Assuntos
Desbridamento/métodos , Estética , Fasciite Necrosante/cirurgia , Doenças Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Infecções Estreptocócicas/cirurgia , Adulto , Fasciite Necrosante/diagnóstico por imagem , Fasciite Necrosante/patologia , Feminino , Humanos , Excisão de Linfonodo/métodos , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/patologia , Transplante de Pele/métodos , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/patologia , Resultado do TratamentoRESUMO
PURPOSE: To report the clinical, pathological, and immunohistochemical features of the first pigmented spindle cell nevus (PSCN) of Reed documented to have appeared in the eyelid. METHODS: The findings of clinical and histopathological examination are presented, along with differential diagnoses and a review of the pertinent literature. CASE: A 3-year-old boy presented with a rapidly growing, heavily pigmented left lower lid papule raising the concern of malignancy, warranting excisional biopsy. Nests of predominantly junctional Mart-1-positive spindle cells were identified by histopathological examination. The cells were largely uniform in size, elongated, surrounded by granular and coarse melanin, with a Ki-67 proliferation index of 0-2%. Five-month follow-up did not evidence any recurrence or invasive behavior of this benign melanocytic tumor. CONCLUSION: This is the first documented case of PSCN of Reed, a distinct entity from Spitz nevus, presenting in the eyelid. The differential diagnoses include spindle cell and superficially spreading malignant melanoma as well as dysplastic nevus. Integration of clinical and histopathological findings with immunohistochemical and fluorescence in situ hybridization markers plays a central role in the diagnosis.
RESUMO
This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Entrópio/cirurgia , Pálpebras/cirurgia , Músculos Oculomotores/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Técnicas de Sutura , Resultado do TratamentoRESUMO
A 76-year-old man presented with slowly progressive swelling in his forehead and left upper eyelid over the course of three months. CT scanning showed non-specific enhancement of subcutaneous tissues, suggesting a low-grade cellulitis. Poor response to treatment prompted an MRI, which revealed the presence of a soft tissue lesion. Biopsy of this lesion was positive for angiosarcoma. The patient underwent chemotherapy and radiation, but unfortunately succumbed to his malignancy eight months later. This case illustrates a rare example of facial/periorbital angiosarcoma, a benign-appearing but aggressive tumor associated with a high incidence of mortality. A review of the literature and current treatment options are discussed.
RESUMO
A 50-year-old man presented with a 1-month history of progressive eyelid swelling and intermittent hemorrhagic epiphora. A 1.2 x 1.3 x 0.7-cm friable hemorrhagic nodule was excised from the posterior eyelid surface. Histopathology revealed a poorly differentiated carcinoma. The patient underwent a systemic workup including CT of the lungs and was subsequently diagnosed with stage IV non-small cell carcinoma presumably of the lung. He received palliative radiation and chemotherapy and died 5 months after initial presentation. This report illustrates a case where metastatic eyelid disease was the presenting sign of hitherto undiagnosed lung cancer. It is followed by a review of clinical aspects of metastatic eyelid disease.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Palpebrais/secundário , Neoplasias Pulmonares/patologia , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/terapia , Terapia Combinada , Neoplasias Palpebrais/diagnóstico por imagem , Neoplasias Palpebrais/terapia , Evolução Fatal , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia , Tomografia Computadorizada por Raios XRESUMO
Congenital nasolacrimal obstruction is a common disorder in infants that results in persistent tearing and may lead to infections, such as dacryocystitis, orbital cellulitis, and bacterial conjunctivitis. The true incidence of this disorder in healthy newborns remains controversial. The most frequently quoted number of 6% comes from a study of 200 consecutive live births in the 1940s in which nasolacrimal patency was assessed by the presence or absence of discharge on compression of the lacrimal sac. Estimates from other studies, which often use different criteria for diagnosis, vary considerably from 1.2% to 30%. The incidence of the disorder is higher in children who have craniofacial disorders and Down's syndrome. This article reviews the causes and treatment of congenital nasolacrimal obstruction.
Assuntos
Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal , Humanos , Obstrução dos Ductos Lacrimais/diagnósticoAssuntos
Anticorpos Monoclonais/uso terapêutico , Oftalmopatia de Graves/tratamento farmacológico , Imunoglobulina G/uso terapêutico , Pseudotumor Orbitário/tratamento farmacológico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais Humanizados , Etanercepte , Glucocorticoides/uso terapêutico , Humanos , InfliximabRESUMO
PURPOSE: Patterns of injury and outcomes after multi-system trauma differ between men and women. Few data exist regarding the epidemiology of gender differences in severe eye trauma. We hypothesized that the incidence and patterns of open globe injuries might differ between men and women. METHODS: Charts of 220 patients with open globe injuries presenting to the Massachusetts Eye and Ear Infirmary during a three-year period were retrospectively reviewed. The data were analyzed with respect to gender, type of open globe injury (penetrating, perforating, or rupture), and mechanism of globe injury (projectile, non-projectile, assault, fall, sports, motor vehicle crash). RESULTS: The majority (78.6%) of patients were men. Women with open globe injuries were older (median age 73 years) than men (median age 36 years). Men were more likely to suffer from penetrating injuries (69.9%) while women were more likely to experience blunt globe rupture (68.1%). Projectile objects accounted for the majority of open globe injuries in men (54.9%) and were an infrequent cause in women (4.3%). Nearly one-third (31.8%) of the projectile injuries in men were work-related, and 19.7% occurred during home improvement projects. Compared with men, falls were more frequently responsible for globe injuries in women (55.3% versus 8.1%). Injuries limited to the cornea were more common in men than women (46.2% versus 23.4%), while more posterior globe injuries were more common among women (46.8% versus 28.3% men). Women were more likely than men to have poor visual acuity at 3 months after injury. CONCLUSIONS: The causes and patterns of open globe injuries differ between men and women. In this series, the majority of injuries to men were caused by projectile objects related to work or home improvement projects. Open globe injuries in women were most often resulted from fall, and were more likely to cause rupture posterior to the limbus.