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1.
Arq Bras Oftalmol ; 88(1): e20230205, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39109745

RESUMEN

Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.


Asunto(s)
Neoplasias del Ojo , Linfoma de Células del Manto , Humanos , Masculino , Anciano , Linfoma de Células del Manto/patología , Linfoma de Células del Manto/diagnóstico por imagen , Biopsia , Neoplasias del Ojo/patología , Enfermedades del Aparato Lagrimal/patología , Enfermedades del Aparato Lagrimal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dacriocistorrinostomía/métodos , Diagnóstico Diferencial
2.
Rom J Ophthalmol ; 68(2): 191-197, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39006336

RESUMEN

Lacrimal gland lymphomas are rare orbital tumors, constituting a minor fraction of all orbital and ocular adnexal malignancies. This case study presents an 83-year-old male with bilateral lacrimal gland tumors, more prominent in the left orbit, causing decreased visual acuity, red eye, excessive tearing, and diplopia. Initial ophthalmological evaluations and imaging suggested bilateral lacrimal gland lymphoma, confirmed by histopathology as diffuse large B-cell non-Hodgkin lymphoma of the MALT type. Due to the significant tumor size and risk of visual function loss, surgical intervention was performed, followed by corticosteroid therapy. Postoperatively, a marked improvement in symptoms and a reduction in tumor size were observed. This case underscores the importance of comprehensive diagnostic approaches, including clinical, imaging, and histopathological evaluations, highlighting the need for a multidisciplinary approach in managing rare orbital tumors like lacrimal gland lymphoma. The patient's postoperative and follow-up care included oncological management to monitor and ensure long-term disease control and patient well-being. Abbreviations: RE = right eye, LE = left eye, CT = Computer tomography, MRI = Magnetic Resonance Imaging, TOD = intraocular pressure of right eye, TOS = intraocular pressure of left eye, US = ultrasound.


Asunto(s)
Enfermedades del Aparato Lagrimal , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Masculino , Anciano de 80 o más Años , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/cirugía , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/cirugía , Neoplasias del Ojo/terapia , Aparato Lagrimal/patología , Aparato Lagrimal/cirugía , Aparato Lagrimal/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/cirugía , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/cirugía , Agudeza Visual , Procedimientos Quirúrgicos Oftalmológicos/métodos , Biopsia
3.
PLoS One ; 19(7): e0305717, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38959275

RESUMEN

BACKGROUND: The present study reviewed the clinicopathological features and outcomes of bilateral lacrimal gland lesions. METHODS: The data of 113 patients who underwent lacrimal gland biopsy at the West China Hospital of Sichuan University, China, between January 1, 2010, and December 31, 2021, are presented in this case series. The patients all presented with bilateral lacrimal gland lesions. The collected data included patient demographics, clinical features, the results of laboratory examinations, imaging presentations, histopathological diagnoses, treatments, and outcomes. RESULTS: The mean age of the 113 enrolled patients was 47.4 ± 14.9 years (range, 11-77 years) with a predominance of females (54.9%, n = 62). The lacrimal gland was the source of the majority of biopsy tissue (98.2%, n = 111). The most prevalent etiology was immunoglobulin G4-related ophthalmic disease (IgG4-ROD) (32.7%, n = 37), followed by idiopathic orbital inflammation (IOI) (28.3%, n = 32), mucosa-associated lymphoid tissue (MALT) lymphoma (17.7%, n = 20), reactive lymphoid hyperplasia (RLH) (10.6%, n = 12), and mantle cell lymphoma (4.4%, n = 5). Patients with IOI were significantly younger than those with IgG4-ROD and MALT lymphoma (t = 2.932, P = 0.005; t = 3.865, P<0.001, respectively). Systemic symptoms were more prevalent among patients with IgG4-ROD (χ2 = 7.916, P = 0.005). The majority of patients were treated with surgery (53.1%, n = 60), with surgery combined with corticosteroid therapy (21.2%, n = 24) being the second most common treatment. The majority of patients (91.2%, n = 103) attained complete resolution, stable disease, or significant improvement. CONCLUSION: In conclusion, there are several aetiologies associated with bilateral lacrimal gland lesions, the most prevalent being IgG4-ROD, IOI, and MALT lymphoma. Systemic symptoms were more common in patients with IgG4-ROD. The majority of patients who presented with bilateral lesions of the lacrimal glands responded satisfactorily to treatment, with favorable results.


Asunto(s)
Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Aparato Lagrimal/patología , Niño , Adulto Joven , Enfermedades del Aparato Lagrimal/patología , Estudios Retrospectivos , Biopsia , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/terapia , China/epidemiología , Resultado del Tratamiento , Enfermedad Relacionada con Inmunoglobulina G4/patología , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones
4.
Int Ophthalmol ; 44(1): 257, 2024 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-38909080

RESUMEN

PURPOSE: The most prevalent lacrimal apparatus dysfunctions associated with differentiated thyroid cancer(DTC) after I-131 therapy are dry eye and nasolacrimal duct obstruction(NLDO), leading to ocular discomfort and lower quality of life for patients. It is crucial to diagnose and manage lacrimal apparatus dysfunction associated with I-131 therapy for DTC. Therefore, this review aims to comprehensively summarize and analyze the advances in mechanisms and therapeutic options underlying lacrimal apparatus dysfunction induced by I-131 therapy for DTC. METHODS: A comprehensive search of CNKI, PubMed, and Wed of Science was performed from the database to December of 2023. Key search terms were "Thyroid cancer", "I-131", "Complications", "Dry eye", "Epiphora", "Tear", "Nasolacrimal duct" and "NLDO". RESULTS: The research indicates that I-131 therapy for DTC causes damage to the lacrimal glands and nasolacrimal duct system, resulting in symptoms such as dry eye, epiphora, and mucoid secretions. Moreover, recent research has focused on exploring relevant risk factors of the condition and experimental and clinical treatments. However, there is some controversy regarding the mechanisms involved, whether it is due to the passive flow of I-131 in tears, active uptake of I-131 by the sodium-iodide symporter (NIS) in the lacrimal sac and nasolacrimal duct, or secondary metabolic and hormonal disturbances caused by I-131. CONCLUSION: It is crucial for early detection and preventive measures by ophthalmologists and the need for further studies to elucidate the mechanisms underlying the disease.


Asunto(s)
Radioisótopos de Yodo , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Neoplasias de la Tiroides , Humanos , Radioisótopos de Yodo/efectos adversos , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Enfermedades del Aparato Lagrimal/etiología , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/fisiopatología , Síndromes de Ojo Seco/etiología , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/fisiopatología , Traumatismos por Radiación/etiología , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/fisiopatología , Calidad de Vida , Conducto Nasolagrimal/efectos de la radiación
5.
Aesthetic Plast Surg ; 48(15): 2786-2792, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38740621

RESUMEN

BACKGROUND: Lacrimal gland prolapse (LGP) is considered to be one of the causes for upper eyelid contour abnormality that should be recognized and treated properly to yield satisfactory outcomes in blepharoplasty. To describe current findings about the prevalence, pre- and intraoperative diagnosis of LGP and its treatment options. METHODS: PubMed and Google Scholar were thoroughly searched for articles published describing the diagnosis and treatment of LGP. RESULTS: The reported prevalence of LGP by various authors varies between 10 and 60% based on their preoperative or intraoperative reports. Techniques such as dacryoadenopexy, modified dacryoadenopexy, and dacryoplasty have been described to secure the prolapsed lacrimal gland back into its original position. Additionally, creating a Whitnall's barrier has also been suggested as a method to reposition the gland. While all these surgical procedures have shown promising immediate results, there is a lack of published data on their long-term outcomes. CONCLUSION: Diagnosis and proper treatment of LGP could enhance the cosmetic results of upper eyelid blepharoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Asunto(s)
Blefaroplastia , Enfermedades del Aparato Lagrimal , Humanos , Blefaroplastia/métodos , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/cirugía , Prolapso , Femenino , Masculino , Resultado del Tratamiento , Medición de Riesgo , Persona de Mediana Edad , Aparato Lagrimal/cirugía , Adulto , Estética
6.
Ophthalmic Plast Reconstr Surg ; 40(3): e91-e94, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38738722

RESUMEN

Calcification within pleomorphic adenomas of the lacrimal gland is well recognized but uncommon, being seen more readily in lacrimal gland carcinomas. Bony formation, ossification, in pleomorphic adenomas of the lacrimal glands is even rarer. Together with extensive sclerosis, or "coagulative necrosis," ossification and necrosis should alert the clinician to the risk of malignant transformation. However, both can mimic carcinomatous change, leading to misinterpretation of malignancy in an otherwise benign lacrimal gland neoplasm. We present 2 case reports of patients with clinically presumed pleomorphic adenomas of the lacrimal gland whose histopathology demonstrated lacrimal gland ossification and necrosis without features of malignancy or invasive disease.


Asunto(s)
Adenoma Pleomórfico , Neoplasias del Ojo , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Necrosis , Osificación Heterotópica , Humanos , Adenoma Pleomórfico/diagnóstico , Adenoma Pleomórfico/patología , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/patología , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/patología , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/patología , Necrosis/diagnóstico , Aparato Lagrimal/patología , Aparato Lagrimal/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Anciano
7.
Vestn Oftalmol ; 140(2. Vyp. 2): 158-165, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38739146

RESUMEN

The lacrimal gland (LG) is a tubuloacinar exocrine gland composed of acinar, ductal, and myoepithelial cells. Three-dimensional distribution of acinar lobules, ducts, and myoepithelial cells is necessary for the effective functioning of the organ. LG is the main organ of immune surveillance of the ocular surface system. The embryogenesis of the gland is regulated by the interaction of genetic mechanisms, internal epigenetic (enzyme systems, hormones) and exogenous factors. There is no doubt that there is a clear genetic program for the implementation of the complex process of embryonic development. The mechanisms regulating LG organogenesis initiate the work of a huge number of structural oncogenes, transcription and growth factors, etc. Studying the expression and selective activity of regulatory genes during organ development, their participation in the differentiation of different cell types is a current trend at the nexus of clinical genetics, molecular biology, embryology and immunocytochemistry. Due to its relatively simple structure and accessibility, human LG is a suitable object for potential application in regenerative medicine. Development of a universal protocol for obtaining functional differentiated secretory epithelium of LG capable of expressing tissue-specific markers is an urgent task. Determining the nature and origin of stem cells and progenitor cells will allow the isolation and multiplication of these cells in culture. After obtaining a functionally active culture of LG cells, it is possible to create a model of autoimmune diseases.


Asunto(s)
Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Medicina Regenerativa , Humanos , Medicina Regenerativa/métodos , Aparato Lagrimal/embriología , Aparato Lagrimal/fisiología , Enfermedades del Aparato Lagrimal/terapia , Enfermedades del Aparato Lagrimal/fisiopatología , Diferenciación Celular/fisiología
8.
Medicine (Baltimore) ; 103(21): e38303, 2024 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-38787969

RESUMEN

RATIONALE: The most common subtype of primary lymphoma of the ocular adnexa is the mucosa-associated lymphoid tissue (MALT) subtype. MALT lymphoma of the lacrimal gland is relatively rare among the lacrimal gland tumors, and the early clinical symptoms are atypical, which can easily lead to misdiagnosis and missed diagnosis. Here, we report a case of MALT lymphoma of the lacrimal gland and explore its clinical manifestations, pathological characteristics, management, and pathogenesis, with the aim of helping clinicians gain an in-depth understanding of ocular adnexal MALT lymphoma. PATIENT CONCERNS: A 60-year-old man presented to our hospital with proptosis and diplopia. The right eye deviated and shifted toward the lower part of the nose. DIAGNOSIS: Orbital enhanced magnetic resonance imaging suggested a mass with a maximum cross-section of 3.2 × 2.1 cm. T1 weighted image was isointense, and the enhancement was more uniform and obvious. INTERVENTIONS: The right orbital mass was treated surgically, and the final pathology report was MALT lymphoma. After the pathological report was released, the patient was transferred to the hematology department for further diagnosis and no further treatment was given eventually. OUTCOMES: Seven months later, the patient did not complain of discomfort. Whole-body positron emission tomography-computed tomography, superficial lymph node examination and orbital magnetic resonance imaging revealed no abnormal changes. LESSONS: The clinical manifestations of MALT lymphoma are heterogeneous. Imaging examination is important for assessing the size of the tumor and its relationship with adjacent tissues. Postoperative pathological examination may provide further evidence for the evaluation of the patient's surgical efficacy and prognosis. Management of MALT lymphoma of the lacrimal gland requires a multidisciplinary approach involving ophthalmologists, hematologists, and radiotherapists.


Asunto(s)
Neoplasias del Ojo , Aparato Lagrimal , Linfoma de Células B de la Zona Marginal , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/terapia , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Persona de Mediana Edad , Masculino , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/patología , Neoplasias del Ojo/terapia , Aparato Lagrimal/patología , Aparato Lagrimal/diagnóstico por imagen , Imagen por Resonancia Magnética , Enfermedades del Aparato Lagrimal/diagnóstico
9.
Acta Otorhinolaryngol Ital ; 44(Suppl. 1): S67-S81, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38745518

RESUMEN

A literature review was conducted to assess the role of minimally-invasive endoscopic treatments for lacrimal pathway neoplasms. The study involved the analysis of 316 patients with benign or malignant tumours affecting the lacrimal drainage system. Histologically, the analysis revealed a prevalence of squamous cell carcinoma, followed by lymphatic neoplasms and melanomas. In terms of treatment, minimally-invasive endoscopic approaches, such as endoscopic dacryocystorhinostomy, play a predominant role in managing early-stage tumours, rather than merely obtaining samples for histological analysis. For more extensive tumours, which constitute the majority of cases, more aggressive external approaches are required, along with the use of adjuvant radiotherapy and chemotherapy. The lack of universally shared staging systems poses a limitation in standardisation and comparison of results. Treatment of these tumours remains complex due to their rarity and histological heterogeneity. A multidisciplinary approach is mandatory to optimise outcomes.


Asunto(s)
Endoscopía , Neoplasias del Ojo , Humanos , Neoplasias del Ojo/cirugía , Neoplasias del Ojo/patología , Endoscopía/métodos , Aparato Lagrimal/cirugía , Enfermedades del Aparato Lagrimal/cirugía
11.
Aesthetic Plast Surg ; 48(12): 2246-2253, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38565726

RESUMEN

INTRODUCTION: Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP. METHODS: We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate. RESULTS: The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4 mm prolapse), with a relapse rate of 0% (0/47). CONCLUSION: Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Asunto(s)
Blefaroplastia , Estética , Enfermedades del Aparato Lagrimal , Humanos , Blefaroplastia/métodos , Femenino , Prolapso , Enfermedades del Aparato Lagrimal/cirugía , Resultado del Tratamiento , Adulto , Dacriocistorrinostomía/métodos
12.
Am J Rhinol Allergy ; 38(4): 211-217, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38623636

RESUMEN

BACKGROUND: No widely accepted, validated instrument currently exists to measure clinical outcomes in patients who undergo dacryocystorhinostomy (DCR) for treatment of epiphora. OBJECTIVE: To develop a patient-reported outcome measure applicable to this population. METHODS: Psychometric evaluations, consultation with experts, and review of the literature informed item generation of a 12-question questionnaire to incorporate the most relevant symptoms experienced by patients with nasolacrimal duct obstruction. This questionnaire, known as the Tearing Assessment and Rating Scale-12 (TEARS-12), was administered to 32 patients before and after intervention, in the form of endoscopic DCR. Statistical analysis was performed to measure internal consistency, responsiveness, and test-retest reliability. RESULTS: Pre-operative and post-operative TEARS-12 scores (28.2 [standard error (SE) 3.19] vs 11.8 [SE 3.25], respectively, P = 0.001) demonstrated improved patient outcome within 6 weeks following endoscopic DCR. Cronbach's alpha for the questionnaire was 0.90, indicating high overall reliability. Additionally, each question demonstrated internal reliability, with a corrected item-total correlation greater than 0.30. The intraclass correlation between the two pre-operative scores was 0.858 (P < 0.001), indicating high test-retest reliability. CONCLUSION: TEARS-12 is a statistically valid, easy-to-administer instrument to measure clinical outcomes in patients who undergo endoscopic DCR.


Asunto(s)
Dacriocistorrinostomía , Enfermedades del Aparato Lagrimal , Medición de Resultados Informados por el Paciente , Psicometría , Lágrimas , Humanos , Encuestas y Cuestionarios , Dacriocistorrinostomía/métodos , Femenino , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Enfermedades del Aparato Lagrimal/cirugía , Enfermedades del Aparato Lagrimal/diagnóstico , Anciano , Resultado del Tratamiento , Obstrucción del Conducto Lagrimal/diagnóstico , Adulto , Endoscopía/métodos
14.
Ophthalmic Plast Reconstr Surg ; 40(2): 192-197, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38427833

RESUMEN

PURPOSE: Botulinum toxin (BoNTA) lacrimal gland injections are one treatment option for managing epiphora. Outcomes for epiphora in existing studies are subjective and lack grading. This study utilized validated grading instruments to evaluate the efficacy of BoNTA lacrimal gland injections. METHODS: Prospective study evaluating the TEARS score and quality of life in patients receiving incobotulinum toxin (Xeomin) lacrimal gland injections for epiphora. Epiphora was graded using the TEARS score. Quality of life was evaluated using the watery eye quality of life score. Etiology, benefit duration, complications and additional injections were recorded. RESULTS: Of the 28 patients, (median age 67.5 years), 19 (68%) had facial palsy gustatory epiphora (GE). Median effect duration was 13 weeks. Improvements in tearing frequency (T), clinical effects (E), and activity limitation (A) were seen in 57%, 57%, and 71% of patients, respectively. Median watery eye quality of life score improved from 42.4/100 ± 10.1 to 10.6 ± 15.5 (p < 0.001). Alongside crocodile tears, reflex tearing R-scores improved in 68% of patients with GE vs. 11% with non-GE causes (p = 0.004618). In total 89% of patients with GE and 56% with non-GE requested repeat injections. Self-reported percentage improvement ranged from 0% to 100% (median 60%, interquartile range 10%-76.25%). CONCLUSIONS: This is the first study reporting the outcomes of BoNTA lacrimal gland injections using validated TEARS and watery eye quality of life scores. Clinical and quality of life improvements are seen in most patients. Patients with GE achieve an additional improvement in dry eye-related reflex tearing alongside crocodile tears which both improve with BoNTA. TEARS data supports using BoNTA in these patients and is a useful validated grading instrument for epiphora.


Asunto(s)
Toxinas Botulínicas Tipo A , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Fármacos Neuromusculares , Humanos , Anciano , Estudios Prospectivos , Calidad de Vida , Fármacos Neuromusculares/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Lágrimas , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/tratamiento farmacológico , Enfermedades del Aparato Lagrimal/etiología
15.
Eur Arch Otorhinolaryngol ; 281(5): 2749-2753, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38502360

RESUMEN

INTRODUCTION: Intravascular papillary endothelial hyperplasia (IPEH) predominantly occurs in the subcutaneous and dermal regions and rarely originates from the sinonasal mucosa. CASE PRESENTATION: We report on the case of a 58-year-old male patient who presented with progressive bilateral nasal obstruction, left-sided epiphora, and intermittent epistaxis. Computed tomography revealed a soft tissue opacity in the left maxillary sinus with intersinusoidal nasal wall demineralization, extending into the surrounding ethmoid cells and the right nasal cavity through a contralateral deviation of the nasal septum. Contrast-enhanced T1-weighted magnetic resonance imaging further confirmed these findings. The IPEH originating from the maxillary sinus extended into the contralateral nasal cavity, and it was successfully removed using an endoscopic endonasal approach, avoiding overly aggressive treatment. CONCLUSION: This case report highlights the diagnostic challenges of IPEH in the sinonasal region and the importance of considering IPEH as a differential diagnosis in patients presenting with nasal obstruction, epiphora, and intermittent epistaxis.


Asunto(s)
Enfermedades del Aparato Lagrimal , Obstrucción Nasal , Masculino , Humanos , Persona de Mediana Edad , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Epistaxis/etiología , Hiperplasia/patología , Obstrucción Nasal/diagnóstico por imagen , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugía , Enfermedades del Aparato Lagrimal/patología
16.
Ophthalmic Plast Reconstr Surg ; 40(4): 419-425, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38319188

RESUMEN

PURPOSE: Lacrimal gland (LG) adenocarcinomas (ACs) are rare, with limited data. We compared clinicopathologic features and local recurrence, distant metastasis, and survival rates between LG AC and LG adenoid cystic carcinoma (ACC). METHODS: The records of LG AC patients treated from 2008 to 2022 and LG ACC patients treated from 1998 to 2022 at the same center were retrospectively reviewed. RESULTS: The study included 20 patients with AC; 10 de-novo AC, 10 ex-pleomorphic AC; and 51 ACC patients. The median age at diagnosis was 61 years for de-novo AC, 54 years for ex-pleomorphic AC, and 45 years for ACC. All groups had male predominance. The initial T category was T2 in 50% (5/10) of de-novo ACs; 60% (6/10) of ex-pleomorphic ACs; and 59% (30/51) of ACCs. Perineural invasion was present in 33% (5/15) of ACs and 90% (45/50) of ACCs ( p < 0.001). Of the 20 AC patients, 14 had eye-sparing surgery; 4 had orbital exenteration; and 2 had unresectable disease. All AC patients received postoperative radiotherapy and 15 (75%) received concurrent chemotherapy. Fourteen AC patients were tested for human growth factor receptor 2 expression, and 10 (71%) were human growth factor receptor 2 positive; 5 received human growth factor receptor 2-targeted therapy. AC and ACC had similar 5-year recurrence rates (20% and 33%, respectively, p = 0.31) and metastasis rates (20% and 34%, respectively, p = 0.30). de-novo AC, ex-pleomorphic AC, and ACC had similar 5-year disease-specific survival rates (80%, 79%, and 81%, respectively, p > 0.99). CONCLUSIONS: LG AC and ACC have similar baseline clinicopathologic features, except that perineural invasion is more common in ACC, and similar recurrence, metastasis, and survival rates. Human growth factor receptor 2-targeted therapy may be appropriate in some patients with LG AC.


Asunto(s)
Adenocarcinoma , Carcinoma Adenoide Quístico , Neoplasias del Ojo , Enfermedades del Aparato Lagrimal , Humanos , Masculino , Carcinoma Adenoide Quístico/terapia , Carcinoma Adenoide Quístico/diagnóstico , Carcinoma Adenoide Quístico/patología , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Enfermedades del Aparato Lagrimal/terapia , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/patología , Neoplasias del Ojo/terapia , Neoplasias del Ojo/patología , Neoplasias del Ojo/diagnóstico , Anciano , Adulto , Adenocarcinoma/terapia , Adenocarcinoma/patología , Recurrencia Local de Neoplasia , Tasa de Supervivencia , Anciano de 80 o más Años , Aparato Lagrimal/patología
17.
Ophthalmic Plast Reconstr Surg ; 40(4): 440-444, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38329425

RESUMEN

PURPOSE: To examine the indications for repeated lacrimal gland biopsies, and the rate of detection of a new diagnosis. METHODS: A single-center, retrospective review of patients who underwent more than 1 lacrimal gland biopsy, either ipsilateral or contralateral, between 2000 and 2022. RESULTS: One hundred and twenty-three patients (80 female; 65%) had repeated lacrimal gland biopsy. The commonest diagnosis on initial biopsy was chronic nonspecific dacryoadenitis (NSD) (49/123; 40%). Indications for repeated biopsy were uncertainty in making a histopathological diagnosis (16/123; 13%), poorly-responsive or recurrent ipsilateral disease (61/123; 50%), new or continued/worsening contralateral disease (30 patients; 24%), and planned tumor resection after initial biopsy (16/123; 13%). Of the 40 patients (33%) with a different histopathological diagnosis after repeated lacrimal biopsy, 4 (10%) had lymphoma, initially reported as NSD (4/49 with NSD; 8%), and 7/40 (18%) (14% of the 49 NSD patients) were reclassified as having specific inflammations (including 2 with granulomatous polyangiitis); of the 7 having reclassification as a specific dacryoadenitis, 6/7 had ipsilateral disease failing to respond to primary treatment, and 1/7 had new onset or progression of contralateral disease. All histology after the primary biopsy of 16 patients with lacrimal gland malignancies retained the same tissue diagnosis. CONCLUSION: Repeated biopsy for lacrimal gland disease in this study revealed a diagnosis of malignancy in 20%, including lymphoma in 8% of those initially diagnosed with NSD. There was a 14% rate of diagnostic progression from "non-specific" dacryoadenitis to a more specific inflammatory disease.


Asunto(s)
Aparato Lagrimal , Humanos , Femenino , Estudios Retrospectivos , Masculino , Biopsia/métodos , Persona de Mediana Edad , Adulto , Aparato Lagrimal/patología , Anciano , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/patología , Anciano de 80 o más Años , Adolescente , Adulto Joven , Dacriocistitis/diagnóstico , Dacriocistitis/patología , Niño
18.
Ophthalmic Plast Reconstr Surg ; 40(4): 445-448, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38346433

RESUMEN

PURPOSE: To explore the endoscopic and histopathologic characteristics of the lacrimal sac (LS) and the nasolacrimal duct in cases with punctal agenesis presenting with LS swellings. METHODS: This is a prospective, interventional study of 13 LSs of 8 patients presenting with punctal agenesis and LS swellings over a 5-year study period (June 2018-July 2023). Complete ophthalmic examination was performed along with CT scans of the orbits. The LS was exposed with an anterior lacrimal crest incision and explored. The exterior and interior of the sac swelling were examined and LS flaps were sent for histopathological analysis. RESULTS: The mean age of the patients was 23 years with a male:female ratio of 5:3. All patients presented with swelling in the LS region. Occasional epiphora was the presenting feature in 6 patients. All patients had both upper and lower punctal agenesis on the affected side with associated LS swelling. CT scans showed a hypodense cystic swelling with expansion of the LS fossa and bony nasolacrimal duct ending abruptly short of the inferior meatus. Intraoperatively, the LS had thin, translucent walls with mucoid secretion and an absence of common canalicular opening. Histopathological analysis showed epithelium consistent with LS with less robust development of the sac walls and poorly structured lacrimal drainage-associated lymphoid tissue with scanty stromal inflammation. CONCLUSIONS: The development of LS and the nasolacrimal duct is structurally affected in patients with punctal agenesis. Retrograde approaches for epiphora resolution are not logical in such cases but conjunctivodacryocystorhinostomy with Jones tube can be a feasible option.


Asunto(s)
Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Conducto Nasolagrimal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Prospectivos , Adulto , Aparato Lagrimal/anomalías , Aparato Lagrimal/diagnóstico por imagen , Aparato Lagrimal/cirugía , Adulto Joven , Conducto Nasolagrimal/anomalías , Conducto Nasolagrimal/cirugía , Conducto Nasolagrimal/diagnóstico por imagen , Adolescente , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/cirugía , Párpados/anomalías , Párpados/cirugía , Endoscopía/métodos , Niño
19.
Curr Eye Res ; 49(5): 543-549, 2024 05.
Artículo en Inglés | MEDLINE | ID: mdl-38353328

RESUMEN

PURPOSE: To evaluate the outcomes of endoscopy-assisted modified Weber-Ferguson's approach in the management of primary lacrimal sac tumors with extension into the neighboring tissues. METHODS: A retrospective interventional study was performed on all patients with lacrimal sac tumors treated with the endoscopy-assisted modified Weber-Ferguson approach between January 2010 and June 2022 at the Shanghai Ninth People's Hospital, China. Data assessed include demographics, clinical presentations, imaging features, surgical techniques, histopathology, adjuvant modalities of management, complications, and outcomes. RESULTS: A total of 13 patients were included in the analysis. Epiphora and palpable mass lesion were the presenting complaint in 84.6% (11/13) of the patients. Nearly half of the patients (46.1%, 6/13) were misdiagnosed as lacrimal duct obstruction. All the lacrimal sac tumors in the present series showed uneven enhancement on T1-weighted MRI imaging. Postoperatively, 84.6% (11/13) patients recovered well with excellent esthetics and were disease-free after a mean follow-up of 58.6 months. Two patients who underwent additional exenteration developed recurrence and succumbed (at 41 and 96 months follow up) while they were on palliative chemoradiation. CONCLUSION: The endoscopic-assisted modified Weber-Fergusson surgical approach is effective in providing better visibility and accessibility to lacrimal sac tumors with extension into neighboring tissue.


Asunto(s)
Dacriocistorrinostomía , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Obstrucción del Conducto Lagrimal , Conducto Nasolagrimal , Humanos , Conducto Nasolagrimal/diagnóstico por imagen , Conducto Nasolagrimal/cirugía , Dacriocistorrinostomía/métodos , Estudios Retrospectivos , China/epidemiología , Endoscopía/métodos , Obstrucción del Conducto Lagrimal/terapia , Enfermedades del Aparato Lagrimal/diagnóstico , Enfermedades del Aparato Lagrimal/cirugía , Enfermedades del Aparato Lagrimal/patología , Aparato Lagrimal/patología
20.
J Plast Reconstr Aesthet Surg ; 90: 192-199, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38394833

RESUMEN

PURPOSE: To compare the clinical effects of two types of lacrimal stents in the repair of canalicular lacerations. METHODS: A retrospective analysis was conducted on patients with canalicular lacerations between January 2017 and December 2022. The canalicular reconstruction was performed using either the Runshi-RS bicanalicular silicone stent or the traditional bicanalicular silicone stent with nasal fixation, under a surgical microscope. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. The anatomical and functional success rates were compared between the two groups. Anatomical success was assessed through diagnostic probing and irrigation of lacrimal passage, while functional success was determined by the patient's subjective symptoms of epiphora. RESULTS: The study included 315 patients (315 eyes) undergoing canalicular laceration repair. The Runshi-RS stent was utilized in 147 patients (46.7%), while the traditional stent with nasal fixation was employed in 168 patients (53.3%). The anatomical success rates (99.3% vs 98.8%, P = 0.642) and functional success rates (87.2% vs 88.1%, P = 0.926) were similar between the RS group and the traditional stent group. Postoperative complications were fewer (4.1% vs 10.1%, P = 0.04) and the operation time was shorter (67.1 ± 35.3 min vs 86.1 ± 43.4 min, P < 0.001) in the RS group. CONCLUSION: The Runshi-RS tube demonstrates favorable surgical outcomes for the repair of canalicular lacerations. Compared to the traditional stent with nasal fixation, the RS stent allows for shorter operation times and fewer postoperative complications in the repair of canalicular lacerations.


Asunto(s)
Lesiones Oculares , Laceraciones , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Humanos , Laceraciones/cirugía , Siliconas , Estudios Retrospectivos , Aparato Lagrimal/cirugía , Enfermedades del Aparato Lagrimal/cirugía , Complicaciones Posoperatorias , Lesiones Oculares/cirugía , Stents
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