system support preventative measures to decrease ocular injuries from sunlight radiation.
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Affiliation(s)
- N Garber
- Productivity Enhancement Group, Inc., Sarasota, Florida, USA.
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35
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Abstract
PURPOSE To determine if there is an association between basal cell carcinoma of the eyelid and cigarette smoking. METHODS A cross-sectional, retrospective, case-controlled study was done comparing the prevalence of cigarette smoking in 112 patients with biopsy-proven basal cell carcinoma of the eyelid to age and sex-matched controls with other eyelid disorders. Exposure-odds ratios were computed for each group. RESULTS Patients with basal cell carcinoma of the eyelid were no more likely to be smokers than controls (odds ratio [OR] 1.78, not statistically significant at the 95% confidence interval [CI]). When divided by sex however, there was an association between cigarette smoking and basal cell carcinoma in women (OR 2.87, statistically significant at the 95% CI) but not in men (OR 1.30, not statistically significant at the 95% CI). CONCLUSION Basal cell carcinoma of the eyelid is associated with cigarette smoking in women but not in men.
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Affiliation(s)
- T H Wojno
- The Emory Clinic, Atlanta, Georgia 30322, USA
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36
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Abstract
OBJECTIVE To determine the frequency of ophthalmic abnormalities in patients with cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome) and T-cell lymphoma involving the skin and to describe the clinical course of the disease with selected examples. DESIGN Retrospective, clinic-based, cross-sectional study. PARTICIPANTS A computerized diagnostic retrieval system was used to identify all patients with T-cell lymphoma involving the skin who were examined at the Mayo Clinic (Rochester, Minnesota) between January 1, 1976 and December 31, 1990. The medical records of affected patients were reviewed. MAIN OUTCOME MEASURES Identification of ophthalmic abnormalities. RESULTS During the 15-year interval from 1976 through 1990, cutaneous T-cell lymphoma was diagnosed in 2155 patients. Of these, 42 (1.95%; 26 male and 16 female) had at least one ophthalmic abnormality attributable to the disease. The diagnoses in these 42 patients were mycosis fungoides in 19, clinical variants of T-cell lymphoma of the skin (most commonly peripheral T-cell lymphoma) in 11, and Sézary syndrome in 12. Cicatricial eyelid ectropion was the most common finding, affecting 17 (40.4%) of the 42 patients. Thirty-seven patients had findings that, although probably not a direct consequence of cutaneous T-cell lymphoma, have been cataloged in previous studies. CONCLUSION Although ophthalmic abnormalities in patients with cutaneous T-cell lymphoma are relatively uncommon, the manifestations of the disease are diverse and frequently difficult to treat.
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Affiliation(s)
- B E Cook
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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37
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Abstract
BACKGROUND Sebaceous cell carcinoma is a distinctive tumor of the eyelid associated with a high rate of metastasis and mortality. Involvement of both upper and lower lids has been described; however, involvement of all 4 eyelids is extremely rare. OBJECTIVE To describe the evaluation and diagnosis of the clinicopathologic features in a 74-year-old patient with 4-eyelid sebaceous carcinoma and a history of whole face irradiation for eczema. METHODS Bilateral eyelid, conjunctiva, map, and fine needle biopsy of enlarged, submandibular lymph node specimens were stained with hematoxylin-eosin and oil-red-O for light microscopy and fresh-frozen sections were evaluated by electron microscopy. RESULTS The biopsy specimens from the eyelids and conjunctiva showed sebaceous carcinoma cells in the meibomian glands and scattered within the conjunctival epithelium. The cells were moderately well differentiated. Similar cells stained with oil-red-O were found in the submandibular lymph nodes. CONCLUSIONS The appearance of bilateral sebaceous carcinoma supports the concept of simultaneous occurrence of multiple primaries in specific patients, especially after radiation therapy. Patients with a history of facial irradiation and atypical eyelid lesions should be evaluated for malignant tumors such as sebaceous carcinoma.
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Affiliation(s)
- S Rumelt
- Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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38
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Abstract
AIMS To compare the distribution of eyelid basal cell carcinoma (BCC) with the relative ultraviolet radiation (UVR) exposure to different sites on the eyelids. METHODS The location of BCC on the eyelids was allocated to one of seven regions. The UVR exposure was recorded with a polymer film attached to the eyelids at seven sites in a manikin and in human subjects. RESULTS Localisation of the 329 tumours was mainly on the lower eyelids (225 tumours), and the medial canthal regions (87 tumours). There was no association between UVR doses at the seven sites of the eyelids and the location of BCCs. The UVR exposure was similar on the upper and lower eyelids, while the number of tumours on the lower eyelids outnumbered the upper lids by a factor of 13 (17 upper, 225 lower) CONCLUSION UVR exposure only partially explains the aetiology of periorbital BCC.
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Affiliation(s)
- G Lindgren
- Department of Ophthalmology, Gothenborg University, Sahlgrenska University Hospital, Sweden
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39
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Wirta DL, Dailey RA, Wobig JL. Eyelid neuroma associated with swim goggle use. Arch Ophthalmol 1998; 116:1537-8. [PMID: 9823367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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40
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Affiliation(s)
- S Young
- University of Cincinnati, Department of Ophthalmology, Ohio, USA
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41
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Margo CE, Mulla ZD. Malignant tumors of the eyelid: a population-based study of non-basal cell and non-squamous cell malignant neoplasms. Arch Ophthalmol 1998; 116:195-8. [PMID: 9488271 DOI: 10.1001/archopht.116.2.195] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the relative frequencies, average annual incidences, and patient characteristics of non-basal cell and non-squamous cell malignant neoplasms of the eyelid in a defined geographic population. DESIGN AND SETTING A retrospective study using the Florida Cancer Data System to identify malignant tumors of the eyelid, except for basal cell and squamous cell carcinomas, from 1981 through 1994. Cases were limited to persons who resided within Florida. MAIN OUTCOME MEASURE Incidence of histologically confirmed malignant eyelid tumors. RESULTS Two hundred six primary malignant eyelid tumors were identified. The 3 most common, in order of frequency, were melanoma, sebaceous carcinoma, and lymphoma. The median age at diagnosis for all patients was 73 years. Only 3 of the 206 malignant neoplasms occurred in blacks. The annual incidence of eyelid melanoma and sebaceous carcinoma in whites older than 20 years was 0.6 and 0.5 per million, respectively. Kaposi sarcoma was the most common type of mesenchymal tumor. Eleven different histologic types of lymphoma were found in the eyelid. Only 2 of 27 lymphomas had T-cell lineage. CONCLUSIONS Malignant tumors of the eyelid other than basal cell and squamous cell carcinoma are uncommon and usually occur in elderly white persons. Primary eyelid tumors of any type are rare in blacks. The risk of a non-basal cell and non-squamous cell malignant neoplasm of the eyelid in Florida is 6.4 times greater for whites than for blacks (95% confidence interval [CI], 2.1-20.2). A variety of B-cell lymphomas can be manifested as primary eyelid tumors.
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Affiliation(s)
- C E Margo
- Department of Ophthalmology, College of Medicine, University of South Florida, Tampa 33612, USA
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42
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Kirova YM, Belembaogo E, Frikha H, Haddad E, Calitchi E, Levy E, Piedbois P, Le Bourgeois JP. Radiotherapy in the management of epidemic Kaposi's sarcoma: a retrospective study of 643 cases. Radiother Oncol 1998; 46:19-22. [PMID: 9488122 DOI: 10.1016/s0167-8140(97)00147-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [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: 02/06/2023]
Abstract
PURPOSE To report to the literature the largest published series of epidemic Kaposi's sarcoma (EKS), treated with radiation therapy, to summarize and discuss our 10 years experience in the treatment of this malignancy. METHODS AND MATERIALS From June 1986 to December 1996, 643 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with radiation therapy (RT) at the Cancerology Department of Henri Mondor University Hospital. The patients, 640 men and 3 women had an average age of 38.5 years (range 20-68 years). Three hundred eighty-seven patients (60.1 %) had received previous treatment for their Kaposi's sarcoma (KS). In total, 6777 fields were irradiated, as follows: face 1342 (19.8%), eyelid and conjunctiva 362 (5.3%), trunk 1903 (28.1%), upper and lower limbs 2866 (42.3%), genitals 189 (2.8%). and oral cavity 115 fields (1.7%). Radiation therapy consisted of 4 MV or 45-70 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. RESULTS Objective response (CR and PR) was observed in 92% (5947/6464) of all cases, treated for cutaneous form of EKS. All patients with irradiated oral lesions had an objective response. The overall tolerance was acceptable for the cutaneous lesions. By contrast, in oral lesions, mucosal reactions were often observed after relatively low doses of radiotherapy. CONCLUSIONS Doses of 15 Gy for oral lesions, 20 Gy for lesions involving eyelids, conjunctiva, and genitals, have been shown to be sufficient to produce shrinkage of the tumor and good palliation of the symptoms. For the cutaneous EKS, we propose 30 Gy given in a local field, using a fractionated scheme with small size applicators. Radiotherapy has its own place in the management of EKS, as an efficient treatment.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Adult
- Aged
- Conjunctival Neoplasms/epidemiology
- Conjunctival Neoplasms/etiology
- Conjunctival Neoplasms/radiotherapy
- Dose-Response Relationship, Radiation
- Eyelid Neoplasms/epidemiology
- Eyelid Neoplasms/etiology
- Eyelid Neoplasms/radiotherapy
- Female
- Follow-Up Studies
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/etiology
- Genital Neoplasms, Female/radiotherapy
- Genital Neoplasms, Male/epidemiology
- Genital Neoplasms, Male/etiology
- Genital Neoplasms, Male/radiotherapy
- Humans
- Male
- Middle Aged
- Mouth Neoplasms/epidemiology
- Mouth Neoplasms/etiology
- Mouth Neoplasms/radiotherapy
- Recurrence
- Retrospective Studies
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/radiotherapy
- Skin Neoplasms/epidemiology
- Skin Neoplasms/etiology
- Skin Neoplasms/radiotherapy
- Treatment Outcome
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Affiliation(s)
- Y M Kirova
- University Hospital Henri Mondor, Department of Cancerology, Creteil, France
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43
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Cook BE, Bartley GB, Pittelkow MR. Ophthalmic abnormalities in patients with cutaneous T-cell lymphoma. Trans Am Ophthalmol Soc 1998; 96:309-24; discussion 324-7. [PMID: 10360295 PMCID: PMC1298401] [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: 02/12/2023]
Abstract
PURPOSE To determine the frequency of ophthalmic abnormalities in patients with cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome) and T-cell lymphoma involving the skin and to describe the clinical course of the disease with selected examples. METHODS A computerized diagnostic retrieval system was used to identify all patients with T-cell lymphoma involving the skin who were examined at the Mayo Clinic (Rochester, Minnesota) between January 1, 1976 and December 31, 1990. The medical records of affected patients were reviewed. RESULTS During the 15-year interval from 1976 through 1990, cutaneous T-cell lymphoma was diagnosed in 2,155 patients. Of these 2,155 patients, 42 (1.95%; 26 male and 16 female) had at least 1 ophthalmic abnormality attributable to the disease. The diagnoses in these 42 patients were mycosis fungoides in 19, clinical variants of T-cell lymphoma of the skin (most commonly, peripheral T-cell lymphoma) in 11, and Sézary syndrome in 12. Cicatricial eyelid ectropion was the most common finding, affecting 17 (40.4%) of the 42 patients. Thirty-seven patients had findings that, although probably not a direct consequence of cutaneous T-cell lymphoma, have been cataloged in previous studies. CONCLUSION Although ophthalmic abnormalities in patients with cutaneous T-cell lymphoma are relatively uncommon, the manifestations of the disease are diverse and frequently difficult to treat.
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Affiliation(s)
- B E Cook
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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44
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Abstract
We report a woman who had a recurrent trichofolliculoma on the upper eyelid margin. Only three cases of this benign tumor on the eyelid have been reported, and no recurrence in this location had been noted in the literature. The lesion, present for 6 years, had been excised twice previously (3 and 4 years before), recurred, and had been injected with a steroid preparation 2 years earlier. Lashes, both normal-looking and immature, arose from the center area of this lesion, and telangiectatic vessels were on its surface. Full-thickness wedge resection was used to excise the lesion completely. Complete primary excision of trichofolliculoma is important, and local steroid preparations should not be used.
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Affiliation(s)
- A D Morton
- Department of Ophthalmology, University of Michigan, Ann Arbor, USA
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45
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Aggarwal R. Diagnosing and managing eyelid problems. Practitioner 1997; 241:540-3. [PMID: 9926586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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46
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Abstract
Immunodysregulation appears to play a prominent role in the evolution of some lymphomas, as evidenced by the strong associations between congenital and acquired immunodeficiencies and lymphoid neoplasia, and abnormal ratios of helper T cells in lymphoid proliferations. Lympho-proliferative diseases of the ocular adnexa encompass a spectrum of lesions that may present with similar clinical and radiological features. Most primary lymphoid proliferations of the ocular adnexa consist of small lymphocytes of B-cell origin. Employing morphological, immunohistochemical, and molecular genetic criteria, proliferations may be separated into polyclonal and monoclonal categories. Increased insight into the biology and behavior of these tumors tells us that seemingly benign, as well as frankly malignant proliferations, might disseminate to nodal or extranodal sites. The diagnosis of lymphoproliferative disease of any type necessitates a complete workup for systemic lymphoma. Major prognostic criteria for lymphomas are anatomical site, stage, and histological features. Radiotherapy is employed for localized lymphoid proliferations, with chemotherapy recommended for disseminated disease. Long-term follow-up with semiannual examination is recommended. A significant percentage of primary ocular adnexal lymphoid lesions are MALT-type lymphomas, extranodal low-grade B-cell lymphomas usually associated with mucosal tissues or glandular epithelia. The pathogenesis of this lymphoma in orbital soft tissue, which normally is devoid of lymphoid tissue, lymphatic vessels, and epithelium, is unclear. MALT-type lymphomas of the ocular adnexa follow an indolent course, with long periods between relapses, and are responsive to therapy. Dissemination, when it occurs, preferentially affects other extranodal sites.
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Affiliation(s)
- G C Cockerham
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA
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47
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Biswas J, Datta M, Subramaniam N. Mucoepidermoid carcinoma of the conjunctiva of the lower lid--report of a case. Indian J Ophthalmol 1996; 44:231-3. [PMID: 9251269] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- J Biswas
- Medical Research Foundation, Madras
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48
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Takeshita S, Sugai S, Ogawa Y, Fukutoku M, Yoshioka R, Shimizu S, Tsubota K. [A case of Sjögren's syndrome with an eyelid tumor, a so-termed pseudolymphoma of the iacrimal gland]. Ryumachi 1996; 36:43-9. [PMID: 8711537] [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: 02/01/2023]
Abstract
The female subject, 64 years old, subjectively noticed a mild dryness of the eyes and bilateral, submandibular swelling in 1988. The clinical symptom was mild, and such autoantibody and hyper-gammaglobulinemia as often observed in Sjögren's syndrome were not recognized. However, by judging from the results of gum test (9 mL/10 min), salivary gland scan (Grade 2) and the labial biopsy, we diagnosed the case as Sjögren's syndrome. We then administered prednisolone at 40 mg at the onset of treatment and gradually decreasing the dosage over 3.5 years, and the symptoms improved. As an eyelid tumor in the left eye was noticed in 1991 and began to enlarge, the subject was hospitalized in June of 1992. The biopsy of the tumor (2.0 x 1.7 cm) showed marked polyclonal lymphoproliferation with lymphoid follicles which was determined by immunohistological staining. The case was a patient with a lymphoproliferative lesion from a lacrimal gland which is equal to a so-termed pseudolymphoma. Since there are some reports concerning the transition from pseudolymphoma to malignant lymphoma, this patient should be followed carefully.
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Affiliation(s)
- S Takeshita
- Department of Internal Medicine, Kanazawa Medical University, Japan
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49
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50
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Le Bourgeois JP, Frikha H, Piedbois P, Le Péchoux C, Martin L, Haddad E. Radiotherapy in the management of epidemic Kaposi's sarcoma of the oral cavity, the eyelid and the genitals. Radiother Oncol 1994; 30:263-6. [PMID: 7516086 DOI: 10.1016/0167-8140(94)90467-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [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: 01/25/2023]
Abstract
From January 1987 to December 1992, 420 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma (EKS) were treated with radiotherapy at the oncology department in the Henri Mondor Hospital. Of these, 146 (34.7%) exhibited tumours at 186 sites; 35 were oral, 102 eyelid or conjunctival (ophthalmic), and 49 penile or scrotal (genital) sites. Most patients had received prior chemotherapy. Radiation therapy consisted of 4 MV or 45 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. In oral lesions mucosal reactions were often observed after relatively low doses of radiotherapy. In 27 patients receiving 15 Gy, severe reactions were observed in 6 (22%), moderate reactions in 4 (15%) and mild reactions in 17 (63%). By contrast, irradiation of eyelid or conjunctival lesions and genital lesions, was well-tolerated. Treatment was generally successful in achieving good symptom palliation. Eyelid and conjunctival Kaposi's sarcoma seemed to be more radiosensitive when compared with cutaneous sites: a high objective remission rate (96%, 98/102) was observed at doses ranging from 10 to 20 Gy. Penile and scrotal lesions showed a good response to low dose radiation (complete response was scored in 34/49 patients (69.4%)). A meticulous evaluation of tolerance was necessary. Toxicity of oropharyngeal irradiation at relatively low doses is an argument for a restrictive use of this procedure in oral lesions.
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Affiliation(s)
- J P Le Bourgeois
- Département de cancérologie, Hôpital Henri Mondor, Creteil, France
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