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At least 523 records · Page 29Linked to original sources

Primary basal cell carcinoma of the caruncle with seeding to the conjunctiva.

BACKGROUND: To report the clinical and histopathological characteristics of a patient with a primary basal cell carcinoma (BCC) of the caruncle with seeding of the tumour to the conjunctiva. METHODS: Surgical excision and histological examination. RESULTS: A 60-year-old female presented with a lesion of the caruncle. Clinical examination revealed a pale lobulated tumour without skin involvement. Computer tomography scans showed orbital invasion. The tumour was excised. Three years later a small polypoid tumour developed in the inferior fornix of the same eye. Two and a half years later, the patient developed an orbital recurrence. Microscopically, both neoplasms were composed of infiltrative islands of basaloid tumour cells, scattered mitoses and peripheral palisading consistent with the diagnosis of BCC. CONCLUSION: This case describes a primary BCC of the caruncle with seeding to the conjunctiva.

Basal Cell Carcinoma↗

Primary sebaceous carcinoma of the lacrimal gland treated by carbon ion radiotherapy.

Sebaceous carcinoma is a rare primary neoplasm of the lacrimal gland and, to the best of our knowledge, only six cases have been reported previously. Sebaceous carcinoma of the orbit more commonly occurs as secondary invasion from the eyelid, but may occur by way of metastatic spread from elsewhere in the body. We describe a patient who presented with a rapidly growing neoplasm of the lacrimal gland which, histologically, was a sebaceous carcinoma. The eyelid was entirely normal on examination. In this patient we found a single tumor cell line within the normal lacrimal gland. In this article we describe the diagnosis and treatment with carbon ion radiotherapy of primary sebaceous carcinoma of the lacrimal gland, a condition not previously reported in Japan.

Adenocarcinoma, Sebaceous↗

Rapid recurrence of papillary squamous cell carcinoma of the canaliculus.

We treated a 76-year-old man who had an epithelial carcinoma that involved the canaliculus and extended into the lacrimal sac. Despite what appeared to be adequate resection (the surgical margins were completely free of tumor on both frozen and paraffin section), the tumor recurred less than one month later. The patient underwent wide local incision, including en bloc removal of the medial third of both eyelids and inner canthi, canaliculi, lacrimal sac, and nasolacrimal duct, and resection of the anterior lacrimal crest, lacrimal bone, anterior portion of the ethmoid bone, anterior medial wall of the maxilla, and subjacent periosteum and mucous membranes. Sixteen months later, the tumor has not recurred. This infiltrating papillary squamous cell carcinoma histologically demonstrated the most rapid and destructive recurrence of any such tumor originating in the lacrimal system.

Aged↗

Combined clinical and computed tomographic diagnosis of primary lacrimal fossa lesions.

We studied 39 patients who had solid mass-lesions primary in the lacrimal gland by computed tomography and reviewed their clinical histories. Twenty-three patients had either inflammatory conditions (16 cases) or lymphoid tumors (seven cases), with average symptomatic periods of less than a year. In this group, soft-tissue contour analysis in the axial and corneal projections demonstrated diffuse, compressed, and molded enlargements of the lacrimal gland in an oblong fashion, and there were no associated bone defects. Sixteen parenchymal benign or malignant tumors (six benign mixed tumors, one schwannoma, and nine malignant epithelial tumors) exhibited rounded or globular soft-tissue outlines and were frequently associated with contiguous bone changes. The benign tumors had smooth encapsulated outlines at their margins, whereas the malignant tumors displayed microserrations indicative of infiltration. The patients with the benign mixed tumors had had symptoms, on the average, for more than a year, whereas those with epithelial malignancies became symptomatic or had a preexisting benign mixed tumor that became exacerbated in periods of less than six months. Contour analysis of the soft-tissue mass depicted in coronal and axial tomograms is a valuable adjunct that leads to more accurate preoperative diagnosis when combined with a radiographic search for bone changes and the clinical history. Once a diagnosis regarding the presumptive lesional family has been made preoperatively, corticosteroid therapy may be instituted for acute inflammation and biopsies through the eyelid should be performed for suspected chronic inflammations, lymphoid lesions, or epithelial malignancies. A lateral orbitotomy without prior biopsy should be performed for rounded, well-encapsulated masses of long duration that are likely to be benign mixed tumors.

Adolescent↗

The role of aminocaproic acid in lacrimal surgery in dyskeratosis congenita.

A 14-year-old boy with bilateral epiphora since birth had absent lacrimal puncta, oral leukoplakia, agenesis of the nails, cutaneous dyschromia, and pancytopenia, findings noted in the rare syndrome of dyskeratosis congenita. Bilateral conjunctivodacryocystorhinostomy was complicated by persistent hemorrhage despite preoperative platelet transfusion. The hemorrhage was controlled by administration of an antifibrinolytic agent, aminocaproic acid. Lacrimal excretory anomalies may be the initial manifestation of a serious systemic disorder, dyskeratosis congenita. Surgical management in this disorder should include appropriate hematologic support.

Adolescent↗

The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures: the role of delayed assessment and dacryocystorhinostomy.

A detailed review of forty-six patients with severe naso-orbital-ethmoid injury confirms that naso-lacrimal system injury is less common than originally suspected. Post-operative epiphora is more frequently due to eyelid malposition than naso-lacrimal obstruction. Eight patients (17.4%) required eventual dacryocystorhinostomy. Three out of five patients (60%), treated with closed reduction and external splint fixation, needed dacryocystorhinostomy. This treatment predisposes to external compression of the naso-lacrimal system by malpositioned bone fragments and segments. Open reduction and internal fixation of all fractures provides optimal repair and minimizes the incidence of post-operative epiphora. During fracture repair, the naso-lacrimal sac should be identified, but not probed or intubated unless obviously lacerated. The upper lacrimal pathway is protected by the medial canthal ligament. Obstruction usually occurs in the bony naso-lacrimal canal. Telecanthus invariably accompanies severe naso-orbital-ethmoid injuries and subsequent naso-lacrimal obstruction. Dacryocystography is useful in the investigation of naso-lacrimal function. When dacryocystorhinostomy is necessary, it should be performed at least 3 months after the primary repair.

Dacryocystitis↗

Frozen section diagnosis in ophthalmic surgery.

Frozen section diagnosis can afford the opportunity for histopathological examination of excised tissues in the operating room. Because frozen section techniques have traditionally been little used in ophthalmic surgery, many pathologists are not familiar with eye tissues. However, with cooperation and understanding between the ophthalmologist and the pathologist, frozen section diagnosis may be able to identify the tissue, the pathologic process and the extent of the lesion within 10-15 minutes. In this review, applications and problems of frozen section diagnosis in various types of ocular surgery are discussed.

Anterior Chamber↗

Lacrimal ductal cysts. Presentation and management.

The authors have reviewed the clinical and histopathologic features of nine cases of lacrimal ductal cysts. Six of these were proven histologically, and three were diagnosed clinically. All presented as masses, three with pain, five with tenderness and two with acute expansion due to hemorrhage in one case and following crying and deep sea diving in the other. Six were treated surgically and three are being followed clinically. The six lesions examined histologically were all ductal cysts with evidence of scarring and inflammation. The differential diagnosis and management are outlined.

Adult↗

Nasal obstruction in the neonate secondary to nasolacrimal duct cysts.

The neonate is an obligate nasal breather and any form of nasal obstruction causes respiratory distress during feeding and sleeping. We report two patients with unusual causes of respiratory distress secondary to nasolacrimal duct cysts. The failure of the lacrimal duct to perforate at the distal end results in dacryocystitis and cyst formation. Removal of the nasal wall of the cyst resolves the obstruction and the dacryocystitis. The nasolacrimal duct cyst is an unusual, but readily treated, cause of neonatal respiratory distress.

Airway Obstruction↗

Lacrimal collecting system lymphomas: integration of magnetic resonance imaging and therapeutic irradiation.

Lymphomas arising within the lacrimal collecting system are rare tumours and unusual causes of lacrimal obstructive symptoms. The presentation, diagnosis, and treatment of this disease in five patients are described, as well as a review of the existing literature. Emphasized in this series is the efficacy of magnetic resonance imaging of these presentations and the importance of irradiation in their treatment.

Adult↗

Computed tomography dacryocystography.

Twenty-one patients with epiphora were examined by conventional dacryocystography, using Lipiodol as a contrast medium, and CT dacryocystography, using a water soluble contrast medium. In the latter, the material was not introduced under pressure but three or four drops were administered, providing a physiological method of investigation. Subsequently, CT dacryocystography provides functional information about lacrimal disorders and is easy to use.

Adult↗