Periocular Mass Research Articles

Orbital Oncocytic Carcinoma: A Comprehensive Case Series and Literature Review.

This case series and literature review evaluated the baseline variables, clinical symptoms, pathological characteristics, and prognosis of patients with orbital oncocytic carcinoma. This retrospective case series collected the medical histories and other related data from 13 patients pathologically diagnosed with oncocytic carcinoma. The average age of patients with orbital oncocytic carcinoma was 64.8 years, with a significantly higher rate of males than females. Furthermore, unilateral disease was more common than bilateral disease. All patients had surrounding tissue invasion, most commonly to extraocular muscles (69.2%) and bones (53.8%). The clinical manifestations were proptosis (30.8%), swelling of the lesion area (23.1%), vision loss (23.1%), diplopia (23.1%), periocular mass (23.1%), tears (15.4%), eye pain (7.7%), ptosis (7.7%), and visual field loss (7.7%). Microscopic examination revealed many large eosinophilic cells. There were obvious nuclei and abundant mitotic figures. The cancer cells expressed cytokeratin, but not P63 or S-100. The follow-up duration was 2-53 months, and the metastasis rate was 16.7%. The patients exhibited a good prognosis. The main treatment methods included surgical resection, surgery combined with radiotherapy, and the enucleation of ocular contents. Orbital oncocytic carcinoma has the immunohistochemical characteristics of eosinophilic tumor cells, with expression of cytokeratin but not P63 or S-100. The prognosis is favorable. Surgical resection, surgery combined with radiotherapy, and enucleation of intraocular material are effective treatment options. Nevertheless, long-term follow-up and close observation for metastases are required.

Periocular Mass Due to Persistent Secretion Within a Transplanted Parotid Duct.

A male patient underwent microvascular transplantation of an autologous submandibular gland and its associated (Wharton's) duct for management of very severe right keratoconjunctivitis sicca due to Stevens-Johnson syndrome; due to hypersecretion, the gland was later removed in toto. Twenty-two years later, he presented with a nontender, sausage-like mass lying subcutaneously in the right temple. Intraoperatively a fluctuant tubular mass passing from the temporalis fossa to the superotemporal conjunctiva was identified and excised intact. Histology showed a slightly proteinaceous fluid within a duct lined with cuboidal epithelium, this being compatible with Wharton's duct. This case highlights that iatrogenic causes should be considered with any history of periocular injury or surgery.

Periocular and orbital amyloidosis: A case series study

To present the demographic and clinical profile and management strategies of patients with periocular and orbital amyloidosis. This study retrospectively reviewed the clinical records of twelve patients with periocular and orbital amyloidosis between January 2011 and February 2019 in Bangladesh. Clinical evaluation and Imaging studies were helpful to diagnosis the patients, but surgical biopsy followed by histopathological study was done to confirm the diagnosis. All cases were investigated to rule out systemic amyloidosis with limited facility and no systemic involvement was found. Informed written consent for surgical procedure and Clinical photographs were taken for all patients for documentation and clinical research. The study included thirteen patients including nine male (69.2%) and four female (30.8%) patients. Among the patients, seven (53.8%) were unilateral and six (46.2%) were bilateral. Clinical signs and symptoms were visible or palpable periocular mass or tissue infiltration in all 13 (100%) cases, mechanical ptosis was observed in 6 (46.2%) cases, and proptosis or globe displacement was found in 4 (30.8%). Age ranges from 25 years to 65 years. The Mean age ± SD was 48.23 ± 10.64 years. Treatment modalities were mainly open surgical biopsy either excision (53.8%) or debulking (46.2%). Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings depending on the location of the disease. The goal of treatment is to preserve function and to prevent sight-threatening complications.

Accuracy in clinical diagnosis of benign peri-ocular mass lesions

To analyze accuracy in clinical diagnosis of peri-ocular benign lesions. A prospective, interventional study of 279 clinically diagnosed and or histo-pathologically confirmed eyelid mass lesions. At presentation, detailed demographic data, symptoms, duration since the mass noted, it’s location, size & physical appearance, progression/regression/recurrence of the lid mass if any and associated systemic ailments were noted. Then, a pre-treatment clinical diagnosis (PTCD) was made. The treatment given, its outcome and histo-pathological examination (HPE) report were noted. Results then analysed in terms of how many cases needed HPE and in how many did PTCD match with HPE reports. Commonest lesions were of infective type (64.5%) followed by cysts and neoplastic which together contributed for 26.9% cases and others like congenital, traumatic, depositive etc., contributed for 8.6%. Totally, 25.8% sent for HPE; 94.4% did match with PTCD. Accuracy in clinical diagnosis is good with a thorough understanding of physical characteristics of lid mass lesions. Studies on a large scale would be extremely beneficial for the practicing ophthalmologists and the training residents and also for public health-care planning.

ECG of the Month.

IntroductionA 26-year-old 290-g female Timneh African grey parrot (Psittacus timneh) was presented to the Colorado State University Veterinary Teaching Hospital for CT as part of radiation planning for treatment of a right periocular mass, suspected to be a squamous cell carcinoma.On initial evaluation, the bird was bright, alert, and responsive and had a body condition score of 2/9. On physical examination, there was severe periocular swelling around the right eye causing the palpebral fissure to be held shut. Thoracic auscultation was performed with a neonatal stethoscope with the diaphragm placed directly over the keel of the

Visual impairment in immunoglobulin G4-related disease: A case report.

The present study reports on the case of a 50-year-old male with sinusitis, diplopia, secretory otitis media and skin eczema for >14 years. The patient presented with visual impairment in both eyes and subxiphoid pain on admission to the First Affiliated Hospital of China Medical University (Shenyang, China). Orbital CT revealed a slightly thickened left inferior rectus muscle. Due to a periocular mass, enlarged lymph nodes, elevated serum immunoglobulin G4 (IgG4) levels and enriched IgG4-positive plasma cells in the lymph nodes, the diagnosis of IgG4-related disease (IgG4-RD), possibly involving at least 10 organs, was established. Following treatment with methylprednisolone, the serum IgG4 levels decreased to normal and binocular vision returned to normal. Unlike previously reported cases, the present case exhibited no swollen masses around the optic nerve. The purpose of the present case report was to improve the understanding of IgG4-RD.

Periorbital Lipogranuloma after Facial Autologous Fat Injection and Its Treatment Outcomes

PurposeTo investigate periorbital lipogranuloma cases that developed after autologous fat injection and to determine various treatment outcomes from these cases.MethodsThis retrospective study involved 27 patients who presented with periocular mass (final diagnosis of lipogranuloma) and had history of facial autologous fat injection. The collected data included information on patient sex, age, clinical presentation, number and site of fat injections, interval between injections, duration from injection to symptom onset, fat harvesting site, use of cryopreservation, and treatment outcome.ResultsThe most common presenting symptom was palpable mass (92.6%), followed by blepharoptosis and eyelid edema. The mean time from injection to symptom onset was 13.6 ± 29.2 months (range, 2 to 153 months). Patients were managed by intralesional triamcinolone injection (six patients) and surgical excision (three patients); 18 patients were followed without treatment. Among the six patients who underwent intralesional triamcinolone injection, five showed complete resolution, and one showed partial resolution. Among the 18 patients who were followed without management, three showed spontaneous resolution over a 5-month follow-up period.ConclusionsLipogranuloma can develop in the eyelid after autologous fat injection into the face. Both surgical excision and intralesional triamcinolone injection yield relatively good outcomes. Simple observation can be a good option because spontaneous resolution can occur in a subset of patients.

Periocular mass lesions secondary to dermatologic fillers: Report of 3 cases

ObjectiveTo describe findings in patients who received dermal fillers and later developed peri-ocular mass lesions. DesignRetrospective case series. ParticipantsPatients who presented with peri-ocular masses secondary to dermal filler use. MethodsRetrospective chart review. ResultsThree patients with remote filler injection (hyaluronic acid and polyalkylimide), not volunteered on initial history, presented with peri-orbital swelling and/or inflammation that was suspicious in each case for more serious pathology. ConclusionsIt is important for the injecting physician, the ophthalmologist, and the patient to recognize this complication to permit appropriate investigation and management.

Orbital solitary fibrous tumor – Case series and new perspectives

AbstractPurpose To present a case series of orbital solitary fibrous tumour (OSFT) from a tertiary referral centre focussing on diagnostic features including assessment of STAT6, a recently described antibody for immunohistochemistry (IHC) in which positivity is said to indicate NAB2‐STAT6 gene fusion.Methods This is a retrospective case series. Among all orbital tumours resected between 2001‐2014, 12 OSFT cases were identified. Data collected included patient demographics, clinical presentation, morphological and IHC features, management and clinical outcome. IHC for STAT6 was also performed in other soft tissue tumours to assess its specificity.Results There were 3 males and 9 females. The average age was 46 years (18 – 81). The mean follow‐up was 39.3 months (3‐156 months). Presenting symptoms included proptosis(n=6), periocular mass(n=4), foreign body sensation(n=1), and epiphora(n=3). Cellularity, hyalinisation and myxoid areas were variable. Necrosis was seen in one recurrent case. Giant cells were present in 3 cases. <4/10HPF mitoses were seen in 6 cases. All cases showed diffuse strong nuclear positivity with STAT6. In contrast, STAT6 expression was not demonstrated in other pathologies (e.g. neurofibroma, schwannoma, haemangioma, nodular fasciitis). CD34, CD99 and BCL2 ware positive in most cases but with varied staining pattern. One case was CD31 positive and 2 cases expressed SMA focally. All cases underwent elective surgical resection or debulking with complete histopathological clearance in 6 cases.Conclusion This case series confirms previously described variation in presentation and management challenges associated with OSFT. STAT6 antibody can be a helpful adjuvant in the diagnosis of OSFT.

Periocular Myxoma in a Child

Myxomas are locally invasive, benign mesenchymal neoplasms with odontogenic, osteogenic, or soft tissue origin. Facial myxomas probably account for less than 0.5% of all paranasal sinus and nasal tumors. We report a case of a left painless periocular mass in a 11-month-old girl. The lesion was resected with a clinical diagnosis of lacrimal sac tumor. Histopathology and immunohistochemistry proved the tumor to be a myxoma. There has been no recurrence after 4 years of followup. Midfacial myxomas should be differentiated from other benign and malignant tumors such as dermoid, hamartoma, neurofibroma, nasolacrimal duct cyst, and sarcomas in particular embryonal rhabdomyosarcoma. Because of the infiltrative nature of these tumors, a wide surgery is required to achieve clear resection margins and avoid recurrence.

Orbital Arteriovenous Malformations

To present the clinical features, management, and outcomes in a series of patients with orbital arteriovenous malformations (AVMs). Clinical records of patients with orbital AVMs confirmed using angiography were reviewed as a retrospective, noncomparative, interventional case series. Eight patients (3 women and 5 men) with unilateral AVMs and a mean age of 39 years (median, 36.5 years; range, 26-70 years) were reviewed. Findings existed for an average of 11.2 years before diagnosis and included periocular mass (7 patients, 88%); periocular edema, pulsation/bruit, proptosis, episcleral congestion, and previous trauma (4 patients each, 50%); elevated intraocular pressure (3 patients, 38%); pain and reduced visual acuity (2 patients each, 25%); and restriction of extraocular movements, and diplopia (1 patient each, 12%). All of the patients except 1 underwent surgical resection, with 3 (38%) receiving preoperative embolization of feeder vessels; all of the patients had initial resolution of manifestations after treatment. Angiography is essential for diagnosis and for planning the management of orbital AVMs. Treatment depends on patient-specific features and includes observation, embolization, and surgical excision or combined preoperative embolization/excision. Given their vascular nature, the main cause of poor management outcomes is perioperative hemorrhage. Outcomes after a multidisciplinary approach are good, with few recurrences reported at follow-up.

Orbital and Adnexal Sarcoidosis

To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis. This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were reviewed for initial examination findings, radiological findings, treatment modalities, and outcome. The study included 26 patients (19 female, 7 male; mean age, 52 years). The most common feature at the first examination was a palpable periocular mass followed by discomfort, proptosis, ptosis, dry eye, diplopia, and decreased vision. The disease affected the lacrimal gland (42.3%), orbit (38.5%), eyelid (11.5%), and lacrimal sac (7.7%). Among orbital lesions, the antero-inferior quadrant was preferentially involved. Treatment modalities included steroids, surgical debulking, and methotrexate. During a mean follow-up of 18.75 months, 84.6% of patients showed a complete response to the treatment, but 19.2% of patients developed further signs of sarcoidosis. Orbital soft tissue involvement is more common in patients older than 50 years and in women. The anterior inferior quadrants of the orbits appear to be preferentially affected. Although a good response to treatment with oral steroids is seen, long-term follow-up is recommended because active systemic disease can develop months to years later.

Periocular and Orbital Amyloidosis: Clinical Characteristics, Management, and Outcome

To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. Retrospective, noncomparative, interventional case series. All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and orbital units. Clinical records of all patients were reviewed. Clinical presentation, radiological and histological findings, treatment modalities, and outcome. The study included 24 patients (15 female, 9 male) with a mean age of 57+/-17 years. Nineteen cases were unilateral, and 5 were bilateral. Clinical signs and symptoms included a visible or palpable periocular mass or tissue infiltration (95.8%), ptosis (54.2%), periocular discomfort or pain (25%), proptosis or globe displacement (21%), limitations in ocular motility (16.7%), recurrent periocular subcutaneous hemorrhages (12.5%), and diplopia (8.3%). Seven cases had orbital involvement, and 17 were periocular. Immunohistochemistry in 7 patients showed B cells or plasma cells producing monoclonal immunoglobulin chains that were deposited as amyloid light chains. Only 1 patient was diagnosed with systemic amyloid light chain amyloidosis. Treatment modalities were mainly observation and surgical debulking. During a mean follow-up period of 39 months, 21% showed significant progression after treatment, whereas 79% were stable or showed no recurrence after treatment. Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Complete surgical excision is not feasible in many cases, and the goal of treatment is to preserve function and to prevent sight-threatening complications.

Periocular Deep Cutaneous Basal Cell Carcinoma

The distinction between benign and malignant cutaneous periocular lesions can be difficult, as the clinical history and appearance are often quite similar. When present, typical cutaneous changes are often helpful in distinguishing between benign and malignant neoplasms. However, when tumors lack characteristic epidermal change, histopathologic examination may be necessary to confirm the diagnosis. The authors present their experience in the evaluation and management of two patients with periocular basal cell carcinoma who were initially diagnosed as having benign cysts. The case records for two patients with periocular basal cell carcinoma were reviewed. Preoperative and postoperative photographs were available for comparison in one case. For each patient, the medical history, clinical presentation, histology, and surgical outcome were reviewed. In each case, the periocular mass was initially diagnosed as a benign process. Histopathologic examination following excisional biopsy established the diagnosis of basal cell carcinoma in both patients. Following biopsy, residual tumor was removed by the Mohs micrographic technique. There were no surgical complications and no tumor recurrences during follow-up of one year and eight years. Periocular basal cell carcinoma may mimic benign cystic lesions of the central face. Incorrect diagnosis may result in delayed or inappropriate therapy, or failure to submit seemingly benign lesions for histopathologic examination. Definitive treatment requires complete excision with histologic margin control.

Nodular Fasciitis Presenting as a Rapidly Enlarging Episcleral Mass in a 3-Year-Old

A rapidly enlarging periocular mass in a child obligates the treating physician to rule out a malignancy, especially a rhabdomyosarcoma. A 3-year-old girl presented with a 5-day history of a rapidly growing episcleral mass superonasal to the globe, adjacent to the superior rectus muscle insertion. The lesion was locally excised. A sarcoma could not be excluded on frozen sections. Permanent sections and electron microscopy revealed nodular fasciitis, a benign lesion with a pseudosarcomatous histologic appearance. No recurrence has been noted at 9 months follow-up. Nodular fasciitis is a benign proliferation which should be considered in the differential diagnosis of a rapidly enlarging subconjunctival or orbital mass in a child.