Roxana Diba

Outcomes in Patients with Adenoid Cystic Carcinoma of the Lacrimal Gland

Purpose To evaluate the outcomes among patients with adenoid cystic carcinoma of the lacrimal gland treated at various stages of their disease at a tertiary care cancer center. Methods A retrospective case series of 20 patients with adenoid cystic carcinoma of the lacrimal gland treated at a single institution between 1952 and 2002. Clinical records were available for all 20 patients; histologic sections from 12 of the 20 patients were available for review. Disease-free survival was measured from the completion of treatment; overall survival was measured from the date of initial diagnosis. Results The study included 6 men and 14 women. The mean age at diagnosis was 39.5 years. The median follow-up time was 34 months (range, 6 to 264 months). The local/regional treatment modalities included exenteration with bone removal and radiation therapy (RT) in 5 patients, exenteration with RT (no bone removal) in 8 patients, exenteration (no RT or bone removal) in 1 patient, exenteration with bone removal (no RT) in 1 patient, local resection with RT in 3 patients, and local resection without RT in 2 patients. Overall, 16 patients had RT as part of their treatment regimen. Seven patients (35%) had local recurrence. Sixteen patients (80%) had distant metastasis during the study period. At the time of this report, 13 (65%) of the patients had died of disease. The median disease-free survival for the entire group was 18 months. Eight patients had a predominantly basaloid histologic pattern. Ten patients had verifiable histologic evidence of perineural invasion. Conclusions This study underscores the generally grave prognosis for patients with adenoid cystic carcinoma of the lacrimal gland and the difficulty in making any conclusive recommendations for local therapy for this disease.

Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center.

Purpose: To describe one center’s experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival malignancies performed with a smaller volume of technetium than was initially used and a small incision directly overlying the sentinel node(s). Methods: A noncomparative interventional case series of 13 patients with clinically negative regional lymph nodes who underwent SLN biopsy for eyelid or conjunctival malignancies at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003. Preoperative lymphoscintigraphy was performed with an injection of 0.3 mCi of technetium Tc-99m sulfur colloid in a volume of 0.2 mL. Images were taken as soon as the first SLN was detected through the gamma camera. Intraoperative mapping was performed with the same volume and concentration of technetium Tc-99m sulfur colloid along with an injection of isosulfan blue dye. Results: Five patients had conjunctival melanoma, 6 had sebaceous cell carcinoma of the eyelid, and 2 had eyelid melanoma. SLN(s) were identified in all patients. In 12 patients, more than 1 SLN was identified. During surgery, no SLNs were blue. One patient with conjunctival melanoma had an SLN that was positive on histologic examination. There were no ocular or extraocular complications from the procedure except for mild temporary weakness of the marginal mandibular branch of the facial nerve in 2 patients that resolved completely within 4 to 6 weeks and without any further intervention. None of the patients had permanent blue tattooing of the conjunctival surface or eyelid skin. Conclusions: Our experience suggests that lymphoscintigraphy and SLN biopsy with a small volume of technetium Tc-99m sulfur colloid and small incisions, even without the use of the blue dye, can identify SLNs in patients with conjunctival and eyelid malignancies, and can be performed safely.

Expression of the epidermal growth factor receptor in conjunctival squamous cell carcinoma

Purpose: To determine whether the tyrosine kinase epidermal growth factor receptor (EGFR) is expressed in squamous cell carcinoma of the conjunctiva. Methods: A retrospective, observational case series of 5 patients with biopsy-proven conjunctival squamous cell carcinoma treated at one institution between January 1996 and April 2004. Medical records and tissue specimens from the 5 patients were reviewed. A control specimen of normal conjunctiva was also obtained from one of the 5 patients. Immunohistochemical analysis was performed using antibodies against EGFR. Results: Immunohistochemical staining showed that EGFR expression was moderate to strong in all tissue specimens, both in the normal mucosa and in the in situ and invasive components of the conjunctival squamous cell carcinomas. Conclusions: An intense expression of EGFR occurs in squamous cell carcinoma of the conjunctiva. Further study is needed to determine whether an EGFR inhibitor that targets this expression would have potential therapeutic benefit in treating squamous cell carcinoma of the conjunctiva.

Outcomes of dacryocystorhinostomy in patients with head and neck tumors

The purpose of this study was to evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors.

Expression of retinoid receptors in sebaceous cell carcinoma

Purpose:  The aim of this study is to investigate whether there are any abnormalities in the in vivo expression of retinoid acid receptors (RAR‐α, RAR‐β and RAR‐γ) and retinoid X receptors (RXR‐α, RXR‐β and RXR‐γ) in sebaceous cell carcinoma.

Growth factor receptor expression in orbital lymphangioma: possible therapeutic implications.

objective To examine the expression of molecules targeted by imatinib mesylate (STI571;Gleevec) and epidermal growth factor receptor (EGFR) inhibitors in orbital lymphangiomas. design Retrospective observational case series. participants Six patients with orbital lymphangioma treated at four institutions between March 2000 and December 2002. methods Tissue specimens and medical records from six patients were collected. Immunohistochemical analysis was performed using antibodies against c-kit and platelet-derived growth factor receptor (PDGFR) alpha and beta and EGFR tyrosine kinase.

Orbital and optic chiasmal extension of uveal melanoma

A 63-year-old woman had a diffuse uveal melanoma with massive extension in the orbit and optic chiasm. She received palliative radiation therapy. The importance of careful inspection of the enucleated specimen and postenucleation imaging studies to delineate the extent of the uveal tumor are underscored in this case. Treatment options may include skull base surgery or palliative radiotherapy.