Periorbital Tumors Research Articles

Pilomatrixoma of the Periorbital Region: A Retrospective Review.

Pilomatrixoma is a benign cutaneous adnexal tumor that differentiates toward hair follicle cells. It infrequently occurs in the periorbital region. In the periorbital area, it is often located in the upper eyelid and eyebrow region. Periorbital pilomatrixoma is often misdiagnosed clinically and is less common than other benign skin tumors. In this retrospective review, we evaluate the demographic, clinical, and histopathological data of patients with periorbital pilomatrixoma, treated from 2010 to 2023. A retrospective analysis of periorbital pilomatrixoma cases treated during a period of 13 years was performed. Deidentified data in relation to the age at surgical excision, gender, location, size, histopathological features, treatment, and recurrence were collected. All histological slides were reviewed by an attending histopathologist. A total of 77 cases of periorbital pilomatrixoma were diagnosed by histopathological examination and treated from 2010 to 2023. A slight female preponderance (56%) was noted, and the majority of cases (52%) were presented in the first 2 decades of life. The left periorbital region was involved in 45.5% of cases, and 54.5% in the right. The upper lid was the most affected site. Two cases of recurrence were reported. No malignant transformation was noted. Pilomatrixoma is an uncommon benign periorbital tumor, commonly misdiagnosed clinically. Ophthalmologists and surgeons should suspect pilomatrixoma in the periorbital region, especially in children or young adults. Complete surgical excision is curative, and recurrence is rare.

Mohs Micrographic Surgery With Immunohistochemistry for the Treatment of Periocular Melanoma In Situ.

Mohs micrographic surgery with immunohistochemistry allows for same-day comprehensive margin assessment of melanoma in situ prior to subspecialty reconstruction. This study describes the oncologic and reconstructive outcomes of eyelid and periorbital melanoma in situ and identifies risk factors for complex reconstructive demands. Retrospective case series of all patients treated with Mohs micrographic surgery with immunohistochemistry for melanoma in situ affecting the eyelids or periorbital region from 2008 to 2018 at a single institution. Tumors were assigned to the eyelid group if the clinically visible tumor involved the skin inside the orbital rim. Reconstructive variables were compared between the eyelid and periorbital cohorts. There were 24 eyelid and 141 periorbital tumors included. The initial surgical margin for all tumors was 5.34 ± 1.54 mm and multiple Mohs stages were required in 24.2% of cases. Eyelid tumors included more recurrences (p = 0.003), and the average defect size was larger (14.0 ± 13.3 cm2 vs. 7.7 ± 5.4 cm2, p = 0.03). Risk factors for complex reconstruction included: initial tumor diameter >2 cm (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 1.95-7.57) and eyelid involved by initial tumor (OR: 4.88, 95% CI: 1.94-12.28). At an average follow-up of 4.8 years, there were no melanoma-related deaths and 1 local recurrence (0.6% recurrence rate). Mohs micrographic surgery with immunohistochemistry achieves excellent local control rates for periocular melanoma in situ. An initial surgical margin of 5 mm is frequently insufficient to achieve clear margins. The resulting defects are large, and the complexity of reconstruction can be predicted by tumor size and clinical involvement of eyelid skin.

An unusual presentation of orbital rhabdomyosarcoma: A case report

Orbital rhabdomyosarcoma (RMS) is the commonest orbital cancer in children. Capillary hemangioma (CH) is the commonest benign periorbital tumor in childhood. We present an unusual case of orbital RMS, which was initially diagnosed as an orbital CH. An 8-year-old girl presented with a right eye protrusion of 3 years’ duration. The protrusion increased with the Valsalva maneuver. There was no history of headache, remarkable weight loss, or swelling of any other parts of the body. A diagnosis of orbital hemangioma was made, and she was commenced on propranolol with some improvement, but she defaulted. When she was represented 4 years later, there was a huge mass surrounding the right eye, with blindness and intermittent bleeding. Orbital computed tomographic angiography revealed features of a very vascular mass with bony expansion of all the orbital walls. She underwent modified exenteration, and her histology revealed Alveolar RMS. These reports highlight an unusual presentation of orbital RMS.

Cemiplimab for the Treatment of Advanced Cutaneous Squamous Cell Carcinoma: Appropriate Patient Selection and Perspectives.

Five percent of patients with cutaneous squamous cell carcinoma develop locally advanced or metastatic disease that is not amenable to definitive surgical or radiation therapy. Cemiplimab, an antibody against programmed death receptor-1, was approved in the United States for the treatment of locally advanced and metastatic cutaneous squamous cell carcinoma in 2018. We performed a literature review on the use of cemiplimab in cutaneous squamous cell carcinoma, with an emphasis on efficacy, safety and tolerability, patient selection, and future directions. Embase and PubMed were searched for relevant terms, and 23 peer-reviewed journal articles presenting primary data on cemiplimab treatment in 5 or more subjects with cutaneous squamous cell carcinoma were included and summarized. Objective response rates in locally advanced and metastatic disease ranged from 42.9% to 50.8% in Phase I/II clinical trials and 32-77% (median 58%) in post-approval observational studies. Phase II trials looking at neoadjuvant use also had favorable response rates. Real-world studies demonstrated cemiplimab efficacy in periorbital tumors, tumors with large caliber perineural invasion, and tumors in solid organ transplant recipients. Cemiplimab was safe and well-tolerated in most patients. While side effects such as fatigue, diarrhea, pruritus, and rash were fairly common, only 9.8% of adverse events required cessation of therapy in phase II trials. Severe adverse events were primarily immune-mediated, including pneumonitis, myocarditis, myositis, and autoimmune hepatitis; the risk of treatment-related death was 3% in clinical trials. Further research on cemiplimab therapy in cutaneous squamous cell carcinoma is needed, and trials are now underway to obtain Phase IV long-term real-world data, further data on adjuvant and neoadjuvant use, and additional data in special populations such as stem cell and solid organ transplant recipients.

Sebaceous carcinoma in Western Australia: A registry-based study of site-related outcomes.

Sebaceous carcinoma is a rare cutaneous malignancy which is typically regarded as relatively aggressive and has traditionally been subdivided into periorbital or extraorbital tumours. We conducted a retrospective review of all cases of sebaceous carcinoma reported to the Western Australian Cancer Registry between 1987 and May 2019. The incidence of sebaceous carcinoma in Western Australia has increased over the last three decades, with extraorbital tumours being much more common than periorbital tumours. Very few sebaceous carcinomas have led directly to the death of patients; however, adverse outcomes were more likely with periorbital tumours, in particular local recurrence and the need for major surgical intervention.

Free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound after periorbital tumor resection and orbital enucleation

Objective: To observe the clinical effect of free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound and after periorbital tumor resection and orbital enucleation. Methods: It was a retrospective case series study. Twelve patients with orbital tumors admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from February 2017 to April 2021 were included. There were 4 males and 8 females, aged 48 to 87 years. Nine patients had cutaneous squamous cell carcinoma, and 3 had basal cell carcinoma. All patients underwent extended resection of the tumor, resection of orbital contents and wound repair.All patients had the lesion completely removed, chimeric anterolateral thigh flap of the anterolateral femoral flap and perforator flap were transplanted to repair the wound. The donor area of the flaps was closed with tension sutures. The size of intraoperative resection lesion,intraoperative resection flap and muscle flap and the depth of the wound cavity were summarized. The postoperative flap survival, wound healing, surgical area appearance, flap color, thickness and texture, scarring and sensation in the surgical area, and tumor recurrence were observed. Results: The surgical procedures were successfully completed in all the 12 patients. The intraoperative resection lesion ranged from 7.0 cm × 5.0 cm to 15.0 cm × 8.0 cm. The depth of the wound cavity was 4.0 to 5.0 cm. The intraoperative resection flap range was 7.0 cm × 5.0 cm to 19.0 cm × 8.0 cm. The muscle flap size ranged from 4.0 cm × 3.0 cm to 5.0 cm × 4.0 cm. All flaps completely survived after surgery, and the wounds healed. The sutures at the recipient area were removed at 5 to 7 days after surgery, while the sutures at the donor area were removed at 12 to 14 days. All of the patients were followed up for 3 to 30 months. The scar at the periorbital area was concealed, and the color, thickness and texture of the flaps were similar to those of the surrounding normal skin. The scarring in the flap supply area was not hypertrophic, with localized decreased skin sensation around it. None of the patients had any tumor recurrence during the follow-up period. Conclusion: The anterolateral femoral muscle flap and perforator flap transplantation could efficiently repair the huge wound after orbital content removal, achieving satisfactory therapeutic effects.

Internal Angular Dermoid Indenting on the Globe

Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis.
 Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.

M-Y Plasty: a Simple Technique for the Reconstruction of Small Periorbital Defects

The goal of this case series analysis is to demonstrate that peri-orbital small to medium-sized skin defects can be treated by a direct closure associated with a M-Y plasty. By crossing the orbital eyelid, this technique allows to avoid large undermining and longer scars that are usually associated with the use of local flaps in this region. Twenty patients were operated on between May 2018 and November 2019, for the removal of periorbital skin tumors. Eleven were at high risk of developing delayed healing, post-operative hematoma, or showed a very thin skin, poorly prone to tolerate a large undermining. Defect size was between 1.5 to 13 cm2. All the defects underwent a direct closure with a M-Y plasty. Eighteen patients healed without any complication. Two had a delayed healing at the Y junction. No hematoma, abscess, cutaneous necrosis, or unaesthetic deformity were recorded. The majority of our patients had significant comorbidities, so that a flap reconstruction was considered too aggressive. We here demonstrate that through a direct closure associated with a plasty, they could all benefit from a oncological excision, with a safe reconstruction and very few complications.

Next-generation sequencing analysis suggests varied multistep mutational pathogenesis for endocrine mucin-producing sweat gland carcinoma with comments on INSM1 and MUC2 suggesting a conjunctival origin

Endocrine mucin-producing sweat gland carcinoma is a low-grade eyelid tumor. Small biopsies and insensitive immunohistochemistry predispose to misdiagnosis. We aimed to identify clarifying immunohistochemical markers, molecular markers, or both. Clinicopathologic data (22 cases) were reviewed. Immunohistochemistry (insulinoma-associated protein 1, BCL-2, mucin 2 [MUC2], mucin 4, androgen receptor, β-catenin, and Merkel cell polyomavirus) and next-generation sequencing (Memorial Sloan Kettering integrated mutation profiling of actionable cancer targets, 468 genes) were performed (3 cases). Female patients (n=15) and male patients (n=7) (mean age 71.8years; range 53-88years) had eyelid or periorbital tumors (>90%) with mucin-containing solid or cystic neuroendocrine pathology. Immunohistochemistry (insulinoma-associated protein 1, BCL2, androgen receptor, retinoblastoma-associated protein 1, and β-catenin) was diffusely positive (5/5), MUC2 partial, mucin 4 focal, and Merkel cell polyomavirus negative. Memorial Sloan Kettering integrated mutation profiling of actionable cancer targets identified 12 single-nucleotide variants and 1 in-frame deletion in 3 cases, each with DNA damage response or repair (BRD4, PPP4R2, and RTEL1) and tumor-suppressor pathway (BRD4, TP53, TSC1, and LATS2) mutations. Microsatellite instability, copy number alterations, and structural alterations were absent. Insulinoma-associated protein 1 and MUC2 are positive in endocrine mucin-producing sweat glandcarcinoma. MUC2 positivity suggests conjunctival origin. Multistep pathogenesis involving DNAdamage repair and tumor-suppressor pathways may be implicated.

Using patient-specific bolus for pencil beam scanning proton treatment of periorbital disease.

PurposeA unique mantle cell lymphoma case with bilateral periorbital disease unresponsive to chemotherapy and with dosimetry not conducive to electron therapy was treated with pencil beam scanning (PBS) proton therapy. This patient presented treatment planning challenges due to the thin target, immediately adjacent organs at risk (OAR), and nonconformal orbital surface anatomy. Therefore, we developed a patient‐specific bolus and hypothesized that it would provide superior setup robustness, dose uniformity and dose conformity.Materials/MethodsA blue‐wax patient‐specific bolus was generated from the patient's face contour to conform to his face and eliminate air gaps. A relative stopping power ratio (RSP) of 0.972 was measured for the blue‐wax, and the HUs were overridden accordingly in the treatment planning system (TPS). Orthogonal kV images were used for bony alignment and then to ensure positioning of the bolus through fiducial markers attached to the bolus and their contours in TPS. Daily CBCT was used to confirm the position of the bolus in relation to the patient's surface. Dosimetric characteristics were compared between (a) nonbolus, (b) conventional gel bolus and (c) patient‐specific bolus plans. An in‐house developed workflow for assessment of daily treatment dose based on CBCT images was used to evaluate inter‐fraction dose accumulation.ResultsThe patient was treated to 24 cobalt gray equivalent (CGE) in 2 CGE daily fractions to the bilateral periorbital skin, constraining at least 50% of each lacrimal gland to under 20 Gy. The bolus increased proton beam range by adding 2–3 energy layers of different fields to help achieve better dose uniformity and adequate dose coverage. In contrast to the plan with conventional gel bolus, dose uniformity was significantly improved with patient‐specific bolus. The global maximum dose was reduced by 7% (from 116% to 109%). The max and mean doses were reduced by 6.0% and 7.7%, respectively, for bilateral retinas, and 3.0% and 13.9% for bilateral lacrimal glands. The max dose of the lens was reduced by 2.1%. The rigid shape, along with lightweight, and smooth fit to the patient face was well tolerated and reported as “very comfortable” by the patient. The daily position accuracy of the bolus was within 1 mm based on IGRT marker alignment. The daily dose accumulation indicates that the target coverage and OAR doses were highly consistent with the planning intention.ConclusionOur patient‐specific blue‐wax bolus significantly increased dose uniformity, reduced OAR doses, and maintained consistent setup accuracy compared to conventional bolus. Quality PBS proton treatment for periorbital tumors and similar challenging thin and shallow targets can be achieved using such patient‐specific bolus with robustness on both setup and dosimetry.

A cross sectional study of periorbital dermatoses in a tertiary care hospital in South India

Introduction: Periorbital dermatoses are the dermatological manifestations of the area around the eye excluding eyelid. It greatly affects quality of life. As there is lack of adequate data about frequency and distribution of periorbital dermatoses, there is need for studies to be conducted to study clinical patterns of periorbital dermatoses. Aesthetic facial concerns have been the main reason for dermatological consults in the last few years, one among which is the periorbital dermatoses. Methodology: It was a hospital based cross sectional study of 75 patients, attending Dermatology OPD in a tertiary care hospital, with complains of periorbital dermatoses. Detailed history, general physical, and detailed cutaneous examination was done in all patients included in the study. Clinical tests, routine haematological investigations & skin biopsy were performed in relevant cases. Results and Discussion: Among 75 patients, common dermatological condition distributed in the periorbital region was periorbital tumors 26 patients(34.7%), pigmentary disorders 18(24%) ,dermatitis 18(24%) infections 7(9.33%) and miscellaneous 6(8%). Among all seborrheic keratosis and periorbital hyperpigmentation were observed to be the commonest conditions in our study. Conclusion: Certain periorbital dermatoses are heralding features of underlying systemic disease, so it helps in early diagnosis and treatment of underlying condition. In our study periorbital tumours were the commonest dermatoses seen. Keywords: Dermatoses, Periorbital, Hyperpigmentation, Tumors.

Значение нативной аутофлуоресценции протопорфирина в диагностике новообразований век и кожи периорбитальной области

Значение нативной аутофлуоресценции протопорфирина в диагностике новообразований век и кожи периорбитальной области

Dermoid Cyst: Outcome Analysis in a Pediatric Referral Hospital.

To describe the management of dermoid cysts in a pediatric referral hospital. Retrospective review of 115 patients with pathological diagnosis of dermoid cyst in a pediatric referral hospital between 2003 and 2019. One hundred fifteen patients, 51 (44.3%) males, and 64 (55.7%) females were retrospectively reviewed. There were fifty-one (44.3%) right eyes and 64 (55.7%) left eyes. Mean age at surgery was 39.15 months (5.6 months-16.4 years). One hundred four (90.4%) lesions were superficial, and 11 (9.6%) were deep. Quadrant location was 63 (54.8%) superior-temporal, 45 (39.1%) superior-nasal, 4 (3.5%) inferior-temporal, and 2 (1.7%) in the nasal inferior quadrant. Most patients only had aesthetic concerns, but 3 (2.61%) showed lacrimal drainage obstruction symptoms, 2 (1.74%) had proptosis, and 1 case spontaneously drained to the cutaneous surface. Imaging was performed in 51 (44.3%) patients. Regarding to their radiodensity, 71.9% had low density content, 28.1% high density, and only 1 patient showed full liquid content; 10.9% showed heterogeneous content; 53.1% showed bone remodeling. Every patient but 1 underwent surgery for a barely accessible asymptomatic retrobulbar cyst. Nine cysts (7.8%) were breached during surgery. Three recurrences were found (2.6%), but only 1 was related to intraoperative breach. Dermoid cysts are the most common benign periorbital tumors in the pediatric population. Imaging is required for evaluation of lesions in atypical locations, deep or fixed to underlying tissue. Surgical removal is the gold standard of treatment. Multidisciplinary approach may be required in the most complex cases. After surgery, few complications and recurrences were found in our series.

Maintaining Quality of Life: Electrochemotherapy for Palliative Periorbital Malignancy.

Electrochemotherapy has been used successfully for treatment of recurrent head and neck skin cancers and skin metastasis. It combines both electroporation and chemotherapy. The authors report 4 patients, who all had metastatic periorbital malignancy. These patients were palliative with widespread metastatic malignancy. All patients had either already had multiple procedures or declined surgical resection and preferred less involved measures. The authors report technique and outcomes. Patient 1: 83-year-old man with recurrent malignant melanoma (MM) nodules (BRAF negative) in the left medial orbit and medial canthal area after rhinectomy and previous resections. Patient 2: 72-year-old man with metastatic MM who developed painful and unsightly metastatic nodules on the right and left forehead and the left medial canthus. Patient 3: 93-year-old man with background of widespread multiple myeloma, considered palliative. He developed a left forehead SCC, apparent as a fungating ulcer, which caused significant pain due to perineural invasion. Patient 4: 91-year-old woman with recurrent metastatic sebaceous cell carcinoma of the left lower eyelid obstructing her vision. All patients experienced an improvement in their pain and quality of life. None of the patients developed any significant periorbital inflammation or adverse complications. Electrochemotherapy may be a useful palliative treatment for periorbital tumors. It improves pain and reduces tumor volume. It can be considered for tumors where palliative radiotherapy may be contraindicated.Electrochemotherapy is a useful palliative treatment for metastases to the periorbital area, improving pain and size of the tumors.

Head and Neck Adenoid Cystic Carcinoma: Focus on Outcomes of Intensity Modulated Proton Therapy

In this study, we report cancer control outcomes and toxicity from intensity modulated proton therapy (IMPT) in patients treated for adenoid cystic carcinoma (ACC) of the head and neck. This study combines 2 prospective protocols evaluating IMPT in head and neck cancer. This analysis included patients with ACC, treated with IMPT in the adjuvant or definitive setting between December 2010 and June 2018. Patients with recurrent or metastatic disease were excluded. Locoregional control (LRC), disease free survival (DFS) and overall survival (OS) were estimated using the Kaplan Meier Method. Patterns of failure as well as toxicities were prospectively collected. Cox regression analysis was performed to determine prognostic factors. Toxicities were graded as per Common Terminology Criteria for Adverse Events version 4.01. 60 patients met the inclusion criteria for this analysis. Median follow-up was 2.9 years. Median age was 50 years (range 18-82) and 58% of patients were female. Primary treatment sites included: Peri-orbital (30%), oral cavity (17%), paranasal sinuses (17%), parotid gland (15%), nasopharynx (12%), oropharynx (7%), larynx (1 patient), and trachea (1 patient). As per AJCC 8th Ed, 22%, 18%, 17%, 44% of patients had T1, T2, T3 and T4 stage; only 1 patient had nodal involvement. Treatments involved surgery followed by chemo-IMPT, surgery followed by IMPT and definitive chemo-IMPT in 47%, 30%, and 23% of patients. Most frequent chemotherapy regimen included Cisplatin (63%) and Carboplatin (17%). Median dose was 64 Cobalt Gray Equivalent (range: 60-70 CGE). In patients treated with definitive chemo-IMPT, adjuvant chemo-IMPT and adjuvant RT alone, 3-year LRC was 83%, 92% and 90%, respectively (p=0.5); 3-year DFS was 44%, 87% and 90%, respectively (p=0.09); and 3-year OS was 80%, 85% and 100%, respectively (p=0.5). Acute toxicities included grade 3 dermatitis, mucositis, and dysphagia in 7%, 7%, and 1 patient; there was no grade 4 toxicity. There was a 7% rate of temporary feeding tubes and no permanent feeding tube. Chronic toxicities included 1 patient who developed optic neuropathy after treatment for a peri-orbital tumor. This is the largest cohort of head and neck ACC treated with IMPT. We report excellent cancer outcomes in patients treated with adjuvant IMPT +/- chemotherapy. In addition, Outcomes of patients treated with upfront chemo-IMPT were acceptable, despite typically high risk, more advanced disease. The acute and late toxicity profiles were highly favorable.

Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. To assess indications for adjuvant radiation therapy in patients with CSCC. Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. Data were compared between treatment groups with a χ2 analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.

Juvenile myelomonocytic leukemia: a surprising cause of peri-orbital tumor and squint

Juvenile myelomonocytic leukemia: a surprising cause of peri-orbital tumor and squint

Bilateral Dermoid Cysts on the Lateral Ends of Eyebrows.

Dermoid cysts are a type of benign periorbital tumor that is frequently encountered in children. According to New and Erich, dermoid cysts originate from dermal and epidermal inclusions along the embryonic cleft closure lines located in the head and neck [1]. Periorbital involvement accounts for more than 50% of the pediatric cases of these cysts. Periorbital dermoid cysts usually manifest as painless, slow-growing swellings on the lateral eyebrows. Sometimes, they can cause inflammation and have a mass effect on the adjacent tissue or bone. Unilateral dermoid cysts on the lateral ends of eyebrows are common, but bilateral dermoid cysts are very rare and only one case has been reported thus far [2]. Here, we report a case of bilateral dermoid cysts on the lateral ends of the eyebrows.

Proton Radiation as a Component of Multidisciplinary Orbit Sparing Treatment for Periorbital Tumors

Proton Radiation as a Component of Multidisciplinary Orbit Sparing Treatment for Periorbital Tumors

Presumed primary ocular lymphangiosarcoma with metastasis in a miniature horse

A 7-year-old, 153.0-kg American Miniature mare presented for evaluation of keratoconjunctivitis of the right eye (OD). A superior palpebral conjunctival mass and stromal keratitis were diagnosed. The incisional biopsy diagnosis was a presumptive corneal hemangiosarcoma. Transpalpebral enucleation was performed, and histopathologic evaluation confirmed angiosarcoma of the conjunctiva, cornea, and extraocular muscles. The horse developed progressive epistaxis and orbital swelling following surgery. A systemic workup was performed 3 months after enucleation, revealing regrowth within the orbit and marked cranial cervical lymphomegaly, suggestive of metastasis. Humane euthanasia was performed, and necropsy confirmed a locally invasive periorbital tumor with metastasis to the submandibular tissue, submandibular lymph node, and thoracic inlet. Histopathologic evaluation of necropsy specimens revealed polygonal to spindle neoplastic cells lining neoplastic vascular channels lacking erythrocytes. Immunohistochemically, the neoplastic cells labeled strongly positive for PROX-1, vimentin, CD-31, VEGF, weakly positive for factor VIII-related antigen, and negative for collagen IV. Based on the clinical, histological, and immunohistochemical features of this tumor, a primary ocular lymphangiosarcoma with metastasis was diagnosed.