Pituitary adenoma invasion into the orbit is a rare phenomenon with only 22 cases, including the present case, in the literature. Our case is a 31-year-old man who presented with biopsy-proven atypical pituitary adenoma invading the right orbit after a prior resection. We compare his clinical course with previous cases and discuss clinical features, radiological features, management considerations, histologic features, and prognosis. Cases are organized by specific pituitary tumor type to aid in determining appropriate management. Early surgical intervention is the key, especially in the setting of pathologic features indicating aggressive tumor behavior or worsening visual function but is generally not indicated in prolactin-secreting adenomas that may respond to medical therapy. The role of radiation therapy is not fully established; however, it should be strongly considered in conjunction with or after surgery, especially in cases where complete resection is not achieved or histological and molecular analyses indicate a high likelihood of recurrence. More uniform and comprehensive data about management and outcomes are needed to determine the optimal treatment approach for this rare entity.
Objective: To report the clinicopathologic features of 2 patients with carcinosarcoma of the orbit.
Design: Case reports.
Participants: Two patients with orbital carcinosarcoma were identified.
Methods: Retrospective chart review with clinicopathologic correlation and literature review.
Main Outcome Measures: Clinical examination, imaging studies, and histopathologic findings.
Results: Two patients, a 56-year-old woman and a 91-year-old woman, with orbital carcinosarcoma were identified. Both tumors contained sarcomatous and carcinomatous components and invaded periorbital structures.
Conclusions: Carcinosarcoma may arise in the orbit or extend into the orbit from the paranasal sinuses. This malignant neoplasm should be aggressively treated with a combination of surgical resection, chemotherapy, and radiation therapy.
Although successful full-thickness corneal transplantation has been performed for over a century, popularization of posterior lamellar transplantation is a recent phenomenon. In fact, we are currently in the midst of a corneal surgery revolution. Many of the corneal transplants performed for endothelial-related disease may be replaced potentially by endothelial keratoplasty (EKP). Work on EKP began in the late 1990s, with the introduction of endokeratoplasty and microkeratome-assisted posterior keratoplasty.3 In these surgeries, an anterior flap is created, a posterior lamellar dissection is performed, and a posterior lamellar donor including posterior stroma, Descemet's membrane, and endothelium is sutured into place.
Macrophages have been found to be negative predictors of outcome in patients with uveal melanoma. In particular, recent studies point towards a disease-progressing role of proangiogenic M2 macrophages in melanomas with monosomy 3. Although most studies implicate a protective effect of PPAR-gamma activation in tumors, PPAR-gamma has also been shown to promote the polarization of M1 macrophages towards the M2 phenotype. The purpose of this investigation was first, to characterize the phenotype of tumor infiltrating macrophages and second, to study PPAR-gamma expression in uveal melanomas with molecular gene expression profile as prognostic predictors for patients’ outcome. Twenty specimens from patients with uveal melanoma were analyzed for clinical and histologic tumor characteristics. The molecular RNA profile (class 1 or class 2) was commercially determined. Using immunohistochemical techniques, the specimens were dual labeled for CD68 and CD163. CD68+CD163− M1 macrophages and CD68+CD163+ M2 macrophages were analyzed in ten high power fields sparing macrophage-poor areas and a mean value was calculated for each tumor. The tumors were immunostained for von Willebrand factor and the mean vascular density (MVD) was analyzed according to Foss. To assess the proliferative rate of each tumor, Ki67 expression was evaluated in ten high power fields followed by calculation of a mean value. Expression of PPAR-gamma was evaluated using a score from 0 (no staining) to 3 (tumor entirely stained). Statistical analysis and a respective correlation was made between histologic characteristics, molecular profile, type of tumor infiltrating macrophages (M1 versus M2), MVD, proliferative rate, and PPAR-gamma expression. Our results showed a correlation between the ratio of M2/M1 macrophages and the molecular profile with a ratio of approximately 1 corresponding to molecular class 1 and a ratio of approximately 2 corresponding to molecular class 2 (p=0.01). The ratio of M2/M1 macrophages was higher in tumors with extraocular extension (p=0.01). PPAR-gamma was predominantly expressed in the cytoplasm of tumor cells. Its expression showed no association with the molecular RNA profile (p=0.83). This study confirmed that the ratio of M2/M1 macrophages is another prognostic factor in uveal melanoma. Thus, polarization of macrophages plays an important role for patients’ outcome. PPAR-gamma is expressed in uveal melanoma tumor cells and further studies are warranted to determine its role in tumor biology.
Objective: To evaluate the efficacy of subconjunctival nanoparticle carboplatin in the treatment of transgenic murine retinoblastoma.
Methods: Dendrimeric nanoparticles loaded with carboplatin were prepared. Forty LHβ-Tag mice were randomly assigned into 4 groups, and treated at 10 weeks of age. Each mouse received a single subconjunctival injection in one eye, and the opposite eye was left untreated as a control. Group 1 (high-dose nanoparticle) received 37.5 mg/ml nanoparticle carboplatin; Group 2 (low-dose nanoparticle) received 10 mg/ml nanoparticle carboplatin; Group 3 (conventional carboplatin) received 10 mg/ml of carboplatin in aqueous solution, and group 4 (phosphate-buffered saline; PBS) received PBS. Mice were euthanized on day 22 after treatment. Eyes were serially sectioned, and retinal tumor burden was quantified by histopathologic analysis.
Results: Mean tumor burden in the treated eyes was significantly smaller compared to the untreated eyes in the same mice in both nanoparticle carboplatin groups (Group 1, P=0.02; Group 2, P=0.02), to the treated eyes in conventional carboplatin group (Group 1 vs. 3, P<0.01; Group 2 vs. 3, P=0.01), and PBS group (Group 1 vs. 4, P<0.01; Group 2 vs. 4, P=0.01). The untreated eyes in high-dose nanoparticle carboplatin showed significantly smaller tumor mass compared to conventional carboplatin (P=0.03) and PBS group (P=0.04). No toxicity was observed in any of the groups.
Conclusions and Clinical Relevance: A single injection of subconjunctival nanoparticle carboplatin was effective in the treatment of transgenic murine retinoblastoma with no associated toxicity. The higher dose of subconjunctival nanoparticle carboplatin decreased the tumor burden in the contralateral eye.
Purpose: To report the clinicopathologic features of three patients with CD30+ lymphoid proliferations of the eyelid.
Design: Retrospective case series.
Participants: Patients with cutaneous CD30+ lymphoproliferative lesions of the eyelid.
Methods: Three patients with CD30+ non-mycosis fungoides T cell lymphoid infiltrates of the eyelid were identified. The histories, clinical findings, pathologic features including immunohistochemical staining, treatments and outcomes were reviewed and compared.
Main Outcome Measures: Pathologic findings including immunohistochemical analysis.
Results: The patients included an 81-year-old man, an 18-year-old man, and a 42-year-old woman, with CD30+ lymphoid proliferations of the eyelid and adjacent soft tissue. The first patient had an isolated crateriform eyelid lesion that was classified as lymphomatoid papulosis (LyP). The second patient had an isolated multinodular lesion of the eyelid that was classified as cutaneous anaplastic large cell lymphoma (cALCL). The third patient presented with eyelid edema with an underlying mass and was found to have widely disseminated anaplastic large cell lymphoma (ALCL). Diagnoses were dependent on clinical findings.
Conclusions: CD30+ lymphoid proliferations represent a spectrum of conditions ranging from indolent LyP, to moderately aggressive cALCL, and to highly aggressive ALCL. Interpretation of the pathologic findings in CD30+ lymphoid proliferations is based in part on clinical findings.
Retinoblastoma is the most common primary intraocular tumor of childhood and may be heritable or occur sporadically. Anterior diffuse retinoblastoma is an uncommon variant that is thought to be sporadic. We describe a child with anterior diffuse retinoblastoma who presented with a pseudohypopyon. Genetic analysis showed a germline mutation of the RB1 allele that is potentially heritable. Immunofluorescence staining was positive for transforming growth factor β and for vascular endothelial growth factor and negative for inducible nitric oxide synthase and for hypoxia inducible factor α in the tumor seeds, indicating acquisition of nonischemia-mediated survival factors of the tumor seeds in the aqueous humor.
A 4-week-old boy with subependymal lesions consistent with tuberous sclerosis was evaluated for a large intraocular tumor in the left eye. The eye was enuclated and examination showed a retinal giant cell astrocytoma composed of giant, round cells and spindle-shaped cells, with associated aggregates of mononuclear inflammatory cells.
Six patients with mucinous eccrine carcinoma of the eyelid were identified in the case records of the L.F. Montgomery Laboratory. Five of these patients had undergone Mohs micrographic surgery after their initial diagnosis. Follow-up ranged from three months to eight years. Four patients with negative margins of excision had no evidence of recurrence, one patient was lost to follow-up and one patient with positive margins of excision had two recurrences after incomplete excision of the tumor. We recommend surgical excision of mucinous eccrine carcinoma of the eyelid with histologic monitoring of the surgical margins of resection.
A 27-year-old woman developed a rapidly progressive left orbital tumor which extended into the cranial fossa. MRI revealed a heterogenous enhancing lesion confined to the left frontal bone and superior orbit. An excisional biopsy was performed and examination of the specimen showed findings diagnostic of a high-grade0020myxofibrosarcoma. Myxofibrosarcoma is a fibroblast-derived soft tissue neoplasm with up to a 60% local recurrence rate and metastasis may be associated with intermediate to high grade tumors. Complete excision with postoperative adjuvant radiation therapy with chemotherapy was performed.