Malignant melanoma of the eyelid and conjunctiva

Four patients with malignant melanoma of the eyelid skin and 14 patients with conjunctival malignant melanoma are presented. Surgery was recommended for eyelid lesions and local excision followed by cryotherapy for conjunctival lesions. One patient with an eyelid skin malignant melanoma died and two patients with extensive malignant melanoma of the conjunctiva died. Nodular lesions involving the lid margin have the worst prognosis of eyelid skin malignant melanomas, and the greater the extent of conjunctival involvement the worse the prognosis for conjunctival malignant melanomas. The complications of cryotherapy are minor, but the follow-up period in this series is too short to comment on survival times.     

眼睑及结膜的卡波西肉瘤

目的 探讨眼部卡波西肉瘤的临床及病理特点。方法 对赞比亚恩多拉中心医院眼科１９９５年１月于１９９６年５月,经手术切除病理证实的１２例眼睑及结膜的卡波西肉瘤进行回顾性分析,同时对其中６例病理切片重新复习并分型。结果 １２例均为非洲年轻男性黑人,４例行血清人类免疫缺陷病毒检测均呈阳性,多娄秀与获得性免疫缺陷综合征有关的全身症状。６例的病理切片分为３型,Ⅰ、Ⅱ、Ⅲ中２例。结论 部卡波西肉瘤为ＡＩＤＳ病较     

Intraepithelial sebaceous carcinoma of the conjunctiva and skin of the eyelid.

The authors report a 65-year-old woman with a 10-year history of conjunctivitis and progressive loss of lashes due to widespread intraepithelial sebaceous carcinoma of the conjunctiva and skin of the eyelid. After surgery, serial sections of the entire conjunctiva and eyelids showed a single focus of invasive carcinoma in the bulbar conjunctiva, which probably arose from the epithelium. The absence of cilia on the affected lower lid was associated with neoplastic obliteration of the cilial orifices and low-grade, smoldering lipogranulomatous inflammation. This type of tumor-related alopecia is likely to masquerade as blepharitis because there is no identifiable tumefaction or clinical evidence of recurrent chalazia to suggest an underlying sebaceous carcinoma. The 10-year history of "conjunctivitis" before diagnosis indicates that intraepithelial sebaceous carcinoma may have a prolonged clinical course.     

Haemangioendothelioma on the conjunctiva of the upper eyelid

A 62-year-old man visited the authors' clinic complaining of a mass on the palpebral conjunctiva of the right upper eyelid. The 2.0 cm x 1.2 cm sized, red and painless mass underwent incision and biopsy for histopathological examination. The mass was confirmed to be Kaposiform haemangioendothelioma characterized by densely packed spindle cells. These cells were positive to vimentin, CD31 and factor VIII-related antigen by immunohistochemical stain. The mass was completely resolved by oral steroid therapy and has not recurred through the presentation. Kaposiform haemangioendothelioma generally occurs in infant and adolescent periods and is characterized by rapid progression and invasion to adjacent tissue. Herein, an unusual case of Kaposiform haemangioendothelioma affecting the conjunctiva of the upper eyelid on a middle-aged man is reported.     

IgA associated lymphoplasmacytic tumor involving the conjunctiva, eyelid, and orbit.

A 65-year-old white man had an unusual disseminated lymphoid tumor that first appeared in the subconjunctival tissues of the right eye. The tumor later appeared in the skin, lymph nodes, and left upper eyelid and orbit. A monoclonal serum IgA spike was present although the urine did not contain Bence Jones proteins. The cells of the tumor appeared to be plasmacytoid lymphocytes. Prominent intranuclear inclusions, or Dutcher bodies, were present. Throughtout the 11-year history, the patient has been treated only with local excision and radiation.     

Bacillary angiomatosis of the anterior orbit,eyelid, and conjunctiva

PURPOSE: To report a case of bacillary angiomatosis of the lower eyelid, conjunctiva, and anterior orbit. DESIGN: Interventional case report. METHODS: A 76-year-old immunocompromised male patient developed a firm vascularized nodule in his left lower eyelid and anterior orbit. RESULTS: An excisional biopsy was performed. Histopathologic examination revealed an abnormal vascular proliferation and a mixed inflammatory infiltrate. A Warthin-Starry stain showed numerous bacilli. These findings are characteristic of bacillary angiomatosis. A serologic specimen was positive for antibodies to Bartonella Quintana. CONCLUSION: The lower lid and anterior orbit are rare locations for bacillary angiomatosis. Our case brings to attention the increasing importance of Bartonella infection as a causative agent of ophthalmic diseases.     

眼睑眼眶恶性淋巴瘤的临床病理分析

目的总结眼部恶性淋巴瘤的临床病理学特征,探讨其可能的致病机制.方法回顾分析3年46例眼部恶性淋巴瘤的临床病理资料.结果眼睑、结膜恶性淋巴瘤14例,占同期眼睑、结膜恶性肿瘤的11.2%;眼眶恶性淋巴瘤32例,占同期眼眶实体性肿瘤的11.3%.均大大高于国内外文献报道(1～3%).免疫组织化学染色33例(71.7%),均为非霍奇金淋巴瘤,其中32例为低度恶性B细胞黏膜相关性淋巴瘤,且λ表达者高达92.3%,1例为T细胞性淋巴瘤.结论眼部淋巴瘤多为低度恶性B细胞黏膜相关性淋巴瘤,免疫组织化学检查有助于诊断,其发病率具有相当大的地域性差异.     

Amelanotic malignant melanoma of the conjunctiva with local metastasis to the eyelid

Conjunctival melanomas are uncommon. The amelanotic variety is extremely rare. We describe a patient with an amelanotic melanoma of the superior conjunctiva that was primarily excised, followed by extensive conjunctival resection and liquid nitrogen cryotherapy applied to the tumour bed. Eight months later a local metastatic lesion was noted in the lower eyelid. Eyelid metastasis in conjunctival melanoma is uncommon but may occur owing to the rich lymphatic vasculature within the conjunctiva.     

Malignant melanoma of the eyelid and palpebral conjunctiva treated with iodine-125 brachytherapy

OBJECTIVE: To evaluate the results on malignant melanomas of the eyelid and palpebral conjunctiva treated with iodine-125 (125I) brachytherapy with shielding of the eye. DESIGN: Noncomparative case series. PARTICIPANTS: Fourteen patients treated with 125I brachytherapy at an ocular oncology referral center from 1974 through 1996, all of whom had had previous debulking, incomplete resection, or recurrence after surgery. INTERVENTION: A stainless steel pericorneal ring eyeshield was attached to the extraocular muscles, over which a lid was fitted to protect the cornea without touching it. Iodine-125 seeds in polythene tubes were inserted into the eyelid and attached to the lid margin for a single plane implant. In five cases additional seeds were glued on to the shield as well for a volume implant. A median dose of 37 Gy (range, 17.3-67.6 Gy) was given over the course of 113 hours (range, 47-190 hours) to the outer surface of target volume. MAIN OUTCOME MEASURES: Local control is regarded as freedom from recurrence in those without measurable disease and complete clinical regression in those with measurable disease. Morbidity is assessed in terms of function and cosmesis. Survival is given from the time of the implant. RESULTS: There was local control in 13 patients maintained from 11 to 227 months (median, 39 months). There were two recurrences at 8 and 13 months in the first patient who received 17.3 Gy. Late complications consisted of mild eyelid telangiectasia, mild eyelid atrophy, and loss of eyelashes in most patients. Five patients, four of whom had upper eyelid tumors, experienced a dry eye, which was managed with tear supplements, and one of these patients developed a cataract. A corneal ulcer developed in one eye, which later perforated after treatment of a subsequent bulbar melanoma and was exenterated. Another eye was enucleated after treatment for a subsequent melanoma in the fornix. Cosmesis was acceptable to patient and doctor in the other 12 patients. Vision was maintained in seven patients, reduced in two, and not recorded in the remaining three patients. Three patients died of hematogenous metastases at 44, 62, and 79 months after implant, one of bronchial carcinoma at 46 months and one of an astrocytoma at 39 months. All patients were clear of local disease. The remainder survived for a median of 45 months (range, 18-227 months). CONCLUSIONS: Iodine-125 brachytherapy can be used as an alternative to wide excision or exenteration of these tumors. There was good local control, reasonable maintenance of vision, and good cosmesis.     

Topical mitomycin-C for pagetoid invasion of the conjunctiva by eyelid sebaceous gland carcinoma

PURPOSE: To evaluate the efficacy of topical mitomycin-C for pagetoid invasion of the conjunctiva by sebaceous gland carcinoma. DESIGN: Prospective noncomparative consecutive interventional case series. INTERVENTION: All patients received topical 0.04% mitomycin-C four times daily for 1 week followed by 1 week off medication. The treatment cycles were repeated until resolution of the conjunctival malignancy was clinically evident. PARTICIPANTS: Four patients with histopathologically proven intraepithelial (pagetoid) invasion of the conjunctiva by sebaceous gland carcinoma were managed with this regimen. RESULTS: The mean patient age was 78 years. Before treatment, the main tumor site included the upper eyelid in two cases and the lower eyelid in two cases. Previous resection of the tumor had been performed elsewhere in three cases over the prior 6 years. At the time of our examination, map biopsies confirmed pagetoid invasion involving 25% to 90% of the conjunctival surface, with bulbar, forniceal, and tarsal conjunctival involvement in all four cases and corneal extension in one case. There was no evidence of deep tumor within the conjunctival stroma or tarsus in any case. After treatment, medication intolerance and early discontinuation occurred in one patient, and continued tumor progression was documented. Of the remaining three patients, chemotherapy was used for a mean of four cycles with complete resolution of the pagetoid invasion, confirmed histopathologically in two cases, and without recurrence in all three cases over 12 months (mean) follow-up. The medication caused moderate temporary local irritation but no serious intraocular or extraocular complications. CONCLUSIONS: Preliminary evidence suggests that topical mitomycin-C is effective treatment for pagetoid invasion of the conjunctiva by sebaceous gland carcinoma. Longer follow-up is necessary to assess the duration of tumor control.     

Topical application of 5-Fluorouracil in premalignant lesions of cornea,conjunctiva and eyelid

Local application of 5-Fluorouracil was practised on 5 patients. In 3 patients with multiple premalignant oculo-cutaneous lesions, two of whom had also premalignant epibulbar lesions, local 5% 5-Fu cream and/or 1% 5-Fu eyedrops were applied. In 2 other patients who had only premalignant lesions on the cornea and conjunctiva, 1% 5-Fu eyedrops were used only. In animal experiments 1% 5-Fu was not found to cause any damage to normal corneal and conjunctival epithelium. The frequency of the applications and the duration of the treatment were dependent on the location and extent of the lesions. Except for easily treatable lesions, caused by the separation of the tumour epithelium, no complications of local 5-Fu treatment were seen. The visual acuity improved in all 4 patients in whom the cornea was affected. In these premalignant conditions the diagnosis and assessment of the therapy were based on exfoliative cytology and biopsies.