Squamous cell carcinoma presenting as an orbital cyst with radiologic evidence of perineural invasion

PurposeTo report clinical and radiologic findings of cystic squamous cell carcinoma (SCC) of the orbit with evidence of perineural involvement.MethodsAnalysis of clinical findings and radiology with a literature review.ResultsA 66-year-old man with SCC of the forehead 8 years prior presented with paraesthesias, diplopia, and proptosis. Magnetic resonance imaging showed a well-defined, cystic mass of the orbit with a single, linear structure running through its center. Lateral orbitotomy revealed a cyst adherent to adjacent periorbita containing viscous, clear, yellow substance and a nerve coursing through the center. Histopathology confirmed poorly differentiated spindle cell carcinoma with positive staining for cytokeratin markers, consistent with SCC.ConclusionsOrbital cysts associated with altered sensation are suggestive of SCC with perineural spread, requiring prompt investigation and treatment to minimize morbidity and mortality. The involved nerve may be seen as a single, linear structure within the mass on imaging

Tarsomarginal graft in upper eyelid coloboma repair

Copyright © 2007 American Association for Pediatric Ophthalmology and Strabismus Published by Mosby, Inc.Eyelid colobomas are congenital defects caused by failure of fusion of the mesodermal lid folds. The timing and approach to surgical repair depend on the severity of the defect and exposure keratopathy. Tarsomarginal grafts have been well described in eyelid reconstructions following tumor excision. Descriptions of lid coloboma repair using this approach are limited. We describe a series of upper lid colobomas repaired with the tarsomarginal graft.Erika Hoyama, Vanessa Limawararut, Raman Malhotra, James Muecke and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/623140/description#descriptio

Acellular dermal tissue study: an ultrastructural evaluation of human and porcine derived tissues in a rat model

The purpose of this study was to evaluate the host response of a human and a porcine derived acellular dermal tissue (ADT) implanted in the subcutaneous tissue of a rat model. Two subcutaneous pockets were surgically created along the dorsal midline of 25 rats (5 rats/group). The human ADT was placed superiorly and the porcine ADT, inferiorly. The animals were sacrificed at 07, 15, 30, 60 and 180 postoperative days (PO) and the ADTs and surrounding soft tissues were assessed for ultrastructural evaluation by transmission electron microscopy. The ultrastructural findings were similar in both materials. Normal collagen and elastic fibers bundles were observed during all experimental moments, as well as macrophages presenting cytoplasmic enlargements digesting cellular portions after 15 PO. From 30 until 180 PO, vacuolar structures filled with an amorphous, electron-transparent substance, were present inside and outside the fibroblasts. Both human and porcine ADT showed similar pattern of ultrastructural response when implanted in the subcutaneous tissue of rats. The porcine ADT appears as a good alternative to be used as a biomaterial

Orbital solitary fibrous tumor: Report of two cases and literature review

Background: Solitary fibrous tumor (SFT) is a rare, benign, and very uncommon lesion in the orbit. Because of its complex and variable clinical and histological appearance the SIFT is often misdiagnosed.Cases: Two new cases of orbital SIFT are reported, one in a man and the other in a woman, both unilateral and in the superomedial orbit.Observations: Clinical and tomographical evaluations were conducted and the lesions were excised. The histological evaluation showed the tumors were composed of spindle-shaped cells within colla.-en bundles and vascular channels. Immunohistochemical staining was positive for CD 34 and negative for S-100 protein.Conclusion: Immunohistochemical study is an important adjuvant in determining the SIFT diagnosis. Long-term follow-up is necessary because of the possibility of SFT recurrence after excision. (C) 2003 Japanese Ophthalmological Society

Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis Sicca

PurposeTo present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca.MethodsA 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips.ResultsMarked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period.ConclusionPartial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.Igal Leibovitch, Erika Hoyama, Vanessa Limawararut, John Crompton and Dinesh Selv

Blinding orbital cellulitis: A complication of strabismus surgery

A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential

Polyethylene gel in the subcutaneous tissue of rats: Histopathologic and systemic evaluation

PurposeTo evaluate the histological and systemic response to subcutaneous injection of polyethylene gel in rats.MethodsTwenty-one white male rats were divided into 3 groups (G): G1 and G2 received subcutaneous polyethylene gel injection in the dorsal midline and were sacrificed at 30 and 60 postoperative days, respectively. G3 was not exposed to the polyethylene gel and was sacrificed after 60 days. Blood levels of lactate dehydrogenase (LDH), creatine kinase (CK), and alkaline phosphatase (ALP) were evaluated. The heart, kidney, liver, adrenal gland, injection site, and adjacent tissues were histologically examined. The results were submitted to statistical analysis.ResultsThere was no clinical evidence of extrusion, reduction of the injected volume, or abnormalities in the adjacent tissues. Blood levels of CK and LDH were normal and similar in all groups. ALP levels were significantly lower in G2 than in G1 and G3. The systemic organs were normal on histological examination in the 3 groups evaluated. Microscopically, the polyethylene gel was surrounded by a thin pseudocapsule formation and minimal inflammatory cell response, which decreased from G1 to G2.ConclusionThe subcutaneous injection of polyethylene gel in rats elicited minimal local inflammatory response and no systemic side effects.Silvana A. Schellini, Gislaine P. M. Zimmermann, Erika Hoyama, Claudia H. Pellizon, Carlos R. Padovani, Dinesh Selv

Expression of Vascular Endothelial Growth Factor (VEGF) in macrophages, fibroblasts, and endothelial cells in pterygium treated with 5-fluorouracil

PURPOSE: To evaluate the VEGF expression in macrophages, fibroblasts, and endothelial cells from pterygium before and after 5-fluorouracil (5-FU) exposure. METHODS: 68 excised pterygia (42 primary and 26 recurrent) were studied by immunohistochemistry, to analyze its expression in cells from pterygium and normal conjunctiva. VEGF expression was evaluated before and after a 5-FU subconjunctival injection 15 days prior to surgery. RESULTS: Expression in macrophages was moderate in normal conjunctiva and low to moderate in pterygium tissues. In fibroblasts, it was negative or low in both tissues. Pterygium had a higher proportion of high VEGF expression in endothelial cells compared to normal tissue (p < 0.05). 5-FU did not have any influence on expression. CONCLUSION: VEGF expression in pterygium macrophages, fibroblasts, and endothelial cells was low and similar to that normal in conjunctival tissue. High VEGF expression was found in pterygium endothelial cells compared to normal conjunctiva. 5-FU does not impact VEGF expression.Erika Hoyama, Magda Massae Hata Viveiros, Claudia Shiratori, Deilson Elgui de Oliveira, Carlos Roberto Padovani, Dinesh Selva, Silvana Artioli Schellin