18-FDG PET/CT staging of ocular sebaceous cell carcinoma.
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Adenocarcinoma, Sebaceous↗
Biomedical subjects
Paul T Finger
Publications and source records attributed to Paul T Finger.
Whole-body positron emission tomography/computed tomography imaging and staging of orbital lymphoma.
OBJECTIVES: To report the use of whole-body positron emission tomography fused with computed tomography (PET/CT) for the diagnosis and staging of orbital lymphoma. DESIGN: Retrospective observational case series. PARTICIPANTS: Four patients with biopsy-proven orbital lymphoma were evaluated by 18-fluoro-2-deoxyglucose whole-body PET/CT imaging. METHODS: Positron emission tomography/CT images were studied for the presence of glucose uptake. Foci were considered suspicious based on their standardized uptake values (SUVs). Physiologic images (PET) and their anatomic counterparts (CT) were fused to allow form and function to be evaluated on the same diagnostic page. MAIN OUTCOME MEASURES: Positron emission tomography/CT images were assessed for foci with abnormally high SUVs that correlated with biopsy-proven lymphoma. RESULTS: Positron emission tomography/CT detected orbital lymphoma in 3 patients (75%). It also revealed systemic lymphoma in 2 of the 4 patients. The 2 patients found to have systemic lymphoma were diagnosed to have extranodal marginal zone B-cell orbital lymphoma of the mucosa-associated lymphoid tissue (MALT) type. Similarly, the 2 with negative PET/CT results also had orbital MALT-type lymphoma. We found that PET/CT imaging helped guide further management in all 4 patients. CONCLUSIONS: Positron emission tomography/CT should be considered as a new method of diagnosing, staging, and restaging patients with orbital lymphomas.
Aged↗
Giant secondary conjunctival inclusion cysts: a late complication of strabismus surgery.
PURPOSE: To present giant conjunctival inclusion cysts as a late complication of strabismus surgery. DESIGN: Retrospective case series of selected patients. PARTICIPANTS: Four patients with a history of strabismus surgery who had developed giant conjunctival inclusion cysts. METHODS: A chart review was performed. The patient's ocular history, ophthalmic examinations, and imaging (ultrasound/ultrasound biomicroscopy and/or computed tomography) were recorded. Surgical excision with subsequent histopathologic correlation was obtained in 3 cases. MAIN OUTCOME MEASURES: Clinical and imaging characteristics with histopathologic correlation. RESULTS: Four patients with giant conjunctival inclusion cysts had a history of strabismus surgery. Ultrasound biomicroscopy was performed in 3 cases and revealed large, cystic, well-circumscribed tumors with low internal reflectivity and hyperechoic components. Computed tomography of the orbits was used to evaluate posterior extension. Their size induced limitation in motility, strabismus, and problems related to chronic exposure. Histopathologic evaluations were consistent with benign inclusion cysts of the conjunctiva. CONCLUSIONS: Giant conjunctival inclusion cysts may appear decades after strabismus surgery. Tumor size, cystic nature, and involvement of underlying structures can be determined by ultrasonography and radiographic imaging. Complete surgical removal can be curative.
Child↗
Bilateral epibulbar granulocytic sarcomas: a case of an 8-year-old girl with acute myeloid leukaemia.
PURPOSE: An 8-year-old girl with a history of acute myeloid leukaemia (AML) presented with bilateral ocular discomfort, conjunctival injection, photophobia, and epiphora. METHODS: Clinical examination and high-frequency ultrasound showed bilateral epibulbar tumours. RESULTS: Granulocytic sarcomas were suspected and leukaemic infiltration was confirmed by fine-needle aspiration biopsy based cytopathologic examination. CONCLUSIONS: Epibulbar granulocytic sarcoma in AML is rare (particularly in a child). We describe the first high-frequency ultrasound images and illustrate the use of a minimally invasive fine-needle aspiration biopsy technique to confirm our diagnosis.
Biopsy, Needle↗
Escitalopram-induced uveal effusions and bilateral angle closure glaucoma.
PURPOSE: To report the onset of bilateral angle closure glaucoma resulting from ciliochoroidal effusions noted after taking escitalopram. DESIGN: Case report. METHODS: A 41-year-old woman with a medical history of depression was placed on escitalopram and presented with acute bilateral angle closure glaucoma. A medical history and ophthalmic examination (including slit-lamp photography and high-frequency ultrasonography) were performed at the time of diagnosis and at resolution of her symptoms. RESULTS: High-frequency ultrasonography revealed bilateral choroidal effusions with ciliary body detachments and angle closure. Attempts to reduce intraocular pressure with topical ocular antihypertensive drugs and subsequent laser peripheral iridotomy were unsuccessful. Over the course of four days, the use of topical cycloplegics, corticosteroids, and discontinuation of escitalopram resulted in normalization of intraocular pressures, deepening of anterior chamber depths, and resolution of her uveal effusions. CONCLUSIONS: The use of escitalopram resulted in uveal effusions, angle rotation, and acute bilateral angle closure glaucoma. Discontinuation of escitalopram and corticosteroid therapy resulted in normalization of the patient's eyes.
Acute Disease↗
Early ocular prosthesis insertion improves quality of life after enucleation.
BACKGROUND: The aim of this study was to evaluate early insertion of ocular prostheses for aesthetic rehabilitation after enucleation and review current methods of enucleation surgery. METHODS: Twelve patients with large intraocular malignancies were treated by enucleation with implant. At the end of surgery, a medium-size conformer was inserted onto the closed conjunctival wound (just before applying a pressure dressing). The pressure dressing was removed 3 to 5 days after surgery. Immediately after bandage removal, the patients saw themselves in a mirror and were offered placement of a relatively small ocular prosthesis. Patients were asked if they preferred their aesthetic appearance with or without the prosthesis. RESULTS: Eight patients (67%) tolerated introduction of the prosthesis at the time of removal of their pressure dressing (3 to 5 days after enucleation surgery). Because of discomfort, 4 were able to receive their prostheses at their second postoperative visit (day 12 or 13). The manipulation at prosthesis insertion and subsequent wearing was found to have no effect on wound closure, final prosthetic fittings, or movement of the permanent prosthesis. All patients were pleased with the cosmetic benefit afforded by early introduction of the prosthesis and preferred their appearance to that of their eye with the conformer. CONCLUSIONS: Early replacement of the conformer by an ocular prosthesis allows for cosmetic rehabilitation and improved quality of life.
Adult↗
Conjunctival malignant melanoma-associated pseudomelanoma of the apposing tarsal conjunctiva.
PURPOSE: To describe a case of conjunctival malignant melanoma associated with pseudomelanomatous alteration of the apposing tarsal conjunctiva. METHODS: A 93-year-old woman presented with an elevated, pigmented mass on her superior bulbar conjunctiva. The tumor was associated with increased pigmentation of the apposing superior tarsal conjunctiva. An excisional biopsy of the epibulbar melanoma and pigmented tarsal conjunctiva was performed. RESULTS: Histopathologic evaluation of the epibulbar tumor revealed epithelioid melanocytes diagnostic of malignant melanoma. Histopathologic evaluation of the pigmented tarsal lesion showed large areas of ulceration and foci of granulation tissue composed of neovascular sprouts arising in the background of a loose connective tissue, with a moderate chronic inflammatory infiltrate. The infiltrate was composed of mature lymphocytes, plasma cells, and scattered histiocytes. Densely packed intracytoplasmic, brown pigment granules that stained positive with HMB 45 were found, attesting to adjacent melanocytes' releasing melanin-laden granules. There was no evidence of malignancy in the pigmented tarsal specimen. CONCLUSION: Noncontiguous pigmented conjunctival tumor can be found in apposition to an epibulbar melanoma. Although a limited biopsy could be considered, only a complete resection and histopathologic evaluation can determine whether the entire lesion is free of malignant melanoma.
Aged, 80 and over↗
Eyelid-sparing adjuvant radiation therapy for renal cell carcinoma.
PURPOSE: To describe the use of debulking surgery with adjuvant external beam irradiation as an eyelid-sparing treatment for renal cell carcinoma. DESIGN: Interventional case report. METHODS: A 63-year-old male presented with a right upper lid tumor. He had a history of renal cell carcinoma and pulmonary metastasis treated with surgery and systemic chemotherapy. The eyelid tumor was biopsied, followed by debulking surgery and external beam radiation therapy to treat this metastatic tumor. RESULTS: Histopathological evaluation of the excised tumor revealed a metastatic renal cell carcinoma, clear cell type. At 4 months' follow-up, he had no evidence of recurrence or radiation oculopathy. He was pleased with his cosmetic result. CONCLUSIONS: Meta static renal cell carcinoma presenting in the eye and orbit can be the initial manifestation of the primary tumor. It is important to include this tumor in the differential diagnosis of recurrent eyelid lesions. Debulking surgery followed by external beam radiation therapy can be used to control the tumor with an eyelid-sparing cosmetic result.
Biopsy↗
Reactive lymphoid hyperplasia one month after LASIK surgery.
BACKGROUND: To describe a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK). METHODS: This observational case report describes a 31-year-old man who underwent LASIK and presented 1 month later with a fleshy, conjunctival (plical) tumour in the left eye. An excisional biopsy of the tumour was performed. RESULTS: Histopathology of the excised tumour revealed reactive lymphoid hyperplasia involving the left conjunctiva. DISCUSSION: Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumours. This report describes the unusual occurrence of a lymphoid conjunctival tumour after LASIK eye surgery.
Adult↗
Small incision surgical iridotomy and iridectomy.
PURPOSE: To describe a minimally invasive method to create a full-thickness surgical iridectomy. DESIGN: An interventional case series. METHODS: Surgical iridectomies were performed through a 1-mm clear corneal incision. The anterior chamber was prepared with acetylcholine chloride 10 mg/ml and sodium hyaluronate 1%. A 25-gauge aspiration-cutter "probe" was introduced through the corneal incision such that the aspiration portal was occluded by the iris stroma. Then aspiration (600 mm/Hg) cutting (300 cpm) was used to create a surgical iridotomy in 2 cases. Then the probe was removed. RESULTS: Full-thickness iridotomies were created. None of the patients were noted to have a secondary increase in intraocular pressure, hyphema, infection, cataract or vision loss. The clear-corneal wounds were self-sealing. CONCLUSIONS: Small incision surgical iridectomy can be minimally invasive and effective. Use of a 25-gauge aspiration-cutting probe allowed for small incision surgery, rapid rehabilitation and no significant complications.
Biopsy↗
Reactive lymphoid hyperplasia 1 month after LASIK surgery.
PURPOSE: This study was conducted to investigate a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK). METHODS: A 31-year-old man who underwent LASIK presented 1 month later with a fleshy conjunctival (plical) tumor in the left eye. An excision biopsy of the tumor was performed. RESULTS: Histopathology of the excised tumor revealed reactive lymphoid hyperplasia. DISCUSSION: Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumors. This report describes the unusual occurrence of a lymphoid conjunctival tumor after LASIK eye surgery.
Adult↗
Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: 12 years' experience.
PURPOSE: To report 12-year follow-up experience with topical mitomycin chemotherapy for diffuse and multifocal primary acquired melanosis (PAM) with atypia and conjunctival melanoma. METHODS: Interventional case series of 16 patients. Mitomycin was a primary treatment for residual epithelial disease in ten patients (eight with PAM with atypia and two with conjunctival melanoma) and as an adjuvant to excision and cryotherapy in six with conjunctival malignant melanoma. Primary treatments consisted of mitomycin 0.04% qid for 28 days (two 14-day cycles) and for 7 consecutive days as adjuvant therapy. Patients were followed for both local recurrence and metastatic disease. RESULTS: Sixteen patients were followed for a mean 81 months (range 13-144 months) after treatment. All tumors responded to chemotherapy. Recurrence was noted in eight (three adjuvant and five primary treatment patients). Three underwent orbital exenteration. The remaining five were treated conservatively. The mean time to recurrence was 36.9 months. The short-term mitomycin-related complications included transient keratoconjunctivitis (n=14), severe keratoconjunctivitis (n=1) and one corneal abrasion with scar formation. The long-term complications included pannus (n=2) and corneal haze (n=1). Visual acuity was maintained within two lines in 14 patients (including measurements just prior to exenteration). Three patients died, one of metastatic conjunctival melanoma. CONCLUSIONS: Conjunctival melanoma and PAM responded to mitomycin 0.04% topical chemotherapy; subepithelial nests appeared resistant to treatment. Treatment-related complications were acceptable. In this series, as primary and adjuvant therapy, topical mitomycin yielded an overall recurrence rate of 50%.
Administration, Topical↗
"Finger-tip" cryoprobe assisted enucleation.
PURPOSE: To report the use of a new cryotherapy probe to induce proptosis during enucleation surgery. DESIGN: Interventional case report. METHODS: Two patients with uveal melanoma and secondary glaucoma were treated by enucleation. A large surface area (70 mm(2)), spatulated, end-freezing cryotherapy probe ("Finger-tip" probes, MIRA, Inc.) was used to induce proptosis during optic nerve transsection. RESULTS: This new probe offers homogeneous freezing over a relatively large surface area. This new cryoprobe was used to create a large cryo-adhesion on the cornea, for an excellent purchase of the eye during enucleation surgery. Using this adhesion, the eye was lifted, enabling transsection of the optic nerve. CONCLUSIONS: This report includes photographs of the cryoprobe, the corneal cryo-adhesion, and describes its use for traction during enucleation surgery.
Cryotherapy↗
Whole body positron emission tomography/computed tomography staging of metastatic choroidal melanoma.
PURPOSE: To evaluate whole-body positron emission tomography (PET)/computed tomography in staging of patients with metastatic choroidal melanoma. DESIGN: Interventional non-randomized clinical study. METHODS: Twenty patients were referred for whole-body 18-fluoro-2-deoxy-D-glucose (FDG) PET/computed tomography imaging because of suspected metastatic choroidal melanoma. PET/computed tomography images were studied for the presence and distribution of metastatic melanoma. Subsequent biopsies were performed to confirm the presence of metastatic disease. RESULTS: Twenty patients underwent PET/computed tomography. Eighteen were imaged because of abnormal clinical, hematologic, or radiographic screening studies during the course of their follow-up after plaque brachytherapy or enucleation. Two were imaged before treatment of their primary tumor. PET/computed tomography revealed or confirmed metastatic melanoma in eight (40%) of these 20 patients. The mean time from initial diagnosis to metastasis was 47 months (range 0 to 154). The most common sites for metastases were the liver (100%), bone (50%), lung (25%), lymph nodes (25%), and subcutaneous tissue (25%). Cardiac, brain, thyroid, and posterior abdominal wall lesions (12.5%) were also noted. Six patients (75%) had multiple organ involvement. No false positives were noted. PET/computed tomography imaging also detected benign lesions of the bone and lymph nodes in three patients (15%). All patients had hepatic metastases and liver enzyme assays were abnormal in only one (12.5%) of eight patients. CONCLUSIONS: PET/computed tomography imaging is a sensitive tool for the detection and localization of hepatic and extra-hepatic (particularly osseous) metastatic choroidal melanoma.
Aged↗
Population-based incidence of uveal melanoma in various races and ethnic groups.
PURPOSE: To investigate racial/ethnic differences in the development of uveal malignant melanoma in a large population-based study. DESIGN: Observational cross-sectional study. METHODS: With the 1992 to 2000 data that was provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, we calculated age-adjusted incidence rates of uveal melanoma in various racial/ethnic groups (black, Asian and Pacific Islander, Hispanic, and non-Hispanic white). In addition, we calculated the standard incidence ratio (risk ratio) and 95% confidence interval to describe the differences within these racial/ethnic groups. RESULTS: From 1992 to 2000, there were a total of 1352 uveal melanomas that were diagnosed in 11 Surveillance, Epidemiology, and End Results registries with known racial/ethnic groups. The annual age-adjusted incidence (per million population) of uveal melanoma was 0.31 (black), 0.38 (Asian), 1.67 (Hispanic), and 6.02 (non-Hispanic white). The difference in the incidence of uveal melanoma between each racial/ethnic group was highly statistically significant, with the exception of the black versus the Asian population in which there was no statistically significant difference. CONCLUSION: The relative risk of uveal melanoma was 1.2 for Asian and Pacific Islander patients, 5.4 for Hispanic patients, and 19.2 for non-Hispanic white patients as compared with the black patients. If the non-Hispanic white population and the Hispanic population were combined, then the overall white:black ratio was 18:1.
Cross-Sectional Studies↗
Melanocytic conjunctival tumors.
Melanocytic conjunctival tumors include a wide range of lesions that vary in their clinical and histopathologic features. Their management depends on numerous factors, including their location, focality, tumor dimensions (including depth), histopathologic characteristics, recurrences, growth, and the presence of metastasis.
Conjunctival Neoplasms↗
Design and dosimetric considerations of a modified COMS plaque: the reusable "seed-guide" insert.
The Collaborative Ocular Melanoma Study (COMS) developed a standardized set of eye plaques that consist of a 0.5 mm thick bowl-like gold alloy backing with a cylindrical collimating lip. A Silastic seed carrier into which 125I seeds are loaded was designed to fit within the backing. The carrier provides a standardized seed pattern and functions to offset the seeds by 1.0 mm from the concave (front) surface of the carrier. These Silastic carriers have been found to be difficult to load, preclude flash sterilization, and are a source of dosimetric uncertainty because the effective atomic number of Silastic is significantly higher than that of water. The main dosimetric effect of the Silastic carrier is a dose-reduction (compared to homogeneous water) of approximately 10%-15% for 125I radiation. The dose reduction is expected to be even greater for 103Pd radiation. In an attempt to improve upon, yet retain as much of the familiar COMS design as possible, we have developed a thin "seed-guide" insert made of gold alloy. This new insert has cutouts which match the seed pattern of the Silastic carrier, but allows the seeds to be glued directly to the inner surface of the gold backing using either dental acrylic or a cyanoacrylate adhesive. When glued directly to the gold backing the seeds are offset a few tenths of a millimeter further away from the scleral surface compared to using the Silastic carrier. From a dosimetric perspective, the space formerly occupied by the Silastic carrier is now assumed to be water equivalent. Water equivalency is a desirable attribute for this space because it eliminates the dosimetric uncertainties related to the atomic composition of Silastic and thereby facilitates the use of either 125I and/or 103Pd seeds. The caveat is that a new source of dosimetric uncertainty would be introduced were an air bubble to become trapped in this space during or after the surgical insertion. The presence of air in this space is modeled and the dosimetric impact discussed. Another unintended consequence of water equivalency is that some fluorescent x rays emitted from the gold backing can now reach the eye. These very low energy x rays were virtually eliminated by absorption in Silastic. When loaded with 125I seeds the modified plaque appears to produce dose distributions that are almost the same as those of the original COMS plaque and the maximum dosimetric uncertainty introduced by an air bubble is about 2%. Dose distributions calculated for a modified plaque loaded with 103Pd seeds show that dose to healthy ocular structures distal to the tumor apex can be reduced compared to 125I. Clearly, it is faster and easier to glue seeds into the reusable gold seed-guide insert than it is to load the COMS-Silastic carrier.
Brachytherapy↗
Palladium 103 (103Pd) plaque radiation therapy for circumscribed choroidal hemangioma with retinal detachment.
OBJECTIVE: To describe clinical experience with palladium 103 ((103)Pd) ophthalmic plaque radiotherapy for choroidal hemangioma. METHODS: One course of (103)Pd ophthalmic plaque radiotherapy was used in each of 5 patients with circumscribed choroidal hemangioma who had progressive loss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900 rad) was delivered. Functional tests of outcome included best-corrected visual acuity. Anatomic results included changes in tumor height and subretinal fluid documented by ophthalmoscopy, fluorescein angiography, and ultrasonography. RESULTS: All patients had complete resolution of subretinal fluid with reattachment of the retina. All tumors decreased in height (mean, 50%) after treatment. Three patients (60%) demonstrated improvement in visual acuity at the last follow-up, and in 1 patient vision remained stable with resolution of metamorphopsia. Twenty-four months after treatment, 1 patient whose visual acuity had recovered from 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy. For all patients, a mean visual acuity improvement of 2 lines was documented (95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range, 6-29 months). CONCLUSIONS: A single (103)Pd plaque radiation treatment was effective in decreasing tumor height, eliminating subretinal fluid, and improving visual acuity in patients with symptomatic circumscribed choroidal hemangiomas.
Aged↗