Roman Shinder

Survey of orbital tumors at a comprehensive cancer center in the United States.

The purpose of this study was to evaluate the frequencies of various types of orbital lesions seen at a comprehensive cancer center in the United States.

Bone invasion by adenoid cystic carcinoma of the lacrimal gland: Preoperative imaging assessment and surgical considerations

Purpose: To identify the incidence of radiologically and histologically documented bony invasion of the lacrimal gland fossa by adenoid cystic carcinoma. Patients and Methods: The authors reviewed the records of all 18 patients with lacrimal gland adenoid cystic carcinoma surgically treated at their institution from 1997 to 2009 for imaging findings (blinded review) and histologic findings on evaluation of the lacrimal gland fossa. Preoperative CT and/or MRI findings were available for 17 patients. Results: The 8 men and 10 women ranged in age from 9 to 69 years. American Joint Committee on Cancer tumor stages after preoperative imaging were as follows: T1N0M0, 2 patients; T2N0M0, 5 patients; T3aN0M0, 2 patients; T3bN0M0, 5 patients; T3bN0M1, 2 patients; T4bN0M0, one patient; and TxN0M0, one patient. Preoperative imaging suggested bony involvement of the lacrimal gland fossa in 13 patients (76.5%); this was histologically confirmed in 11 of the 13. Preoperative imaging suggested no bone involvement in 4 patients, 3 of whom had bone involvement by histology. Overall, 14 of 17 histologically evaluable cases (82.3%) had invasion of the lacrimal gland fossa. Histologic findings of bone/periosteal involvement led to upstaging of 3 tumors. Metastases developed in 8 of 18 patients and trended with basaloid histology (p = 0.066). Conclusions: Adenoid cystic carcinoma of the lacrimal gland is associated with bone invasion in essentially all but the smallest of tumors (T1). This high rate of bone involvement may warrant addressing the bony walls during surgery for adenoid cystic carcinoma of the lacrimal gland.

Superior Ophthalmic Vein Thrombosis in a Patient with Chronic Myeloid Leukemia Receiving Antifibrinolytic and Thrombopoietin Receptor Agonist Therapy

Isolated superior ophthalmic vein (SOV) thrombosis is a rare condition usually related to inflammation of the orbit or paranasal sinuses. Patients present with acute orbital signs, including proptosis, ophthalmoplegia, globe dystopia, and periorbital edema, and may have diminished vision secondary to optic neuropathy. SOV thrombosis is typically seen in the setting of septic cavernous sinus thrombosis, and antimicrobial therapy is the treatment of choice. We herein report what may be the first case of isolated SOV thrombosis related to hypercoagulability in a patient with cancer who was receiving antifibrinolytic and thrombopoietin receptor agonist medications.

Preoperative radiation therapy in the management of recurrent orbital hemangiopericytoma

A 77-year-old man presented for evaluation of a recurrent right orbital hemangiopericytoma. It had been excised twice over the past 6 years. After the second resection, the tumor rapidly recurred and was insensitive to systemic chemotherapy, and the patient was thus referred to the authors institution. The patient had proptosis, restricted ocular movement, and binocular diplopia on presentation. Orbital imaging confirmed a well-circumscribed right extraconal mass in the medial orbit. Preoperative radiation therapy was given, which reduced the tumor volume considerably and allowed a successful complete surgical excision of the mass.

Idiopathic inflammation of the orbit and contiguous structures

Idiopathic orbital inflammation is a common cause of acute orbital signs and symptoms. It is typically confined to the bony orbit; however, it can rarely involve contiguous structures with or without lytic change raising clinical suspicion for malignancy. Three cases of idiopathic inflammation of the orbit that affected adjacent structures are reported here; 2 cases had maxillary sinus involvement, while a third had extension in the temporal fossa.

Eyelid and Ocular Adnexal Reconstruction

Reconstruction of an acquired defect following ocular adnexal cancer excision is a common challenge to ophthalmic plastic surgeons, and various surgical techniques may be employed during repair: With a depleting ozone layer and increasing ultraviolet radiation exposure, the incidence of eyelid cancers is on the rise, and we can expect a growing need for eyelid reconstruction. Several reconstructive techniques may be appropriate for a particular eyelid defect. The choice of procedure by the surgeon depends on the patient’s age, the degree of eyelid laxity and quality of eyelid skin, the location and size of the defect, and the surgeon’s preference. Regardless of the surgical procedure chosen, the goals of the procedure should be: restoration of both the anatomy and the dynamic function of the eyelid, creation of a stable eyelid margin, acceptable vertical eyelid height, adequate eyelid closure, smooth posterior epithelial surface, canthal fixation, and maximum cosmesis and symmetry. Surgeons must have a repertoire of procedures that can be used either singly or in combination to reconstruct ocular adnexal defects.

Primary orbital liposarcoma misdiagnosed as thyroid associated orbitopathy

Orbital malignancy can mimic thyroid associated orbitopathy (TAO) due to overlap of clinical and radiographic findings, which include proptosis, extraocular muscle (EOM) enlargement on imaging, and EOM restriction with diplopia. We report a case of primary orbital liposarcoma masquerading as TAO which required exenteration.

Analysis of αv integrin protein expression in human eyelid and periorbital squamous cell carcinomas

Background: Alpha v integrins are receptors for many extracellular matrix (ECM) protein ligands, including latent transforming growth factor betas (TGFβs). Various studies in mice have shown that ablation of genes encoding αv integrin or TGFβ signaling pathway components leads to spontaneous squamous cell carcinomas (SCCs) in the conjunctiva and periocular skin. Here, we have analyzed patterns of αv integrin protein expression and TGFβ signaling in human eyelid and periorbital SCC samples.

Reconstructive Surgery for Eyelid Defects

With a depleting ozone layer and increasing ultraviolet radiation exposure, the incidence of eyelid cancers is on the rise, and we can expect a growing need for eyelid reconstruction. Several reconstructive techniques may be appropriate for a particular eyelid defect. The choice of procedure by the surgeon depends on the patient’s age, the degree of eyelid laxity and quality of eyelid skin, the location and size of the defect, and the surgeon’s preference. Regardless of the surgical procedure chosen, the goals of the procedure should be restoration of both the anatomy and the dynamic function of the eyelid, creation of a stable eyelid margin, acceptable vertical eyelid height, adequate eyelid closure, smooth posterior epithelial surface, and maximum cosmesis and symmetry.

Secondary Orbital Tumors Extending from Ocular or Periorbital Structures

Secondary orbital tumors are those that extend into the orbit from contiguous structures, such as the globe, eyelids, lacrimal sac, bone, sinuses, nasopharynx, and brain. They account for approximately one-quarter of orbital neoplasia. A computed tomography or magnetic resonance imaging scan is used to investigate suspicious lesions, and biopsy is typically undertaken to establish a tissue diagnosis and help construct a treatment plan. Prognosis is often poor owing to significant extension of the tumor at presentation.