INTRAOCULAR LYMPHOMA WITH RETROBULBAR INFILTRATION. A CASE REPORT.

Subjective and objective symptoms following intraocular lymphoma could lead to a misdiagnosis at the beginning of the disease, which is the cause for the delay in an effective treatment. The most common manifestation of lymphoma is an inflammatory disease affecting the uvea. A multidisciplinary approach to the diagnosis is required. Suspicion based on the ophthalmological examinations has to be verified by histology. We present a case report of a 78-year-old patient examined at our clinic, with progressive loss of vision in the left eye over 6 months, suspected of retinal detachment. Objectively the visual acuity was counting fingers in front of the left eye. Intraocular pressure changed from normotensive to hypertensive values during regular examinations. We realised imaging exams, ultrasonography and magnetic resonance, which proved an intraocular tumour with retrobulbar infiltration and retinal detachment. The patient was indicated for enucleation, which enabled assignment of a histological type of intraocular B-Non-Hodgkin lymphoma from marginal zone B-cells. We sent the patient to a haematologist-oncologist for management of the subsequent treatment and we prescribed an individual prosthesis to the patient after the enucleation. The patient remains under observation; no surgical treatment, chemotherapy or radiotherapy have been used for 15 months after the enucleation. The enucleation was both a diagnostic and treatment modality.

Optic nerve orbital meningioma.

INTRODUCTION: Orbital meningioma treatment has achieved significant success over the last period. Primary optic nerve sheath meningiomas by the clinically progressive finding, but still persistent sufficient visual acuity, can be treated by fractionated stereotactic radiotherapy. Surgery is indicated for secondary meningiomas of the orbit. Surgical treatment is indicated due to intracranial tumor propagation of meningioma from the chiasm towards the orbit. MATERIAL AND METHODS: In the period 2014 - 2016 we monitored in dispensary 15 patients with meningioma of the orbit, who were checked at least in yearly intervals and underwent magnetic resonance examination of the orbit and brain. RESULTS: In group of 15 patients with histologically unverified meningioma of the orbit, the surgical solution was indicated in 3 patients. In 14 (93.3%) patients meningiomas were secondary infiltrating orbit from the intracranial part of visual pathways, and in 1 case meningioma was primary arising from the optic nerv. We indicated enucleation and partial exenteration in 3 (20%) patients. Histopathological examination confirmed meningioma - in two cases gr. I., in one patient gr. II. In all of them, more than 5 years after the primary diagnose of the process, the tumor infiltration from the chiasm towards the orbit was the indication for surgery. In one patient with meningioma gr. II in 12 months interval after surgery - exenteration with lid sparing technique, there was a further progression from the sella turcica area and the growth of tumor masses to the area of the orbital conus. Patient underwent secondary surgical reduction of tumor mass of the orbit and treatment with sandostatin. CONCLUSION: When deciding to treat meningioma, it is necessary to involve multidisciplinary collaboration. Ophthalmology examination is important because further treatment is indicated on the basis of changes in visual function in correlation with the imaging methods. In cases of progression of the tumor with the infiltration of the orbit, resulting in the loss of visual acuity, in certain conditions a radical solution - enucleation with partial exenteration of the orbit, is necessary. Key words: meningioma of the orbit, primary tumors of the orbit, secondary tumors of the orbit, enucleation, exenteration with lid sparing technique.

Uveal melanoma survival rates after single dose stereotactic radiosurgery.

This paper presents the long-term results of single dose stereotactic radiosurgery for intraocular uveal malignant melanoma, and summarizes the results of the retrospective study in 170 Slovak patients. A group of uveal melanoma patients (149 choroidal melanoma, 21 ciliary body melanoma) from 20 to 92 years of age with 59 year median were treated in 2001-2016. There were 81males (47.7%) and 89 females 89 (52.3%). The median overall follow-up time was three years. The median tumor volume at baseline was 0.5 cm³ (ranging from 0.2 to 1.6 cm³). The therapeutic dose was 35.0 Gy by 99% of dose volume histogram. The survival after single dose stereotactic radiosurgery was 96% in one year, 93% in two years, 84% in five years, 80% in seven years and 52% in eleven years. Secondary enucleation was necessary for 22 patients because of secondary glaucoma complication. The enucleation free interval ranged from one to six years. The survival rates in five year intervals and necessity of secondary enucleation due to complications after single dose stereotactic radiosurgery is comparable to other techniques.

Conjuctival lesions - the relationship of papillomas and squamous cell carcinoma to HPV infection.

The etiology of papilloma formation is multifactorial. There is a strong association between human papillomavirus (HPV) and the development of these conjunctival lesions. HPV is tumorigenic and commonly produces benign tumors with low malignant potential. Papillomas rarely go through malignant transformation. MATERIAL AND METHODS: Retrospective study of patients with a diagnosis of conjunctival papilloma or squamous cell carcinoma. RESULTS: From a collection of 125 patients with conjunctival non-pigmented tumours in the period from 2007 to 2017, in 119 (95.2%) patients histological examination confirmed papilloma and in 6 (4.8%) patients it confirmed carcinoma. Of the total number of patients, 39 were women (31.2%) and 86 men (68.8%). The mean age of patients was 68.4 years (range 20-94 years). Localization of lesions: bulbar conjunctiva - 65 (52.0%), upper eyelid tarsal conjunctiva + fornix - 6 (4.8%), lower eyelid + fornix - 27 (21.6%), caruncle - 20 (16.0%) and plica semilunaris - 7 (5.6%) patients. In the patient cohort we recorded 2 papillomas that were transformed into squamous cell carcinoma. HPV16 was positive in these patients, the carcinomas were from the area of the bulbar conjunctiva, and the surgical solution was associated with the perioperative administration of Mitomycin C. In one case, the inverted papilloma developed into orbital carcinoma within 2 years of primary excision, and the patient underwent radical surgical procedure (partial exenteration of the orbit) followed by radiotherapy. CONCLUSION: Transformation of the papilloma into the carcinoma is rare, but it must always be taken into consideration in case of a recurrence of the disease. HPV can infect the conjunctiva. The ophthalmologist, in collaboration with a pathologist, may recommend appropriate laboratory tests to confirm the diagnosis. Long-term outpatient follow-up of patients after excision of the conjunctival papilloma is also necessary. Key words: epibulbar tumors, conjunctival tumors, papilloma, carcinoma.

Prognostic value of apoptosis inducing factor in uveal melanoma.

In malignant tumors including uveal melanoma there is a continuous effort in search for additional and relevant factors with predictive value and possible therapeutic indications. In the present work we evaluated the 5-year mortality in a group of patients with surgically treated uveal melanoma and its relation to selected demographic, clinical and histopathological parameters, including the expression of apoptosis inducing factor (AIF) in the neoplastic tissue.We analyzed retrospectively the clinical data of patients with uveal melanoma treated surgically (enucleation, endoresection, exenteration) in the period from 2001 to 2007 (n=54). Immunohistochemical detection of AIF expression in formalin fixed and in paraffin embedded tissue samples was evaluated semiquantitatively, intensity and percentage multiplicative Quick Score (QS) was calculated and compared between patients with over 5 year (n=32) and less than 5 year (n=22) survival. In the analyzed group of 54 patients the 5 year mortality was 41 %. We confirmed the negative prognostic significance of some of the known prognostic factors as the tumor size and volume, T3 and T4 stage in the TNM classification and the mixed histological type of the tumor. Immunohistochemistry performed on 49 melanoma specimens showed AIF cytoplasmic positivity, no nuclear translocation was detected. The cut-off value of AIF expression QS ≥ 4 (18) in tumor cells separated the 5 year survival of patients (P = 0.018), odds ratio 5.2 (1.24 - 21.73). Moderate and strong expression of AIF in tumor cells also correlated with less favorable prognosis. Confocal microscopy proved colocalization of AIF with mitochondrial marker in neoplastic cells.The prognosis of patients with uveal melanoma can be more accurate with inclusion of immunohistochemical detection of AIF expression. Increased expression of the AIF protein appears as a new negative prognostic factor predicting the 5 year survival.

[THE BRAF MUTATION AND THE POSSIBILITIES OF UVEAL MELANOMA METASTASING PROGNOSTIC MARKERS IDENTIFICATION]. / MUTÁCIA BRAF A MOZNOSTI IDENTIFIKÁCIE PROGNOSTICKÝCH MARKEROV METASTÁZOVANIA UVEÁLNEHO MELANÓMU.

AIM: The aim is to assess the BRAF gene mutations in patients with posterior uveal melanoma. MATERIAL AND METHODS: Retrospective analysis of the group of patients with malignant melanoma of the uvea, who were indicated to enucleation between 1.1 2015 to 1.3.2016. We analyzed stage of uveal melanoma, volume, cell type and BRAF gene mutations. RESULTS: In clinical study of 20 patients after enucleation due to uveal melanoma at the Department of Ophthalmology in Bratislava, patient age was ranged from 22 to 89 years with a median of 62 years. In 14 patients (70 %) enucleation was the primary treatment and in 6 patients (30 %) enucleation was after irradiation (brachytherapy, Leksell gama knife, linear accelerator). In 17 cases (85 %) the mutation of the BRAF gene was negative and in 3 cases the sample was not assessable for the BRAF mutation. CONCLUSION: BRAF gene mutation is confirmed by several studies found in malignant melanoma of the skin. The histopathology findings in our group did not confirmed our theory, that since the uveal melanoma itself has the similar origin as skin melanoma, should also contain a BRAF mutation.Key words: malignant melanoma of the uvea, mutation of the BRAF gene, chromosomal abnormalities as a prognostic factor.

[Non-melanotic Tumors of the Eyelids Skin and Inner Corner - Basocellular Carcinoma]. / Nemelanómové nádory koze mihalníc a vnútorného kútika - bazocelulárny karcinóm.

AIM: Non-melanoma skin cancer cases in the European population are increasing. Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer of the eyelids and in the inner corner of the eyelid. Due to the latest statistics compiled and published in 2008 in the Slovak Republic (SR) there were registered 5,173 cases of non-melanoma skin cancer (C44 according to ICD-10) in both sexes together (of which women accounted for 51.2 %). The proportion of non-melanoma skin cancer accounted for 17.2 % (16.3 % of men and 18 % of women) of the total number of all reported cancer cases (n = 30,144). The aim of this study is to evaluate the number of clinical relapses in a group of patients. MATERIAL: Retrospectively analyzed data from the medical records of patients with newly detected basal cell carcinoma in period between Jan. 1 2008 to Dec. 31 2013 who underwent surgery and outpatient follow-up at the Department of Ophthalmology and the University Hospital in Bratislava. METHODS: The incidence of relapse was evaluated up to date Dec. 31 2014. We followed the following parameters: location and tumor size, TNM classification, histopathological degree of differentiation, the edges of excised tissue and evaluated recurrence rate separately for each parameter. Statistics were analyzed by chi2 test, which was found to be significant for P < 0.05. The results of continuous parameters were expressed as arithmetic mean ± standard deviation. RESULTS: At the Department of Ophthalmology Faculty of Medicine and UNB, Ruzinov Hospital, in Bratislava, in the period 2008 - 2013 were treated 219 basal cell carcinomas in 217 patients and basal cell carcinoma was histologically confirmed. Basal cell carcinomas were divided into groups according to the stage: G1 (n = 139), G 1-2 (n = 41) and G 2 (n = 39). Localization was more frequent on left side (n = 112) compared to the right one (n = 107). We recorded significantly lower incidence (n = 5) in the area - angulus externus, prevalent occurrence was in the inner area - angulus internus (n = 65). The incidence in the lower eyelid (palpebra inferior) was recorded more frequently (n = 127) as in the upper eyelid (palpebra superior) - (n = 24). During these six years period we have seen 11 recurrences (5.02 %). Exenteration of the orbit was indicated in 5 cases (2.7 %). CONCLUSION: When monitoring patients with newly detected eyelid basal cell carcinoma, operated at the Department of Ophthalmology Faculty of Medicine and UNB in period 2008-2013, incidence of recurrence was recorded in 11 cases, accounting for 5.02 %, which is about one percentage point lower share than in the previous reporting period from period 2005 -2007 from the same Department. The occurrence of relapses corresponds to those in the literature. None of the clinical parameters statistically did affect significantly the incidence of relapses. KEY WORDS: eyelid basal cell carcinoma, non-melanoma skin cancer, tumors eyelashes.

[Orbital ontogen dermoid cyst]. / Odontogénna dermoidná cysta orbity.

In the paper is described the very rare orbital dermoid cyst in lacrimal sac region containing ectopic dental elements. There was an uneventful clinical picture after the first operation, but a recurrence of the cyst with the presence of teeth in lacrimal region of the down eyelid has occurred four years after the first operation. After exstirpation of entire cyst contents has been achieved the favourable cosmetic and functional result.

[The embedded mobile orbital implant from methylmethacrylate "Hydron"--clinical and histopathological findings 25 years after implantation]. / Zanorený pohyblivý orbitálny implantát z methylmetakrylátu "hydron"--klinický a histopatologický obraz 25 rokov po implantácii.

The embedded mobile hydrogel methylmethacrylate ("HYDRON" Spofa) orbital implants introduced in the beginning of 70th years of 20th century was a new method to get good cosmetic effects after enucleation. At the Dept. of Ophthalmology of the Comenius University, Bratislava, the rejection rate of this type of orbital implants in the first years after enucleation (1971-1974) was only 16.8%. This technique was applied in patients after enucleation due to traumatic phtisis of the eye globe. Authors submit a case report of a female patient from the group of implanted mobile orbital implant HYDRON implanted in 1984. They analyze clinical features and histopathological findings after surgical removement 25 years after implantation.

First case of cutaneous human dirofilariosis in Slovak Republic.

Dirofilariosis is a zoonotic disease caused by several species of the genus of Dirofilaria. The causative agent initiates a dangerous canine disease reported from many parts of the globe. The parasites are transmitted by arthropods, which act either as a vector or intermediate hosts. In humans the parasites do not usually reach the adult stage but microfilaremia is absent because of mating impossibility. Human dirofilariosis is caused by D. immitis or D. repens and has been reported from many parts of the world including European countries, namely Italy, France, Spain and Greece. Sporadically, this parasitosis is detected in Central European countries such as Hungary and Switzerland. The presented paper reports the first case of human cutaneous dirofilariosis in Slovakia. The clinical manifestation was a typical subcutaneous granuloma with the adult worm in the center. The identification of Dirofilaria repens was made based on morphological appearance of the parasite. The patient 60 years old, lives in the area where in 2005 six cases of canine dirofilariosis caused by the same species were reported (Fig. 2, Ref. 16).

[Traumatic rupture of the spleen. Histopathologic findings]. / Traumaticke ruptúry sleziny. Niektoré histopatologické nálezy.

The most common causes of splenic rupture are blunt injury and surgical intervention in abdominal cavity. Morphological investigation of the spleen often shows but a small capsular laceration as well as haemorrhage and granulocytic infiltration in microscopy of its margins. The laceration may be sometimes difficult to find. There are two types of microscopical haemorrhage. One in sinus-lacking subcapsular tissue zone, the other in deeper layers. In this case the tissue haemorrhage is diffuse, sometimes within or around the marginal zone. The sinuses are neither collapsed nor obturated by any material even close to margins of the wound.

Endothelial changes following repeated effect of vasoconstrictive substances in vitro.

Using perfusion method the reactivity of rabbit femoral and ear arteries was investigated following the administration of rising noradrenaline doses in four consecutive intervals. Progressive increase of vasoconstrictive activity of vessel segments was found. Results of histological examination showed a progressive de-endothelialization of perfused vessels. The loss of endothelium increased depending on time of action and on intensity of vasoconstrictive stimuli.

Combined chronic toxicity/carcinogenicity study of the fungicide trimorphamide in rats.

Trimorphamide, a new fungicide, was fed over 2 years to groups of 50 male and 50 female rats at dietary levels of 0, 67, 330 and 665 mg/kg. No adverse effects on mortality, haematology, urinalysis, organ weights, incidence and severity of tumors were observed. Isolated observations of abnormalities in blood chemistry suggested the possibility of certain renal damage in the highest dosage group; however, the clinical significance of these findings is dubious. According to the results of the present study, 67 mg/kg in the diet can be considered as the "no observed effect level".

On the mechanism of acute toxicity of phosmet.

Rats were given single oral doses of phosmet (LD50 or 3/4 LD50). Changes of hematological parameters were studied in several time intervals; the main interest was paid to disturbances in blood clotting. Both light and electron microscopy were used to evaluate histopathological changes in selected organs (liver, lungs, spleen, stomach). Marked changes could be observed in all blood clotting parameters studied, other findings were not standard. The pathological picture was dominated by endothelial damage to the blood vessels and findings of thrombocytic clots in microcirculation of all organs examined. Together with hemocoagulation changes, they could be considered as reflecting the compensated stage of diffuse intravascular coagulopathy. In addition, damaged alveolar endothelium and interstitial edema could be observed in the lungs together with hepatic steatosis, damaged proximal renal tubuli, release of cellular elements from the splenic pulp and decomposition of megakaryocytes as well as serious exfoliation of the superficial layers of the gastric mucosa. The pathohistological alterations coincided with changes in organ weights.