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At least 811 records · Page 45Linked to original sources

Orbital foreign body masquerading as conjunctival melanoma 60 years after injury.

A 74-year-old man presented with a 6-month history of a pigmented conjunctival lesion on his left eye. The lesion was initially suspicious for conjunctival melanoma. The patient admitted to a remote history of trauma from a airgun pellet over 60 years ago. Anterior examination revealed a 6 x 6 mm pigmented left conjunctival lesion and B-scan of the lesion was suggestive of a retained orbital foreign body. The lesion was removed through a transcaruncular medial orbitomy and pathology showed a retained orbital foreign body. A newly pigmented conjunctival lesion although initially concerning for melanoma represented a retained orbital body that surfaced many years after the initial orbital trauma.

Aged↗

Malignant fibrous histiocytoma of the conjunctiva.

Fibrous histiocytomas are mesenchymal tumours composed of cells with fibroblastic to histiocytic differentiation. They can occur in any part of the body including the orbital tissues. To date, there are 18 cases of fibrous histiocytoma arising from the corneoscleral limbus reported in the literature. Eleven of these were classified as benign, and the rest were malignant fibrous histiocytomas. Benign fibrous histiocytomas have been reported in the orbit, eyelid, episclera and conjunctiva. Malignant fibrous histiocytoma has been well described in the orbit, but rarely as a primary conjunctival tumour. The rarity of the tumour makes its diagnosis and management a challenge. Herein, the clinicopathological features of a case of malignant fibrous histiocytoma are presented and its management with wide excision and cryotherapy followed by ocular reconstruction with amniotic membrane transplant is discussed.

Biomarkers, Tumor↗

Interferon alpha 2b treatment for residual ocular surface squamous neoplasia unresponsive to excision, cryotherapy and mitomycin-C.

Three patients had residual or recurrent tumour following excision of large ocular surface squamous neoplasia (OSSN) lesions, which did not resolve despite the use of adjunctive cryotherapy and topical mitomycin-C therapy. The residual tumour was treated with topical or subconjunctival injectable interferon alpha 2b. All three eyes had complete resolution of the OSSN lesions after an average of 6 weeks (range 4-8 weeks) of treatment with interferon alpha 2b. No regrowth was seen during the follow-up period of 22.7 +/- 32.3 months (range 5-60 months). No adverse reactions or complaints were reported during and following interferon use, and previous symptoms from mitomycin-C treatment resolved completely. In these patients subconjunctival or topical interferon was an effective and safe treatment for residual OSSN. Longer follow up is required to confirm the long-term efficacy in prevention of recurrences.

Aged↗

Haemangioendothelioma on the conjunctiva of the upper eyelid.

A 62-year-old man visited the authors' clinic complaining of a mass on the palpebral conjunctiva of the right upper eyelid. The 2.0 cm x 1.2 cm sized, red and painless mass underwent incision and biopsy for histopathological examination. The mass was confirmed to be Kaposiform haemangioendothelioma characterized by densely packed spindle cells. These cells were positive to vimentin, CD31 and factor VIII-related antigen by immunohistochemical stain. The mass was completely resolved by oral steroid therapy and has not recurred through the presentation. Kaposiform haemangioendothelioma generally occurs in infant and adolescent periods and is characterized by rapid progression and invasion to adjacent tissue. Herein, an unusual case of Kaposiform haemangioendothelioma affecting the conjunctiva of the upper eyelid on a middle-aged man is reported.

Administration, Oral↗

Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and cornea: review of the evidence and recommendations for treatment.

Surgical excision with cryotherapy is a well-established treatment option for malignant melanoma or primary acquired melanosis (PAM) with atypia of the conjunctiva and cornea. Topical chemotherapeutic agents such as mitomycin C (MMC) however, are increasingly finding use in clinical practice. A search was performed of Medline and Pubmed databases for English language articles from 1980 to the present in this field. Relevant studies were reviewed with regards to treatment regimen, rates of recurrence and metastasis, side effect profile and length of follow up. A total of 22 and 16 unique cases of biopsy proven PAM with atypia and malignant melanoma, respectively, treated with topical MMC were identified. Topical MMC was well tolerated and shows considerable promise, particularly in the treatment of diffuse PAM with atypia. However, long-term data are lacking and further studies are required.

Administration, Topical↗

Pigmented squamous cell carcinoma of the conjunctiva of a horse.

Abstract A heavily pigmented tumor was removed from the lateral, perilimbal, bulbar conjunctiva of a bay Thoroughbred horse. Excision was incomplete and the base of the tumor was lasered on the assumption that the tumor was a melanoma. No other ophthalmic lesions were seen. Histology showed the mass to be a pigmented squamous cell carcinoma (SCC). The prognosis and recommended treatment protocols are different for SCC and melanoma. This is, to the best of our knowledge, the first report of an ocular, pigmented SCC in the veterinary literature.

Animals↗

Bilateral nodular lymphocytic conjunctivitis in a horse.

A Russian jumper horse presented because of an ocular perilimbal conjunctival mass and, on clinical examination, two bilateral conjunctival masses were found, of different size and conformation. Attempts at complete excision of the left eye mass and excisional biopsy of the right eye mass were performed. The left eye mass recurred rapidly, but resolved completely after topical corticosteroid therapy. The two lesions had similar histopathologic features, characterized by focal, chronic, primarily lymphocytic conjunctivitis with follicular lymphoid hyperplasia. Special histopathologic staining techniques (Gomori methenamine silver and acid fast stains) and immunohistochemistry (for CD3, BLA36 and lysozyme) failed to reveal any etiologic agents and indicated an inflammatory lesion composed of a heterogeneous population of lymphocytes and macrophages (nodular lymphocytic conjunctivitis). The lesions were indistinguishable, clinically and behaviorally, from what has been reported as 'conjunctival pseudotumor' in the horse. Equine conjunctival pseudotumor/nodular lymphocytic conjunctivitis has been reported to be unilateral and have a good prognosis after partial or complete surgical excision. This is the first reported case of bilateral nodular lymphocytic conjunctivitis in a horse and for which surgical excision alone was not curative.

Animals↗

Canine limbal melanoma: 30 cases (1992-2004). Part 1. Signalment, clinical and histological features and pedigree analysis.

OBJECTIVES: (1) To review the signalment, clinical, and histological features of canine limbal melanoma; (2) to perform pedigree analysis on breeds predisposed to limbal melanoma to establish if common ancestry exists; and (3) to investigate if any ancestral relationship exists between canine limbal melanoma and canine anterior uveal melanoma (CAUM). DESIGN: Retrospective study. ANIMALS STUDIED: Thirty dogs with limbal melanoma. METHODS: Medical records of patients were reviewed. Follow-up information was obtained by re-examination of patients or telecommunications with the referring veterinary surgeons or the owners. Pedigrees were analyzed for common ancestry amongst affected dogs. RESULTS The mean age (+/- SD) at diagnosis was 6.2 (+/- 2.75) years with a range from 1 to 11 years. There was a bimodal distribution of ages with a peak at 3-4 years and a peak at 7-10 years. There was no eye predilection or predisposition for sex or coat color. Twenty-five (83%) of the limbal melanomas occurred within a dorsal arc from the dorsomedial to the ventrolateral limbus. Golden retrievers were four times more common in the melanoma group compared to the Animal Health Trust population (P < 0.0001). Labrador retrievers were three times more common in the melanoma group (P=0.01). Pedigree analysis on eight Golden retrievers [limbal melanoma (n=5), CAUM (n=2) and diffuse ocular melanosis (n=1)], revealed a pattern of inter-relatedness consistent with the condition(s) being caused, at least in part, by a genetic mutation(s). A similar level of inter relatedness was evident in six Labrador retrievers (limbal melanoma (n=2) and CAUM (n=4)). In 5/22 cases (23%), histological features suggestive of malignancy were present including intratumor necrosis in 4/22 cases (18%) and cellular atypia in 1/22 cases (5%). CONCLUSIONS: In Golden and Labrador retrievers there is evidence that limbal melanomas, CAUM and ocular melanosis are at least in part heritable and that the same genetic mutation(s) may be causally associated with melanocytic disease at different ocular sites. The same genetic mutation(s) may be present in these two breeds. Histology should be performed on all cases to identify those with greater malignant potential.

Age Factors↗

Canine conjunctival hemangioma and hemangiosarcoma: a retrospective evaluation of 108 cases (1989-2004).

Canine conjunctival tumors of vascular endothelial origin are common, although under-reported. The purpose of this study was to evaluate the epidemiology of and potential risk factors for these tumors. This study evaluated 108 cases (70 hemangiomas, 38 hemangiosarcomas) from 8300 canine submissions between 1989 and 2004. Signalment, location, pigmentation, size, duration, diagnosis, margins, ancillary therapy, and geographic location were recorded. Follow-up information was available for 49 cases. Each case was matched with two unaffected controls and compared using logistic regression analysis. Average age upon presentation was 8.6 years; there was no sex predilection. Risk of conjunctival tumors was statistically different among breed groups (P = 0.0010), demonstrating a propensity to occur in groups likely to have increased outdoor activity. Primary involvement occurred within nonpigmented epithelium along the leading edge of the nictitating membrane (41/108) and temporal bulbar conjunctiva (33/108). The etiology remains unknown; however, the strong site predilection, involvement of nonpigmented epithelium, and development within specific breed classes strongly suggest ultraviolet (UV) light as a significant risk factor. In a full-logistic model including breed, gender, age, and UV exposure, UV was not a statistically significant variable (P = 0.1215). In a reduced-model including UV only, significance was approached (P = 0.0696) and posthoc contrast demonstrated a significant linear trend with increasing UV exposure (P = 0.0147). In separate analysis of risks associated with hemangiosarcoma, compared with hemangioma, breed was not significant while increasing UV exposure was significant (P = 0.0381). Early surgical therapy is recommended and may be curative; however, recurrence is possible and more likely with hemangiosarcomas (11/20).

Animals↗

Feline conjunctival hemangioma and hemangiosarcoma: a retrospective evaluation of eight cases (1993-2004).

The purpose of this retrospective study was to evaluate feline primary conjunctival vascular tumors of endothelial origin. Eight cases (six hemangiomas, two hemangiosarcomas) from a collection of 3460 feline submissions between 1993 and 2004 were evaluated using routine hematoxylin and eosin (H&E). Signalment, location, size, duration, epithelial pigmentation, margins, adjuvant therapy, outdoor activity, and geographic location, comparing ultraviolet (UV) radiation levels by state, were recorded. Follow-up information was available for five cases. In this study, the average age was 10.6 years, with neutered males over-represented. The Domestic Short-haired cat was most commonly affected. The most common anatomic site was the nictitating membrane, with the left eye preferentially affected. The average size and duration, prior to presentation, was 7.5 mm and 4.4 months, respectively. Seven of eight cases were devoid of epithelial pigmentation in nonaffected areas and the majority of cases were from states with high annual UV-light exposure. Only cases of hemangiosarcoma underwent surgical re-excisions following incomplete excision; however, no further recurrences were reported. No cases evaluated had evidence of metastatic disease at the time of excision. Surgical excision alone may be curative. However, recurrence is possible. These tumors demonstrate similar predilection sites and involvement of nonpigmented epithelium, as is true in canine cases, which may relate to risk factors as well.

Animals↗

Primary conjunctival mast cell tumor in a Labrador Retriever.

A 4-year-old, intact male Labrador Retriever with a rapidly progressive conjunctival mass was evaluated. Ocular examination showed a 2-cm elongated mass arising from the superior bulbar conjunctiva of the left eye. The mass resulted in distortion of the palpebral fissure and contacted the superior aspect of the cornea without modifying its structure; no adhesion to the sclera was detected. The superior palpebral conjunctiva was unaffected, and the remaining ocular examination was normal. The initial diagnostic work-up included CBC, serum biochemical analysis, urinalysis, and fine needle biopsy of the mass. A poorly differentiated mast cell tumor was diagnosed by cytology. Immunocytochemistry was performed to evaluate Ki-67 proliferation index, and 54/1000 tumoral nuclei showed a dark red staining. After a complete clinical staging, the mass was excised and identified histologically as a grade-II mast cell tumor. An adjuvant treatment with prednisone and vinblastine was instituted because of the limited excisional margins. No evidence of local recurrence or metastasis has been apparent during the 29-month follow-up period. This report contributes to the current literature pertaining to canine conjunctival mast cell tumors; unfortunately, the paucity of case reports and the absence of large studies regarding this tumor make conclusions regarding its biologic behavior impossible.

Animals↗

Goldenhar syndrome and autistic behaviour.

Two girls with concomitant Goldenhar syndrome (oculo-auriculovertebral spectrum disorder) and autistic disorder are described. One was diagnosed as having Goldenhar syndrome in the first few weeks of life and as having autistic disorder in her fifth year; the other was diagnosed as having Goldenhar syndrome when she was referred for evaluation of autistic symptoms at seven years of age. The type of physical abnormalities encountered in Goldenhar syndrome suggests damage to neural structures in the second or late stages of the first trimester. The two cases described in this report suggest that autistic disorder sometimes can result from neural damage during the second trimester.

Autistic Disorder↗

Are concurrent or subsequent malignant melanomas in the skin and eye related or coincidental?

Malignant melanomas sometimes occur simultaneously or subsequently in the skin and in the eye, multicentrically, not metastatically. The phenomenon is understandable in the B-K mole syndrome, in which multiple malignant melanomas are the rule. Otherwise simultaneous or subsequent malignant melanomas in one organ alone or in two disparate organs are rare and by change.

Basal Cell Nevus Syndrome↗

The failure of immunotherapy with dinitrochlorobenzene and Rhus extract for recurrent conjunctival squamous papillomas.

A 25-year-old white male is described who presented with recurrent conjunctival squamous papillomata. Despite prior reports of successful dinitrochlorobenzene use for tropical immunotherapy, its failure in our patient, and the first documented attempt to employ Rhus oleoresin (poison ivy/oak) extract for topical conjunctival immunotherapy is reported. The role of topical immunotherapy in treating recurrent conjunctival papillomas is discussed.

Administration, Topical↗