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1.
Ophthalmic Plast Reconstr Surg ; 40(3): 312-315, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38215454

RESUMO

PURPOSE: To evaluate the rates of amenorrhea and menstrual irregularities in patients with active thyroid eye disease treated with teprotumumab. METHODS: A retrospective review was conducted of patients with active thyroid eye disease treated between 2020 and 2022 at a single institution. Female thyroid eye disease patients with regular menstruation at baseline who completed 8 infusions of teprotumumab were assessed. Patient-reported irregularities in menstruation or amenorrhea were recorded during routine clinic visits. Two sample t tests were used to assess differences between patients endorsing and denying menstrual irregularities. RESULTS: Twelve patients met the inclusion criteria. The mean age was 38.33 ± 9.6 years (range 25-53 years). The average follow-up after treatment completion was 11.43 months. Nine patients (75%) reported changes from their baseline menstruation. Four patients (33.3%) reported irregularities during treatment only. Three patients (25%) had persistence of irregularities after treatment; these patients regained normal cycles at an average of 3 months following teprotumumab completion. Two patients (16.7%) did not regain their normal cycles at the time of their last follow-up. One 53-year-old patient-reported persistent amenorrhea after treatment completion. One patient-reported menorrhagia at a 4-month follow-up. No significant age difference was found between patients with or without reported menstrual changes ( p = 0.43). CONCLUSION: Abnormalities of menstruation, including amenorrhea, were reported by 75% of patients treated with teprotumumab. These changes reverted to baseline after treatment in most affected patients.


Assuntos
Amenorreia , Anticorpos Monoclonais Humanizados , Oftalmopatia de Graves , Humanos , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Amenorreia/induzido quimicamente , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Distúrbios Menstruais/tratamento farmacológico
2.
Ophthalmic Plast Reconstr Surg ; 39(6): e186-e188, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37338324

RESUMO

A 27-year-old woman with well-documented neurofibromatosis 2 developed a soft, painless, nodular lesion on the skin surface of the left upper eyelid over 2 years. Following excision, histopathology revealed a plexiform neurofibroma with intradermal nodules comprised of benign round and spindle cells that reacted diffusely with immunohistochemical stains SOX-10 and S100. A subset showed focal reactivity for neurofilament and CD34. A perineurium surrounded each nodule with cells staining positively for markers EMA (epithelial membrane antigen) and GLUT1 (glucose transporter 1). Plexiform neurofibromas are rare tumors that occur in 5%-15% of patients with neurofibromatosis 1. Cutaneous abnormalities in neurofibromatosis 2 have not been widely studied although reports have described schwannomas, plexiform schwannomas, and occasional neurofibromas. Plexiform neurofibromas in neurofibromatosis 2 have rarely been illustrated and the current case represents a unique bona fide eyelid example to date.


Assuntos
Neurilemoma , Neurofibroma Plexiforme , Neurofibroma , Neurofibromatose 1 , Neurofibromatose 2 , Feminino , Humanos , Adulto , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/patologia , Neurofibromatose 1/patologia , Neurilemoma/patologia , Pálpebras/patologia , Neurofibroma/patologia
3.
Ophthalmic Plast Reconstr Surg ; 39(3): e96-e97, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36806128

RESUMO

A small ruptured cyst was excised from the left inner canthus of a 68-year-old woman. Histopathology displayed a cyst lined by a double layer of cuboidal epithelium and filled with amorphous material. The lining cells were strongly positive for cytokeratins 5/6 and 14, with weak reactivity with cytokeratin 7. These findings were identical to those in a single previous report of an eccrine cyst of the eyelid, making this the second example of a bona fide eccrine hidrocystoma of the eyelid.


Assuntos
Cistos , Hidrocistoma , Neoplasias das Glândulas Sudoríparas , Feminino , Humanos , Idoso , Hidrocistoma/diagnóstico , Hidrocistoma/patologia , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/patologia , Cistos/diagnóstico , Pálpebras/patologia
4.
Ophthalmic Plast Reconstr Surg ; 39(2): e33-e35, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36136733

RESUMO

A 42-year-old woman presented with a small pigmented lesion of the palpebral conjunctiva that had been present for a few months. Because of the possibility of melanoma, the lesion was resected. Microscopic examination displayed an intratarsal blue nevus at the level of the meibomian glands comprised of bland nonpigmented and pigmented cells that enveloped a sebaceous gland and its ducts. The cells were of admixed spindle and epithelioid configuration and were immunoreactive for Melan-A. The Ki67 proliferative marker was negative in these cells, contrasting with the epithelium of the overlying conjunctiva and the sebaceous ducts, and thereby militating against the diagnosis of melanoma. Clusters of melanophages were also present. Although an intratarsal blue nevus has been described as a component of a combined nevus, the current lesion demonstrates the occurrence of a sole tarsal blue nevus. Palpebral pigmented lesions should be customarily excised because many are melanomas.


Assuntos
Melanoma , Nevo Azul , Neoplasias Cutâneas , Feminino , Humanos , Adulto , Neoplasias Cutâneas/patologia , Melanoma/patologia , Túnica Conjuntiva/patologia , Diagnóstico Diferencial , Síndrome
5.
Ophthalmic Plast Reconstr Surg ; 39(5): e142-e145, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37010052

RESUMO

An 83-year-old woman experienced the slow enlargement of a right lower eyelid mass. Histopathologic examination of the excised tissue showed a mucin-filled cystic tumor emanating from an apocrine bilayer that displayed bleb-like apocrine decapitation secretion. The outer flattened myoepithelial layer of the bilayer reacted with immunohistochemical stains for smooth muscle actin and calponin. In foci, the tumor exhibited a cribriform architecture with small pockets of mucin. Tumor cells were reactive for cytokeratin 7, Gross Cystic Disease Fluid Protein 15 (BRST-2), estrogen and progesterone receptors, androgen receptors, mammaglobin, epithelial membrane antigen, and GATA3. Ki67 showed a very low proliferation fraction. The lesion exemplifies the fourth instance of an eyelid apocrine cystadenoma in the literature.


Assuntos
Cistadenoma , Hidrocistoma , Neoplasias das Glândulas Sudoríparas , Feminino , Humanos , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/patologia , Hidrocistoma/patologia , Pálpebras/patologia , Cistadenoma/patologia , Mucinas , Glândulas Apócrinas/patologia
6.
Radiology ; 302(2): 419-424, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34783593

RESUMO

Background There are multiple tools available to visualize the retinal and choroidal vasculature of the posterior globe. However, there are currently no reliable in vivo imaging techniques that can visualize the entire retrobulbar course of the retinal and ciliary vessels. Purpose To identify and characterize the central retinal artery (CRA) using cone-beam CT (CBCT) images obtained as part of diagnostic cerebral angiography. Materials and Methods In this retrospective study, patients with catheter DSA performed between October 2019 and October 2020 were included if CBCT angiography included the orbit in the field of view. The CBCT angiography data sets were postprocessed with a small field-of-view volume centered in the posterior globe to a maximum resolution of 0.2 mm. The following were evaluated: CRA origin, CRA course, CRA point of penetration into the optic nerve sheath, bifurcation of the CRA at the papilla, visualization of anatomic variants, and visualization of the central retinal vein. Descriptive statistical analysis was performed. Results Twenty-one patients with 24 visualized orbits were included in the analysis (mean age, 55 years ± 15; 14 women). Indications for angiography were as follows: diagnostic angiography (n = 8), aneurysm treatment (n = 6), or other (n = 7). The CRA was identified in all orbits; the origin, course, point of penetration of the CRA into the optic nerve sheath, and termination in the papilla were visualized in all orbits. The average length of the intraneural segment was 10.6 mm (range, 7-18 mm). The central retinal vein was identified in six of 24 orbits. Conclusion Cone-beam CT, performed during diagnostic angiography, consistently demonstrated the in vivo central retinal artery, demonstrating excellent potential for multiple diagnostic and therapeutic applications. © RSNA, 2021 Online supplemental material is available for this article.


Assuntos
Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada de Feixe Cônico , Artéria Retiniana/diagnóstico por imagem , Angiografia Digital , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Ophthalmology ; 128(7): 971-980, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33248156

RESUMO

PURPOSE: To identify the role of gender and other factors in influencing ophthalmologists' compensation. DESIGN: Cross-sectional study. PARTICIPANTS: U.S. practicing ophthalmologists. METHODS: Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. MAIN OUTCOME MEASURES: Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. RESULTS: Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of -$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03). CONCLUSIONS: Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.


Assuntos
Atenção à Saúde/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Internato e Residência/organização & administração , Oftalmologistas/educação , Adulto , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários
8.
Ophthalmic Plast Reconstr Surg ; 37(6): e208-e209, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34284427

RESUMO

Apocrine hidrocystomas are benign cystic tumors derived from apocrine sweat glands; they are most commonly located in the skin of the head and neck regions. Ophthalmic occurrences characteristically appear at the lash line and canthi of the eyelid, although rare instances have been described in the conjunctiva, caruncle, and orbit. The authors describe an exceptional instance of a mobile epibulbar subconjunctival apocrine hidrocystoma in a 57-year-old woman without a history of previous ocular injury or surgery. Histopathology of the excised specimen displayed an empty cyst lined by a double layer of cuboidal epithelium with the inner layer exhibiting periodic acid-Schiff-positive apical decapitation secretion. Confirmatory immunohistochemistry included reactivity with cytokeratin-7, smooth muscle actin, D2-40, and CDGFP-15.


Assuntos
Hidrocistoma , Neoplasias das Glândulas Sudoríparas , Glândulas Apócrinas , Pálpebras , Feminino , Hidrocistoma/diagnóstico , Hidrocistoma/cirurgia , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/cirurgia
9.
Ophthalmic Plast Reconstr Surg ; 37(4): e141-e143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33587420

RESUMO

A 58-year-old man presented with left-sided orbital inflammation, including chemosis and a lateral rectus abduction defect. Initially presumed to represent cellulitis, the condition responded poorly to oral and intravenous antibiotics. CT showed the epicenter of an infiltrate to involve the lateral rectus. The patient improved dramatically when oral prednisone was added. Lateral rectus biopsy displayed intramuscular polyclonal lymphoid infiltrates, rich with eosinophils. Complete resolution of the inflammatory process was confirmed by a follow-up CT. The presumptive diagnosis was idiopathic orbital myositis, an uncommon condition of unknown etiology. However, the patient had taken rosuvastatin, which has been rarely associated with diplopia and ophthalmoplegia, raising the question of whether this case was truly idiopathic.


Assuntos
Miosite , Miosite Orbital , Preparações Farmacêuticas , Diplopia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Miosite/diagnóstico , Miosite/tratamento farmacológico , Músculos Oculomotores , Miosite Orbital/diagnóstico , Miosite Orbital/tratamento farmacológico
10.
Ophthalmic Plast Reconstr Surg ; 36(6): e147-e149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32304502

RESUMO

Pilomatrixoma, an uncommon, usually benign cutaneous appendageal tumor, shows differentiation toward the hair follicle matrix cell. It undergoes various histopathologic stages, early on displaying epithelial and shadow cells along with granulomatous inflammation. In later stages, illustrated by this unusual case, epithelial cells disappear and are replaced by calcification and ossification. Immunohistochemistry in the current case showed transitional cell reactivity for ß-catenin, probably linking the tumor to a mutation in the ß-catenin gene CTNNB1. There was also transitional cell positivity for cyclin D1, a marker found in matrical cells of the human hair follicle. While pilomatrixoma occurs occasionally in the eyelid, the ossified eyelid variant in the current case is very rare, with only one preceding description in the literature.


Assuntos
Doenças do Cabelo , Pilomatrixoma , Neoplasias Cutâneas , Pálpebras , Doenças do Cabelo/diagnóstico , Humanos , Osteogênese , Pilomatrixoma/diagnóstico
11.
Ophthalmic Plast Reconstr Surg ; 36(1): e23-e24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895726

RESUMO

A 72-year-old woman who presented with right-sided epiphora and conjunctivitis underwent a probing and irrigation procedure with normal results. She improved with antibiotic-steroid drops. A swelling in the medial canthal region completely resolved. One year later, she returned with symptoms of dacryocystitis. An external dacryocystorhinostomy was performed. Characteristic dacryoliths were removed from the sac lumen, and biopsy of the sac wall showed spicules of lamellar bone within a fibrous stroma. Diagnosed as fibrous dysplasia of the lacrimal sac, this rare entity represents the second such case in the literature.The histopathology of an ossified lacrimal sac resembled fibrous dysplasia of bone and exemplifies the second case of this rare entity in the literature.


Assuntos
Dacriocistite , Dacriocistorinostomia , Displasia Fibrosa Óssea , Doenças do Aparelho Lacrimal , Ducto Nasolacrimal , Neoplasias , Idoso , Dacriocistite/diagnóstico , Dacriocistite/cirurgia , Feminino , Humanos , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/cirurgia
17.
Orbit ; 35(6): 357-359, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27715372

RESUMO

The authors describe an esthesioneuroblastoma (olfactory neuroblastoma) that occurred within the nasal cavity and brain in a 31-year-old man. Following excision, the tumor recurred in the left orbit and in mediastinal lymph nodes. Treatment included orbital excision and systemic chemotherapy. Histopathology showed a high-grade neuroepithelial tumor with positive immunohistochemical markers for neuroendocrine and epithelial components, an unusual combination raising issues concerning taxonomy.


Assuntos
Neoplasias Encefálicas/patologia , Estesioneuroblastoma Olfatório/secundário , Recidiva Local de Neoplasia/patologia , Neoplasias Nasais/patologia , Neoplasias Orbitárias/secundário , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Estesioneuroblastoma Olfatório/diagnóstico por imagem , Estesioneuroblastoma Olfatório/terapia , Humanos , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Mediastino , Cavidade Nasal , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/terapia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/terapia , Tomografia Computadorizada por Raios X
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