Orbital solitary fibrous tumor: a clinicopathologic study of ten cases with long-term follow-up.

BACKGROUND: Solitary fibrous tumor (SFT) is a rare spindle-cell benign neoplasm and located in orbit. The present research represents case reports of ten patients with orbital SFT. METHOD: Prognosis was assessed by clinic service and telephone interview. Clinical data were retrieved from the medical records. Immunohistochemistry for CD34, CD99, EMA, HMB-45, Bcl-2, GFAP, S-100, MBP, CK, and MIB-1 was performed. Distributions of time to progression and recurrence between different operative methods were estimated using the Kaplan-Meier method and compared using the log-rank test. FINDINGS: The ten patients included six men and four women (range: 19-75 years). The most common initial symptom was painless proptosis (n = 6). After the ten initial surgeries, with four requiring gross total resection (GRT) and six requiring subtotal resection (STR), an additional nine were required to remove recurrent tumors. Eighteen samples were obtained for pathological examination (the third sample for case 4 was not achieved). Cellular areas with partial hemangiopericytoma pattern were noted in four samples (4/18); scarce mitosis was noted in six samples (6/18). All SFTs (18/18) were positive for CD34, CD99 and vimentin, while all SFTs (18/18) were negative for EMA, CK, MBP, HBM-45 and GFAP. Bcl-2 was positive in 13/18 cases, while S-100 was negative in 14/18 cases. The MIB-1 labeling index varied from 1% to 3%. Follow-up was available for nine patients with a median of 88 months. All four patients who underwent GTR on initial operation did not recur; while the five patients who underwent STR recurred. The log-rank test showed that the incomplete surgical resection was significantly associated with recurrence (p = 0.015). CONCLUSIONS: Orbital SFT is a rare mesenchymal tumor and painless proptosis is the most common initial symptom. Immunohistochemistry should be used to differentiate SFT from other tumors. Orbital SFT usually has a non-aggressive histological characteristic, and has a good prognosis if GTR is performed. Postoperative regular and long-term follow-up remains mandatory to monitor recurrence.

[Clinical features and treatment of lateral orbital wall blow-in fracture].

OBJECTIVE: To analyze the clinical features of lateral orbital wall blow-in fracture and summarize the points of treatment. METHODS: A retrospective analysis of 12 patients with lateral orbital wall blow-in fracture treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2007 to January 2010 was investigated. Clinical records and results of follow-up were analyzed. RESULTS: Twelve cases of the lateral orbital wall blow-in fracture with the frontal process of the zygoma impacted into the orbit were confirmed. Globe rupture occurred in 1 case, 4 cases had traumatic optic neuropathy. 1 case suffered exophthalmos, 8 cases had enophthalmos. Diplopia was found in 5 cases and eyeball movement disturbance in 5 cases.3 cases had upper eyelid deformity, 1 case had ptosis, 3 cases had telecanthus accompanied with lacrimal ducts obstruction. 11 cases suffered orbital floor fracture, 9 cases had zygomatic arc fracture, 6 cases had orbital medial wall fracture, and 3 cases had naso-orbito-ethmoid fracture. Surgical treatment was performed by different combination of approaches according to the extents of injury; Osteotomy was performed in patients whose blow-in fracture was malformation. Orbital reconstructive surgery was performed in 11 patients and fractures were completely restored. CONCLUSIONS: The lateral orbital wall blow-in fracture could cause serious impairment to the ocular components, better outcomes could be achieved by timely and proper treatment with improving recognition of this type of fracture.

[A pilot investigation on serum protein fingerprinting of nasopharyngeal carcinoma].

OBJECTIVE: To establish a preliminary foundation for developing a serum proteomics diagnostic model of nasopharyngeal carcinoma (NPC) by comparing the differences in serum protein fingerprints between patients with NPC and healthy subjects and between different types of NPC. METHODS: The serum samples of 41 patients with different types of NPC and 20 healthy subjects were collected. Surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) were used to detect the blood samples to obtain serum protein mass spectrum, i.e. serum protein fingerprinting. Biomarker Wizard and Biomarker Patterns system software were used to compare the differences in serum protein mass spectrum between NPC patients and healthy subjects and between different types of NPC, and to screen out the NPC-related serum proteins. RESULTS: Compared with the healthy control, NPC patients emerged 9 very prominent protein peaks (P < 0.001), with the combined differential peaks. No significant difference was found in relative amount of serum proteins with different molecular mass between different types of NPC (P > 0.05). CONCLUSIONS: The serum marker proteins and specific protein fingerprints of NPC can be screened out by SELDI-TOF-MS, which could be used to develop a serum proteomics model for clinical screening and early diagnosis of NPC.

[Repairing rabbit orbital defects with human BMP-2 gene modified bone marrow stromal cells and coral].

OBJECTIVE: To investigate the efficacy of tissue-engineered bone (human BMP-2 genetic modified BMSC combined with coral) in healing the segmental orbital defect in rabbits. METHODS: Rabbit BMSC were isolated and cultured in vitro, and cells of passage 2 were infected with adenovirus-mediated transfection of human BMP-2 gene (150 pfu/cell). After infection, the expression of BMP-2 was determined by RT-PCR and Western blot analysis, and cell proliferation and osteogenic differentiation were observed by flow cytometry, ALP and Alizarin red staining. A 12 mm bone defect in the infraorbital rim was induced by surgery in both orbits of 24 New Zealand white rabbits. The defects were repaired with modified tissue-engineered bone constructed with coral plus BMP-2 transfected BMSC (Group A, n = 12), constructed by coral plus non-transfected BMSC (Group B, n = 12) and grafts of coral alone (Group C, n = 12), with untreated group (Group D, n = 12) served as control. The osteogenesis of bone defect was monitored by gross observation, micro-CT measurement, histological and histomorphologic analysis at 4, 8, and 16 weeks after the implantation. RESULTS: After transfection, the BMP-2 expression was confirmed by RT-PCR and western blot, and the osteogenesis activity of BMSC could be obviously enhanced. The 12 mm segmental defect of rabbit orbit couldn't heal alone. Gross observation and micro-CT demonstrated well the bony-union in experimental group, with higher bone mineral density and more bone volume than other control groups (F = ll.46, F = 7180.97; P < 0.05). CONCLUSION: This study demonstrated that the rabbit orbital defect could be successfully repaired by tissue-engineered bone constructed with human BMP-2 gene modified BMSC and coral.

[Treatment of orbital venous malformation using surgical procedure combined with Nd:YAG laser].

OBJECTIVE: To evaluate the security and efficacy of surgical procedure combined with Nd:YAG laser in the management of orbital venous malformation. METHODS: A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd:YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm2 or less than 100 J/cm2, respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. RESULTS: Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis (1 case) and ptosis (1 case). Relapse or aggravation of residual lesion was not found during the whole follow-up period. CONCLUSIONS: Surgical procedure combined with Nd:YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment.

[Obstruction of lacrimal pathways in naso-orbital-ethmoid fractures and the relationship between lacrimal obstruction and fracture types].

OBJECTIVE: To analyze the incidence and pattern of lacrimal pathways obstruction after naso-orbital-ethmoid fractures (NOE), and to investigate the relationship between lacrimal obstruction and fracture types. METHODS: One hundred and one patients with NOE fractures were analyzed retrospectively. These patients were treated in the Department of Ophthalmology, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University from January 2000 to January 2005. The fractures were grouped in according to the classification of Markowitz. All of the patients were assessed with syringing and probing or dacryocystography. The incidence of obstruction in different NOE fracture types was analyzed to illustrate the relationship between obstructions and fracture types. The incidence of different obstruction parts of lacrimal system was evaluated to find which part was more vulnerable. RESULTS: In 101 NOE cases, 63 cases were accompanied with lacrimal obstruction. The naso-lacrimal system was more vulnerable in its bony canal than in the lacrimal canalicular. Obstruction was found in the bony nasolacrimal canal in 39 patients (61.90%), and in the lacrimal canaliculus in 12 patients (19.48%). The defect of lacrimal sacs was found in 7 cases (11.11%), and lacrimal punctum was lost in 5 cases (7.94%). Three patterns of fracture were defined according to the Markowitz classification. Sixteen patients were classified into type I; 37 into type II; 48 into type III according to the Markowitz standard. The incidence of obstructions were 25% in type INOE fracture, 54.05%% in type II, 81.25% in type III, respectively. CONCLUSIONS: NOE fracture can cause lacrimal obstruction. Naso-lacrimal obstruction is the most common type. The incidence of obstruction changes with the severity of injury and the pattern of fracture.