1/9. Renal cell carcinoma with involvement of iris and conjunctiva.PURPOSE: To report a case of metastatic renal cell carcinoma with involvement of the iris and bulbar conjunctiva. methods: Case report. A 70-year-old man without known systemic disease developed an iris mass in his left eye. Iridocyclectomy was performed to remove the iris mass. RESULTS: Histopathologically, the iris mass was consistent with metastatic renal cell carcinoma. Further evaluation disclosed a mass of the left kidney. The patient underwent a left nephrectomy and was found to have renal cell carcinoma, with focal penetration into the renal capsule. One month after the nephrectomy, he developed a highly vascular nodule of the left bulbar conjunctiva. An excisional biopsy was performed, and histopathology disclosed an additional focus of renal cell carcinoma. CONCLUSIONS: iris and conjunctival involvement may be a clinical manifestation of renal cell carcinoma. Renal cell carcinoma should be considered in the differential diagnosis of a fleshy, vascular iris and a conjunctival nodule.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/9. 5-fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea.OBJECTIVE: To evaluate the efficacy of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of conjunctival and corneal intraepithelial neoplasia. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Seven patients with histologic evidence of intraepithelial neoplasia were identified by conjunctival biopsy or tumor excision. methods: Seven patients with a minimum of 7 months of follow-up were treated with pulsed dosing of 1% 5-FU. Topical 1% 5-FU was administered four times daily for 2 to 4 days for each cycle. The number of initial treatment cycles was two to six, with the time between cycles being 30 to 45 days. MAIN OUTCOME MEASURES: The presence or absence of clinically evident intraepithelial neoplasia was evaluated after each treatment interval. patients were also monitored for adverse reactions to the use of topical 5-FU. RESULTS: Four patients remain disease free with a mean follow-up of 18.5 months (range, 7-36 months) with no additional treatment after the initial treatment cycles (mean, 3.75 cycles; range, 2-5 cycles). Three patients had recurrence of disease after the initial treatment cycles. Two patients were treated with additional cycles for recurrent disease (six cycles in one patient and five cycles in the other patient) and are free of disease at 20 and 21 months after treatment, respectively. One patient had persistent disease despite treatment with topical 5-FU and was treated with topical mitomycin C with resolution of the disease without recurrence for 16.5 months. No adverse reactions to pulse dose treatment with topical 5-FU were noted. CONCLUSIONS: Pulsed dosing with 1% topical 5-FU for the treatment of conjunctival and corneal intraepithelial neoplasia, alone or as an adjunct to excision of bulky disease, is a well-tolerated and effective method of treatment.- - - - - - - - - - ranking = 10keywords = cycle (Clic here for more details about this article) |
3/9. Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma.PURPOSE: To present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia. DESIGN: Observational case report; follow-up at 30 months. methods: In a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month. RESULTS: After MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. cataract surgery was performed uneventfully. The patient was followed up for 30 months. CONCLUSIONS: In selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
4/9. A case of conjunctiva-cornea intraepithelial neoplasia successfully treated with topical mitomycin C and interferon alfa-2b in cycles.PURPOSE: To report a case of conjunctiva-cornea intraepithelial neoplasia (CCIN) treated with topical mitomycin C (MMC) and interferon alfa-2b in cycles. methods: A 52-year-old woman referred for limbal stem cell deficiency and epithelial defect was found instead to have CCIN. The diagnosis was confirmed by impression cytology and treated in cycles with topical 0.02% MMC for 14 days in the first cycle, 12 days in the second cycle, and 3 days in the third cycle followed by topical interferon alfa-2b 1 x 106 U/mL for 11 days. RESULT: Topical MMC for 2.5 cycles resulted in 95% reduction of CCIN and improvement of 2 lines of vision. Because of intolerance to MMC, she was switched to topical interferon alfa-2b for 11 days, resulting in total resolution of CCIN, which lasted for at least 10 months. CONCLUSIONS: After differentiation from a persistent corneal epithelial defect and limbal stem cell deficiency by dye staining and impression cytology, the patient in this case of CCIN was successfully treated with topical MMC and interferon alfa-2b in cycles.- - - - - - - - - - ranking = 11keywords = cycle (Clic here for more details about this article) |
5/9. Follicular conjunctivitis caused by a mantle cell lymphoma.BACKGROUND: lymphoma of the conjunctiva as part of a systemic disease is rare. The follicular appearance of the lymphocyte hyperplasia may mimic the clinical picture of infectious or allergic conjunctivitis. We report on a case of marked chronic follicular conjunctivitis, finally diagnosed as mantle cell lymphoma. history AND SIGNS: A 52-year old male with a history of epiphora for one year, presented with follicular conjunctivitis in both eyes, a nodal mass in the upper right eyelid and nuchal lymphadenopathy. No infectious or allergic aetiology could be found. Conjunctival biopsy revealed a mantle cell lymphoma. Magnetic resonance tomography showed a bilateral spread into the orbital cavity. Other sites of involvement were the epipharynx and the cervical, axillary and paratracheal lymph nodes. THERAPY AND OUTCOME: Chemotherapy with hyper-CVAD (cyclophosphamide, vincristine, doxorubicine, dexamethasone) was initiated. After 4 of 6 cycles, all clinical tumour manifestations had disappeared completely. CONCLUSIONS: Conjunctival lymphoma may clinically resemble follicular conjunctivitis. Conjunctival biopsy may lead to early diagnosis and initiation of therapy.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/9. Lethal Epstein-Barr virus associated NK/T-cell lymphoma with primary manifestation in the conjunctiva.BACKGROUND: Lethal midline granulomas (LMG) are very rare angiocentric NK/T-cell lymphomas in association with Epstein-Barr virus. LMG are reported mainly in East Asia occurring in immune compromised patients. history AND SIGNS: A 41-year old male patient presented with a conjunctival swelling of his upper left eyelid. The lesion had increased over a period of 2 months despite topical corticosteroid treatment. Conjunctival biopsy revealed a highly malignant, CD3 and BCL2 extranodal T-cell lymphoma with features of an NK/T-cell origin (CD56 , TIA TCR-rearrangement: germline). All lymphoma cells were positive for Epstein-Barr virus rna. The proliferation rate was highly elevated at 100 %. THERAPY AND OUTCOME: Systemic 1 (st) cycle chemotherapy with cyclophosphamide, doxorubicin, vincristin and prednisone resulted in a complete remission of the swelling within 4 days. However, one week later a massive conjunctival tumour reappeared with only partial regression after combined chemo- and radiotherapy. The patient died within a month because of untreatable pancytopenia due to malignant bone marrow infiltration. CONCLUSIONS: LMG is a rare but highly malignant Epstein-Barr virus associated NK/T-cell lymphoma that can occur in healthy, immune competent Caucasians. This is the first reported case of an LMG in an immune-competent Caucasian patient with primary ocular manifestation. The LMG has a high mortality rate despite systemic treatment and can be lethal within a few months or even weeks.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/9. Combined surgery and cryotherapy for scleral invasion of epithelial malignancies.Three patients with epithelial malignancies of the ocular adnexa, a basal cell carcinoma, a squamous cell carcinoma, and a malignant melanoma, are presented. All three had invasive tumors with scleral involvement. In an attempt to preserve the globe, treatment consisted of local surgical excision without lamellar or full thickness sclerectomy , followed by cryotherapy utilizing a double cycle freeze-thaw- refreeze technique to the underlying scleral bed and areas of suspected residual tumor. All three patients have been followed from 24 to 37 months without change in their initial visual acuity and without clinical recurrence of tumor. Although this combined surgical and cryosurgical approach cannot be advocated as a primary mode of therapy, it may offer a useful alternative to enucleation or exenteration in selected patients with ocular invasion of tumor in whom more radical surgery may be visually incapacitating or not otherwise feasible.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/9. Invasive squamous cell carcinoma of the conjunctiva.A 73-year-old man had been treated for a sore, red, left eye for 4 months before a clinical diagnosis of squamous cell carcinoma of the limbus was made. This diagnosis was confirmed on examination of a biopsy specimen, but after an initial surgical attempt to fully excise the tumor, there was clinical evidence of intraocular spread. An extensive corneoscleral resection and iridocyclectomy appeared to completely excise the tumor, as indicated by frozen section review. However, 1 year later, the patient re-presented with obvious residual squamous cell carcinoma of the iris and trabecular meshwork, well away from the original tumor site. Subsequent exenteration has resulted in a tumor-free patient for 1 year. Apparent surgical clearance of an extensive squamous cell carcinoma does not ensure total intraocular clearance of residual tumor, which may be remote from the original tumor site.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
9/9. Primary conjunctival rhabdomyosarcoma: 2.5 years' follow-up after combined chemotherapy and brachytherapy.BACKGROUND: The 2.5-year outcome of a 3-year-old girl with a primary intraconjunctival rhabdomyosarcoma treated by biopsy-controlled combined chemo- and brachytherapy is reported. methods: The patient presented with a conjunctival dermoid-like lesion which showed modest growth on 1-month follow-up. The first biopsy appointment was missed because of a viral illness. When she showed up 3 months later a further increase in size was obvious and several incisional biopsies were taken immediately. RESULTS: light microscopy revealed an undifferentiated subepithelial small cell tumour. On immunohistochemistry the tumour reacted with vimentin and desmin antibodies. Thus, the diagnosis of an embryonal rhabdomyosarcoma was made. The patient underwent 9 cycles of polychemotherapy and the tumour mass disappeared macroscopically. However, immunohistochemistry of incisional biopsies showed residual tumour cells. The latter were eradicated by an individually shaped strontium-90 applicator. CONCLUSION: At 2.5 years after biopsy-controlled combined chemotherapy and brachytherapy the patient is free of tumour at a manageable level of complications. This new approach appears to be a good alternative in the treatment of primary conjunctival rhabdomyosarcomas since it takes advantage of the unique location of this rare tumour and avoids hemifacial retardation, known to be induced by external beam radiation.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |