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Biomedical subjects

Ralph C Eagle

Publications and source records attributed to Ralph C Eagle.

67 records · Page 4Linked to original sources
PubMedDate not supplied

Melanocytoma of the optic disk: a review.

Melanocytoma is a deeply pigmented variant of melanocytic nevus that classically occurs in the optic disk, sometimes with contiguous involvement of the adjacent retina or choroid. Historically, this tumor was often confused with malignant melanoma both clinically and histopathologically. Today, however, it is generally recognized by its typical clinical features that differ from most melanomas and erroneous enucleation is rarely done. Histopathologically, melanocytoma is composed of intensely pigmented round to oval nevus cells with benign features. Although traditionally believed to be a relatively stationary lesion, it is now known to exhibit minor enlargement in 10-15% of cases and can cause minor visual loss by a variety of mechanisms. In rare instance, it can induce severe visual loss due to spontaneous necrosis of the lesion or compressive optic neuropathy. More importantly, it can exhibit malignant transformation into melanoma in 1-2% of cases. Ophthalmologists should be familiar with melanocytoma of the optic disk and affected patients should be followed periodically.

Diagnosis, Differential↗
PubMedDate not supplied

Conjunctival amyloidosis: report of six cases and review of the literature.

Conjunctival amyloidosis is an uncommon condition that occasionally is associated with systemic involvement. The clinical presentations of conjunctival amyloidosis are diverse. We present six patients with conjunctival amyloidosis who were referred to us with the suspicion of another conjunctival lesion. The conjunctival lesion was circumscribed in two patients and diffuse in four patients. The lesion color was yellow in one patient and yellow-pink in five patients. The associated features were intrinsic vascularization (six patients), recurrent subconjunctival hemorrhage (four patients) and blepharoptosis that involved the palpebral conjunctiva (two patients). Systemic evaluation revealed primary systemic amyloidosis in one patient and no related systemic abnormalities in five patients. Management consisted of complete excisional biopsy for the two circumscribed lesions and incisional biopsy for the four diffuse lesions. Two patients with diffuse involvement showed progressive involvement of the conjunctiva over 3 years following incisional biopsy and the other four patients remained stable. Additionally, there was no systemic involvement in five patients. In conclusion, conjunctival amyloidosis generally manifests as a yellowish-pink, hemorrhagic mass deep to the epithelium. Most patients show no evidence of systemic amyloidosis.

Aged↗
PubMedDate not supplied

Two discrete choroidal melanomas in an eye with ocular melanocytosis.

We report a case of multifocal choroidal melanoma arising in an eye with ocular melanocytosis and review the pertinent literature. A 63-year-old Caucasian male with ocular melanocytosis in the left eye was found to have two discrete choroidal melanomas in the same eye. Histopathology of the enucleated eye confirmed the diagnosis of two discrete choroidal melanomas of mixed cell type within a region of choroidal melanocytosis. It is estimated that 1 in 160,000 patients with unilateral ocular melanocytosis may develop two uveal melanomas, based on the reported data. On the basis of random chance, patients with two melanomas in the same eye would be expected to have approximately 1000-fold greater likelihood of underlying ocular melanocytosis than the general Caucasian population. In conclusion, multifocal choroidal melanoma is rare and may be related to underlying ocular melanocytosis.

Choroid Neoplasms↗
PubMedDate not supplied

Two discrete uveal melanomas in a child with ocular melanocytosis.

OBJECTIVE: To describe a case of two uveal melanomas in a child with mild ocular melanocytosis. METHODS: A 6-year-old girl was followed for 5 years with an ill-defined, slowly enlarging presumed choroidal nevus in the postequatorial fundus. Ocular oncology evaluation revealed mild sectorial scleral and uveal melanocytosis and an episcleral sentinel vessel superotemporally. Two discrete uveal melanomas were present. In the circumpapillary and macular region, tumor 1 was diffuse at 9.0 mm in base and 4.1 mm in thickness and with overlying subretinal fluid. In the ciliary body, tumor 2 was discovered by transillumination and was 6.0 mm in base and 2.2 mm in thickness. Enucleation was performed. RESULTS: Histopathologic analysis disclosed two discrete uveal melanomas in a bed of diffuse mild uveal melanocytosis. Tumor 1 was a mixed, predominantly epithelioid cell melanoma with active mitotic figures, and tumor 2 was a mixed, predominantly spindle cell melanoma. The choroid between the melanomas showed only benign, dendritic melanocytes consistent with melanocytosis. There was no extrascleral extension. CONCLUSIONS: Ocular melanocytosis can predispose to one or multiple uveal melanomas. Lifetime ophthalmic monitoring of affected patients is warranted.

Child↗
PubMedDate not supplied

Orbital lymphoma simulating thyroid orbitopathy.

An 82-year-old man with hypothyroidism had vertical diplopia and swelling around his left eye. Visual acuity was 20/20 OD and 20/50 OS. There was moderate blepharoptosis and edema of the left eyelids and superior scleral show of the right eye. The left eye showed 4 mm of proptosis, motility restriction, afferent pupillary defect, and normal optic disc. Orbital MRI revealed enlargement of the left superior and medial rectus muscles without tendinous involvement. These findings were initially suggestive of thyroid orbitopathy. Thyroid function tests were normal. Coronal MRI showed additional superior oblique enlargement and involvement of the levator superioris palpebrae muscle, which are both suggestive of a non-thyroid pathology. Muscle biopsy revealed large B-cell lymphoma. The patient was treated with chemotherapy, immunotherapy, and radiotherapy, with complete tumor control. Orbital lymphoma can simulate thyroid orbitopathy, even in patients with classic "thyroid-like" symptoms and imaging.

Aged, 80 and over↗
PubMedDate not supplied

Solitary intraosseous orbital myofibroma in four cases.

PURPOSE: To report four pediatric cases of a bone-destructive orbital tumor that proved to be a benign solitary intraosseous myofibroma. METHODS: Four children, aged 1, 7, 11, and 72 months, developed eyelid fullness or slight proptosis. A solitary intraosseous mass was detected in the inferior (n = 2), superotemporal (n = 1), and supranasal (n = 1) orbital walls. On CT, the mass showed bone destruction. On MRI, the mass appeared circumscribed within a shell of normal surrounding bone and with features of isointensity on T1-weighted images, intense homogeneous gadolinium enhancement, and midrange signal on T2-weighted images. Complete surgical excision of the mass in each case was performed. RESULTS: On histopathologic examination, the tumors were characterized by whorls and bands of plump myoid cells with eosinophilic cytoplasm consistent with myofibroblasts, sometimes associated with a hemangiopericytoma-like vascular pattern. The diagnosis was also supported by immunohistochemical studies showing positive immunoreactivity for vimentin and smooth muscle actin. None of the patients have shown recurrence in follow-up ranging from 6 months to 3 years. CONCLUSIONS: Myofibroma is a benign tumor that can occur in the orbital bony wall of children. It can manifest as a bone destructive mass and can simulate a malignant process.

Child↗
PubMedDate not supplied

Retinoblastoma in an eye with features of Coats' disease.

A 44-month-old girl developed retinal detachment with extensive telangiectasia and "light bulb" aneurysms suggestive of Coats' disease. However, underlying and within the retina was diffuse retinoblastoma. Diffuse infiltrative retinoblastoma can manifest features of Coats' disease and could lead to diagnostic confusion.

Child, Preschool↗
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Orbital melanoma metastatic from contralateral choroid: management by complete surgical resection.

We discuss a clinicopathologic correlation of orbital metastasis from a contralateral choroidal melanoma wherein the orbital tumor was removed completely by surgical resection. In October 1982, a 29-year-old woman was treated with cobalt-60 plaque radiotherapy for a choroidal melanoma in her right eye. The tumor responded well but recurred after 9 years, necessitating enucleation. In August 1999, 17 years after initial presentation, metastatic melanoma to liver, lung, and brain were found and the patient had a favorable response to chemotherapy and brain irradiation. Five months later, in November 2000, an enlarging orbital mass was documented to be compressing the left optic nerve. Complete surgical removal of the tumor was achieved by a superotemporal orbitotomy. Histopathologically, the tumor was a malignant melanoma with features similar to the choroidal tumor. The contralateral orbit can be the site of late metastasis from choroidal melanoma. In rare instances, an orbital metastasis can be completely removed surgically without subjecting the patient to orbital irradiation.

Adult↗
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Tube occlusion from the external ostium after implantation of an aqueous shunt.

Two patients had undergone double-plate Molteno shunt implantation. Both patients required surgical revision, the first at 41 months and the second at 8 months postoperatively, because of a failure of previously functioning tube shunts caused by blockage of the external ostium and intraluminal invasion of the tube by fibrous tissue. At the time of surgical revision, fibrous tissue extended down the lumen of the tube, occluding its external ostium. After excision of this tissue, both shunts became fully functional. When functioning aqueous shunts fail and there is no evidence of a bleb over the shunt reservoir or blockage of the internal ostium, ingrowth of fibrous tissue into the external ostium should be considered as a potential cause, especially if a ripcord or Latina suture has been left in place.

Aqueous Humor↗
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Differentiation of pigmented conjunctival squamous cell carcinoma from melanoma.

A 69-year-old man developed a pigmented conjunctival tumor that had a papillomatous vascular configuration but no leukoplakia. Although the pigmentation suggested melanoma clinically, histopathologic study of the resected lesion disclosed squamous cell carcinoma, with scattered dendritic melanocytes in the tumor. Conjunctival squamous cell carcinoma can be pigmented, similar to melanoma. The papillomatous arrangement of blood vessels in such tumors should strongly suggest squamous cell carcinoma despite the absence of leukoplakia.

Aged↗