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At least 775 records · Page 43Linked to original sources
PubMed2006

Short-term mitomycin C followed by long-term interferon alpha2beta for conjunctiva-cornea intraepithelial neoplasia.

PURPOSE: To report a case of extensive conjunctiva-cornea intraepithelial neoplasia (CIN) treated topically with mitomycin C (MMC) and interferon (INF)-alpha2beta without surgical resection. METHODS: Case report. RESULTS: : An 82-year-old woman showed an extensive gelatinous red mass in the bulbar conjunctiva with invasion into the caruncle, inferior fornix, and tarsal conjunctiva and extending for 270 degrees of the corneal surface. A diagnosis of CIN was made by surgical biopsy. Surgical excision with safety margins carried the risk of limbal stem cell depletion. A conservative treatment strategy was used with 2 cycles of topical MMC (0.02%), followed by INF-alpha2beta eye drops at a dose of 1 million IU/mL, 4 times a day until tumor disappearance. Total resolution was noted after 75 days of treatment with INF, with no clinical evidence of limbal stem cell deficiency. After 1 year of monitoring, no signs of CIN recurrences were observed. CONCLUSION: MMC (0.02%), followed by INF-alpha2beta (1 million IU/mL) 4 times a day, is an effective treatment against highly extensive CIN, in cases where surgical resection with safety margins is unfeasible.

Administration, Topical↗
PubMed2003

Plaque radiotherapy for selected orbital malignancies: preliminary observations: the 2002 Montgomery Lecture, part 2.

PURPOSE: To describe the principles and preliminary results of plaque brachytherapy for selected orbital malignancies. METHODS: A custom-designed Iodine-125 plaque, designed to deliver a target dose of 50 Gray, was placed surgically in the region from which an orbital malignancy was partially resected. The mean dose to the target area was 50 Gray. The initial and follow-up patient data were reviewed. RESULTS: Of the 8 patients, the diagnosis was adenoid cystic carcinoma of the lacrimal gland (4 cases), orbital invasion by basal cell carcinoma (2), orbital extension of conjunctival melanoma (1), and metastatic carcinoma (1). Of the 4 with adenoid cystic carcinoma, there was microscopic residual tumor after excision and orbital exenteration was considered. Three have tumor control with follow-up of 1, 3, and 6 years. One patient required exenteration for recurrence separate from the field of brachytherapy and is free of tumor after 10 years. All 4 patients are alive and well with tumor control. Of the 2 patients with orbital extension of basal cell carcinoma, tumor control without recurrence has been achieved in both after 2 years. The patient with orbital metastasis responded to plaque radiotherapy, with no orbital recurrence, but died of systemic metastasis. The patient with orbital melanoma had local orbital recurrence separate from the area of irradiation and is currently being treated for systemic metastasis. CONCLUSIONS: Based on preliminary observations, plaque radiotherapy appears to be a reasonable alternative to exenteration and external irradiation for selected orbital malignancies.

Adult↗
PubMed2003

Feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes in patients with conjunctival and periocular skin malignancies.

PURPOSE: To determine the feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes (SLNs) in patients with conjunctival and periocular skin tumors and to determine the patterns of lymphatic drainage from such tumors. METHODS: We retrospectively reviewed the records of all patients with biopsy-confirmed conjunctival and periocular skin malignancies who underwent lymphoscintigraphy with or without SLN biopsy between January 1999 and June 2000. Patients underwent lymphoscintigraphy with 0.3 to 1 mCi of technetium Tc-99m sulfur colloid in a volume of either 0.2 mL or 1 mL. Images were taken as soon as the first SLNs were detected through the camera and every 15 minutes thereafter. Intraoperative mapping and SLN biopsy was performed 1 to 2 days after lymphoscintigraphy unless the patient refused or there were medical contraindications to the procedure. RESULTS: The study included 7 patients with malignant melanoma of the conjunctiva or periocular skin and 1 patient with Merkel cell carcinoma of the eyelid. On lymphoscintigraphy, at least 1 SLN was identified in 7 of the 8 patients. Although all lesions located in the lateral half of the ocular adnexa drained to at least one SLN in the parotid (preauricular) area, there was some variability in the drainage patterns of lesions located in the medial half of the ocular adnexa. A smaller injection volume (0.2 mL) was adequate for detecting the nodes draining the area of injection and led to less spread of technetium to the surrounding areas. Six patients underwent SLN biopsy. In all but one, the nodes identified during surgery corresponded with those visualized on lymphoscintigraphy. CONCLUSIONS: Preoperative lymphoscintigraphy successfully identifies SLNs in most patients with conjunctival and periocular skin malignancies. Smaller injection volumes (0.2 mL) appear to be adequate for identification of the sentinel nodes and lead to less spread to surrounding tissues.

Adolescent↗
PubMed2003

Successful treatment with mitomycin C eye drops for conjunctival diffuse intraepithelial neoplasia with sebaceous features.

Conjunctival biopsy specimens from the right eye of a 66-year-old woman who had a 10-year history of an irritated and swollen right upper eyelid were diagnosed as diffuse intraepithelial neoplasia with sebaceous features. The treatment consisted of two courses, 2 weeks apart, of 0.02% mitomycin C eye drops. Biopsies performed after completion the second course showed no evidence of neoplastic involvement. Severe trichiasis that developed after the biopsies was managed surgically. Today, 46 months after completion of mitomycin C treatment, the conjunctiva shows no inflammation, the eyelid is not swollen or irritated, and there is no clinical indication of recurrence. This case report demonstrates that conjunctival diffuse intraepithelial neoplasia of the conjunctiva with sebaceous features can be successfully treated by treatment with mitomycin C drops.

Aged↗
PubMed2004

Sebaceous gland tumors of the eyelids and conjunctiva in the Muir-Torre syndrome: a clinicopathologic study of five cases and literature review.

PURPOSE: To study the sebaceous tumors of eyelid/conjunctiva associated with Muir-Torre syndrome (MTS) and to determine the role of immunohistochemical markers (MSH2, mismatch repair gene) in the diagnosis of patients with MTS. METHODS: A retrospective, noncomparative case series of 5 patients diagnosed with MTS from our laboratory. We also reviewed all previously reported cases of sebaceous eyelid tumors with a visceral malignancy. RESULTS: Four of the 5 patients were men, with a mean age of 55 years (range, 41 to 76 years). Four of the 5 patients had gastrointestinal carcinoma. On histopathological examination, 4 of the 5 tumors were classified as sebaceous adenomas that exhibited a distinct lobular pattern with prominent basaloid cells at the periphery of the lobules. One tumor was classified as a well-differentiated sebaceous gland adenocarcinoma. The diagnosis of MTS in all 5 patients was made after the diagnosis of the eyelid lesions. Immunohistochemical stains showed a lack of MSH2 expression in two tumors, which is highly consistent with MTS. CONCLUSIONS: Muir-Torre syndrome should be considered in patients who develop sebaceous tumors of the ocular adnexa. Immunohistochemistry for MSH2 is a practical initial approach for screening MTS in patients with sebaceous tumors.

Adenocarcinoma, Sebaceous↗
PubMed2004

Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center.

PURPOSE: To describe one center's experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival malignancies performed with a smaller volume of technetium than was initially used and a small incision directly overlying the sentinel node(s). METHODS: A noncomparative interventional case series of 13 patients with clinically negative regional lymph nodes who underwent SLN biopsy for eyelid or conjunctival malignancies at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003. Preoperative lymphoscintigraphy was performed with an injection of 0.3 mCi of technetium Tc-99m sulfur colloid in a volume of 0.2 mL. Images were taken as soon as the first SLN was detected through the gamma camera. Intraoperative mapping was performed with the same volume and concentration of technetium Tc-99m sulfur colloid along with an injection of isosulfan blue dye. RESULTS: Five patients had conjunctival melanoma, 6 had sebaceous cell carcinoma of the eyelid, and 2 had eyelid melanoma. SLN(s) were identified in all patients. In 12 patients, more than 1 SLN was identified. During surgery, no SLNs were blue. One patient with conjunctival melanoma had an SLN that was positive on histologic examination. There were no ocular or extraocular complications from the procedure except for mild temporary weakness of the marginal mandibular branch of the facial nerve in 2 patients that resolved completely within 4 to 6 weeks and without any further intervention. None of the patients had permanent blue tattooing of the conjunctival surface or eyelid skin. CONCLUSIONS: Our experience suggests that lymphoscintigraphy and SLN biopsy with a small volume of technetium Tc-99m sulfur colloid and small incisions, even without the use of the blue dye, can identify SLNs in patients with conjunctival and eyelid malignancies, and can be performed safely.

Adenocarcinoma, Sebaceous↗
PubMed2005

Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement.

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.

Administration, Topical↗
PubMed2005

Conjunctival Kaposi sarcoma as the initial presentation of human immunodeficiency virus infection.

A 34-year-old man presented to the ophthalmology clinic because of an enlarging mass of the left bulbar conjunctiva, found to be Kaposi sarcoma by histologic examination. The patient had no prior diagnosis of human immunodeficiency virus infection, making this one of only two descriptions in the literature of conjunctival Kaposi sarcoma as the initial presentation of human immunodeficiency virus infection. With surgical resection and highly active antiretroviral therapy, the prognosis is good.

AIDS Serodiagnosis↗
PubMedDate not supplied

Dermoid cyst of conjunctival origin.

A 22-year-old man with a recurrent intraconal cystic mass of the orbit presented with proptosis, motility restriction, and optic disc edema. On initial surgery, the cyst wall showed nonkeratinized cuboidal epithelium with adnexal structures. After recurrence, repeat histopathologic evaluation again showed nonkeratinizing conjunctival epithelium with goblet cells. The diagnosis was consistent with a dermoid cyst of conjunctival origin. Our review of the literature found 29 previous cases in the literature. Unlike typical cutaneous dermoids, conjunctival dermoids occur in young adults and are usually located in the nasal or superonasal deep orbit. The location and adnexal structures associated with these lesions suggests derivation from embryonic epithelium destined to become caruncle.

Adult↗
PubMedDate not supplied

Expression of the epidermal growth factor receptor in conjunctival squamous cell carcinoma.

PURPOSE: To determine whether the tyrosine kinase epidermal growth factor receptor (EGFR) is expressed in squamous cell carcinoma of the conjunctiva. METHODS: A retrospective, observational case series of 5 patients with biopsy-proven conjunctival squamous cell carcinoma treated at one institution between January 1996 and April 2004. Medical records and tissue specimens from the 5 patients were reviewed. A control specimen of normal conjunctiva was also obtained from one of the 5 patients. Immunohistochemical analysis was performed using antibodies against EGFR. RESULTS: Immunohistochemical staining showed that EGFR expression was moderate to strong in all tissue specimens, both in the normal mucosa and in the in situ and invasive components of the conjunctival squamous cell carcinomas. CONCLUSIONS: An intense expression of EGFR occurs in squamous cell carcinoma of the conjunctiva. Further study is needed to determine whether an EGFR inhibitor that targets this expression would have potential therapeutic benefit in treating squamous cell carcinoma of the conjunctiva.

Adult↗
PubMedDate not supplied

Conjunctival squamous cell carcinoma of the orbit 40 years after enucleation.

Conjunctival squamous cell carcinoma developed in a 51-year-old man 40 years after he had enucleation of his left eye because of an explosion injury. He had worn several ocular prostheses for more than 40 years. Recently he had noticed an increasing sanguineous conjunctival discharge, a foreign body sensation, and swelling of his left lower eyelid. Incisional biopsies of an underlying conjunctival mass revealed squamous cell carcinoma. His work history did not involve exposure to radiation, chemicals, or the sun. The authors concluded that squamous cell carcinoma in this case was caused by chronic irritation as the result of long-standing use of a poorly fitting ocular prosthesis.

Blast Injuries↗
PubMedDate not supplied

Basal cell carcinoma of the caruncle.

An 82-year-old white man presented with a 2- to 3-month history of a lesion in his left medial canthal region. Surgical excision of the lesion was performed, and histopathology showed a nodular basal cell carcinoma of the caruncle. Because of incomplete surgical margins after the initial excision, a second excision was performed, followed by a course of adjuvant radiotherapy. No tumor recurrence was detected in the caruncle after 6 months of follow-up.

Aged, 80 and over↗
PubMedDate not supplied

Aggravation of eyelid and conjunctival malignancies following photodynamic therapy in DeSanctis-Cacchione syndrome.

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.

Carcinoma, Squamous Cell↗
PubMed2005

Conjunctival melanoma: the role of conservative surgery and radiotherapy in regional metastatic disease.

OBJECTIVE: To evaluate prognostic factors and determine the role of conservative surgery and radiotherapy in managing metastatic conjunctival malignant melanoma (MM) involving preauricular/submandibular lymph nodes. METHOD: A retrospective analysis (1990-2003) of clinical and histopathologic data from 12 patients presenting with regional metastases after failed local treatment for conjunctival MM. Patients received a common, multispecialty, conservative management approach: wide local excision, topical cryotherapy or radiotherapy to conjunctival MM (orbital exenteration for more advanced local disease), lumpectomy, and adjuvant "ring" radiotherapy of regional metastases, with chemotherapy for distant metastases. RESULTS: Median age at primary diagnosis was 51 (range 28-86) years with equal sex predilection. Six of the 12 patients had primary tumors of the bulbar conjunctiva; the remainder arose in the palpebral conjunctiva, the caruncle, or the fornix. Of 11 originating in primary acquired melanosis (PAM), 2 were amelanotic. Epithelioid tumor cells were noted histologically in seven of eight specimens in which cell type could be determined. Eight tumors metastasised to preauricular nodes, three to submandibular and one to both, with a median interval of 23 (range 12-108) months after primary diagnosis. After conservative surgery and "ring irradiation," 7 of 12 patients remained free of regional nodal relapse at median interval of 16 (range 3-126) months. Five patients developed regional nodal recurrence at median interval of 11 (range 6-13) months, 3 of whom were within radiotherapy portals. Eight patients developed distant metastasis at median interval of 44 (range 22-138) months. Eleven patients had tumor-related death. The mean Kaplan-Meier adjusted survival time after primary diagnosis was 76 months with death ensuing postregional metastasis within a median 18 (range 4-127) months. The sole survivor's follow-up duration was 56 months. CONCLUSION: Locoregional metastasis after treatment for conjunctival MM is associated with a poor prognosis. Both epithelioid tumor cells and PAM are associated with disseminating disease and poorer outcome. Literature review has failed to demonstrate advantages of mutilating radical surgery over a conservative approach in this rare disease.

Adult↗