George M. Howard

Leiomyoma and Leiomyosarcoma of the Orbit

Comparison of the clinical and pathologic features of two orbital leiomyomas, two leiomysarcomas, and one embryonal rhabdomyosarcoma showed the leiomyomas occurred in young individuals and the leiomyosarcomas in older patients. The histopathologic diagnosis rested on the intense cytoplasmic eosinophilia and nostriated longitudinal cytoplasmic filaments demonstrated by means of the trichrome stain. The leiomyosarcomas disseminated 15 months and seven years after their orbital presentations. The treatment of both leiomyoma and leiomyosarcoma is surgical. Leiomyomas are encapsulated growths that may have small satellite nodules projecting from the main tumor mass; thus, a margin of normal tissue should also be excised, lest a small lobulation be left behind to serve as the seed for a late recurrence. Once the diagnosis of leiomyosarcoma has been made, and no evidence of metastasis has been found after a thorough systemic evaluation, the orbit should be exenterated, because the tumor is unencapsulated and liable to widespread dissemination. Rhabdomyosarcoma has a much more fulminant course than leiomyosarcoma, and especially more so than that of leiomyoma of childhood. The histopathologic diagnosis of a malignant smooth muscle tumor in a child should always be questioned, since embryonal rhabdomyosarcoma is a much more likely diagnosis.

Orbital arteriovenous malformation with secondary capillary angiomatosis treated by embolization with silastic liquid.

A 19-year-old Caucasian man developed signs of an orbital arteriovenous malformation, which was biopsied and then treated by embolization with a rapidly polymerizing silastic liquid. The biopsy from the initial specimen showed arteries and veins that were malformed with irregular elasticas and muscularis thicknesses, but the most curious feature was a secondary endothelial cell proliferation of such proportions as to simulate in various fields a capillary hemangioma of childhood. Approximately 50% of the bulk of the tumor was the result of the secondary endothelial cell proliferation, which we presume occurred in response to the irritative circumstances of increased intracapillary pressure from the high blood flow between the abnormal arteries and veins. Four years after the tumor was treated with the silastic liquid, it recurred and was again removed surgically. On this occasion, the histopathologic study of the tissues demonstrated a persistent secondary capillary angiomatosis, as well as chronic inflammatory reaction and granulomatous response surrounding the entrapped fragments of the polymerized silastic liquid.

Electron Microscopic Diagnosis of Medulloepithelioma

A 20-month-old boy with a ciliary body tumor presented with two white flocculi floating in the anterior chamber of his left eye. This material was examined by electron microscopy. Both the clinical appearance of the tumor and the ultrastructural findings suggested the diagnosis of medulloepithelioma. The flocculi contained tumor cells forming lumina and displaying neuronal-type cilia, neurotubules, and a complex band of apical desmonosomal junctions. Since the last finding is not present in retinoblastoma rosettes in the absence of fleurette differentiation, it distinguishes medulloepithelioma from retinoblastoma. The electron microscopic diagnosis has permitted a trial period of conservative cryotherapy directed at the tumor and the associated glaucoma. The electron microscopic characteristics of the tumor favor the neuroepitheliomatous and neuroblastic differentiation of medulloepithelioma rather than ependymal differentiation.

Pulsating Metastatic Tumor of the Orbit

A 47-year-old white man in apparent good health had diplopia and swelling of the right upper eyelid. Ocular examination showed proptosis of the right eye, together with a large, pulsatile, collapsible mass simulating a vascular neoplasm and involving the right temple as well as the right upper outer quadrant of the orbit. Biopsy of the orbital tumor disclosed a clear-cell carcinoma compatible with a renal primary tumor; subsequent laboratory examination revealed the offending tumor in the left kidney. Renal carcinomas may metastasize to the globe or to the orbit before the primary tumor is recognized. Pulsatile exophthalmos acquired in middle life associated with significant bone destruction represents a constellation of findings most consistent with a metastatic tumor, probably renal carcinoma, caused by the exceedingly rich vascularization of these metastatic deposits.

The Tumors of the Eye and Its Adnexa.

The tome under review, a weighty one from the literal standpoint as well as in terms of academic and literary content, is a compilation of the published versions of some 100 papers that were presented at the Second Congress of the European Ophthalmological Society. This Congress met from June 7 to 13, 1964, in Vienna, under the aegis of Prof J. Bock. The volume by and large contains information in review form, and does not provide a great deal of intellectual material which has not already appeared in various ophthalmologic journals throughout the world. Nevertheless, Francois has performed a service by handily bringing together in one book a vast amount of opinion regarding the diagnosis and therapy of ocular tumors. The papers are printed in one of three languages, English, French and German, and one would have to be proficient in all three to derive maximum benefit from the publication,

Retinal Degenerations ERG and Optic Pathways: The Proceedings of the Fourth International Society of Electroretinography Symposium

In this formidable symposium, which is primarily directed at the basic scientist working in the field of retinal electrophysiology, one may satisfy his curiosity about various influences upon the electroretinogram ranging from the effect of pyruvate on the dark adapted frog retina to the changes induced by operations on the cisterna magna of rabbits. Clinicians, do not despair, however, for those of you who are sufficiently intrepid to scan the volume will find articles dealing with clinical electroretinography in thyroid disorders, vascular occlusion, diabetes, the tapetoretinal degenerations, congenital nystagmus, and high myopia. The symposium was made up of 94 contributors hailing mostly from Japan, but coming also from Europe, India, Great Britain, Australia, and the United States; and it was held in the beautiful city of Hakone. The manuscripts submitted by the Oriental authors contain multiple humorous malapropisms which tend to keep the reader on his mental toes at all

Human Pathology: An Introduction to Medicine.

There is no question that Dr. Morehead, professor of pathology at the Bowman Gray School of Medicine, North Carolina, has performed a courageous task by writing a full-length textbook covering the essentials of human pathology. In so doing, he has entered a small but highly select field in which his volume will compete with established works by such renowned and revered names as Anderson, Boyd, Florey, Robbins, Moore, and Ackerman. Since this is the initial edition, only time will tell whether it, like some of the preceding volumes, will run to many editions and multiple printings. The initial impression of this reviewer is that the text will survive. It is painstakingly prepared, scrupulously organized, and sufficiently illustrated. In addition, it has the overwhelming advantage of being up-to-date in a field of medical knowledge in which textbooks become obsolescent at an astonishing rate due to the quickening tempo and proliferating quantity

Highlights of Ophthalmology 1964 (vol 6).

The apparently limitless energy and enthusiasm of the editor is again reflected in this latest volume of the Highlights , a journal which is specifically dedicated to bringing useful clinical information to the practicing ophthalmologist. Several worthy papers and symposia are summarized, some of which have been presented before the American Academy of Ophthalmology. McLean reminds us that ocular mycosis may be of endogenous origin and that it may adopt the manifestations of an exudative retinochoroiditis. In view of recent evidence showing a transient elevation in intraocular pressure following the use of α-chymotrypsin in cataract surgery, the reader will undoubtedly elect not to follow the suggestion of Bedrossian and Weimar that it is unnecessary to irrigate the anterior chamber following its use. Thygeson and Kimura note that Staphylococcus aureus is the commonest cause of chronic conjunctivitis, whereas fungus infection is an extremely rare cause. There follows a symposium by several authorities