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Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach

PURPOSE To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery. METHODS In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication. RESULTS A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up. CONCLUSION Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.

Spontaneous regression of retinal astrocytic hamartoma in a patient with tuberous sclerosis

PURPOSE To report the complete regression of a retinal astrocytic hamartoma in conjunction with tuberous sclerosis. DESIGN Observational case report. METHODS A 12-year-old boy with tuberous sclerosis, diagnosed early in life, was found to have a retinal astrocytic hamartoma in his left eye. He had bilateral optic atrophy because of long-standing increased intracranial pressure due to a cerebral giant cell astrocytoma. He was followed on a yearly basis with fundus photography and fluorescein angiography. RESULTS At the time of initial presentation, the minimally elevated intraretinal tumor measured 2 x 1.5 mm. A year later, the same tumor measured 1.5 x 1 mm. Two years after initial presentation, the tumor totally disappeared. CONCLUSION This patient has demonstrated that retinal astrocytic hamartoma may undergo spontaneous regression.

Intramuscular hydatid cyst of the medial rectus muscle

PURPOSE To describe a unique case of orbital hydatid cyst that was located solely within the medial rectus muscle. DESIGN Retrospective, interventional case report. METHODS A 20-year-old woman presented with right periocular pain induced by ocular movements. Magnetic resonance imaging studies showed a focal, well-circumscribed intramuscular cystic lesion of the right medial rectus muscle. The cyst was completely extirpated from the muscle, but some of the fluid content escaped into the surrounding tissues. Irrigation with hypertonic saline was performed. RESULTS Histopathologic examination showed an acellular cyst wall with inner germinal layer, diagnostic for hydatid cyst. Two cycles of oral albendazole were administered with no recurrence. CONCLUSIONS In the orbit, hydatid cyst may be localized primarily within an extraocular muscle and produce painful eye movements. Hydatid cyst must be considered in the differential diagnosis of solitary cystic enlargements of extraocular muscles.

PARANEOPLASTIC RETINOPATHY ASSOCIATED WITH METASTATIC CUTANEOUS MELANOMA OF UNKNOWN PRIMARY SITE

Purpose: To describe further the clinical and immunological features of cutaneous melanoma-associated retinopathy, which is an infrequent form of paraneoplastic syndrome.Methods: We studied the salient clinical and immuno-logical aspects of a 66-year-old man with metastatic cutaneous melanoma to lymph nodes of unknown primary site who developed melanoma-associated retinopathy.Results: There was gradual loss of vision in the left eye. Colour vision and night vision were not affected. Visual fields showed arcuate defects. A full-field electroretinogram demonstrated attenuation of the b-wave amplitude in the left eye. The a-wave was intact. Indirect immunofluorescence techniques showed that the antibody reactions took place mainly in the outer plexiform layer of the retina.Conclusions: Bipolar cells seem to be the target in melanoma-associated retinopathy. Contrary to previous reports, night blindness may not be a universal finding.

Mucosa-associated lymphoid tissue lymphoma of the lacrimal gland

PURPOSE Mucosa-associated lymphoid tissue lymphoma recently has been defined as a distinct subtype of non-Hodgkins lymphoma with characteristic clinicopathologic features. A 37-year-old woman with systemic lupus erythematosus and unilateral mucosa-associated lymphoid tissue lymphoma of the lacrimal gland is described. METHODS The tumor was totally excised by lateral orbitotomy. Immunohistochemical studies were performed with UCHL-1, CD20 (L26), leukocyte common antigen, cytokeratin (CAM5), and kappa and lambda light chain antibodies. RESULTS The tumor was composed of centrocyte-like lymphocytes, cells with plasmacytoid features, and lymphoepithelial lesions. Most of the cells expressed the CD20 protein and were positive for immunoglobulin kappa light chain. The patient received no supplemental therapy. No systemic dissemination or local recurrence occurred during a follow-up of 26 months. CONCLUSION The features of this case support the association between systemic diseases and the subsequent development of mucosa-associated lymphoid tissue lymphoma.

Expression of Vascular Endothelial Growth Factor A, Matrix Metalloproteinase 9 and Extravascular Matrix Patterns in Iris and Ciliary Body Melanomas

Purpose: It was the aim of this study to assess the expression of vascular endothelial growth factor (VEGF)-A, matrix metalloproteinase (MMP)-9 and extravascular matrix patterns (EMPs) in iris and ciliary body melanomas and their correlations with histopathologic parameters. Methods: The study was conducted on 3 iris and 15 ciliary body melanomas. All tumors were subjected to immunohistochemical techniques for VEGF-A and MMP-9 expressions, the presence of EMPs was assessed, and routine paraffin sections were stained with hematoxylin-eosin. Cell type, tumor localization, degree of pigmentation, necrosis, mitotic index, lymphocytic infiltration and sclera invasion were analyzed using light microscopy. Results: The mean patient age at the time of treatment was 43 years (range 19–69, median 39.5); 10 (55.6%) patients were males and 8 (44.4%) females. Histopathological cell types were spindle cells in 55.6%, mixed cells in 16.7%, and epithelioid cell types in 27.8% of tumors. Positive reaction for VEGF-A and MMP-9 was present in 66.7 and 72.3% of the tumors, respectively. Microvascular loops and/or networks were seen in 33.4% of the tumors, with the remaining 66.7% of tumors displaying one or more of the other patterns. Metastatic disease developed in only 1 patient during follow-up. Tumor cell type, tumor size, mitotic rate, degree of pigmentation and EMPs were not correlated with metastasis. Conclusions: This study suggests that VEGF-A and MMP-9 were positive in the majority of iris and ciliary body melanomas. No correlation was found between VEGF-A and MMP-9 immunoreactivity and EMPs and occurrence of metastases in cases of anterior uveal melanoma.

Intramuscular hemangiomas of extraocular muscles

PURPOSE To report two patients, 3 and 40 years of age, respectively, each of whom had an isolated intramuscular hemangioma of an extraocular muscle. DESIGN Two retrospective, interventional case reports. INTERVENTION Incisional biopsy and short-term oral corticosteroids. MAIN OUTCOME MEASURES Clinical observation and pathologic examination of specimens and tumor status, visual acuity, and ocular motility at final follow-up. RESULTS Orbital magnetic resonance imaging revealed that, compared with other extraocular muscles, the tumor was isointense on T1-weighted scans and hyperintense on T2-weighted images. Marked homogeneous enhancement was observed after contrast agent administration. Biopsy results showed a hemangioma of the lateral rectus muscle with predominantly capillary-like small vessels in the child and a mixed small and large vessel type hemangioma of the medial rectus muscle in the adult. CONCLUSIONS Intramuscular hemangiomas may cause painless, isolated extraocular muscle enlargement in children and in adults without disturbing the ocular motility. The tumors do not seem to be sensitive to systemic corticosteroid therapy.

Congenital orbital teratoma : A clinicopathologic case report

A 5-day-old infant boy was noted to have severe left proptosis at birth. The left eye protruded superotemporally through the palpebral fissure and had exposure keratopathy. There was frank left afferent pupillary defect. Computerized tomography (CT) showed a left orbital soft tissue mass with foci of calcification. Magnetic resonance imaging (MRI) studies revealed a left orbital mass with solid and cystic portions without intracranial extension. As the eye was considered to be nonsalvagable, a lid-sparing type, modified exenteration was performed. Histopathologic examination demonstrated various mature tissues of all three embryonic germinal cell lines. This case represents one of the rare examples of true congenital orbital teratoma, which is an uncommon cause of hideous proptosis in the neonate. MRI may prove useful in differentiating this tumor from more common conditions.

Transpupillary thermotherapy in the management of choroidal metastases

PURPOSE To report the authors experience in the use of infrared diode laser transpupillary thermotherapy in the management of selected posterior choroidal metastatic tumors. METHODS Seven eyes of seven patients were treated using 810 nm infrared diode laser. Spot sizes of 0.5 to 3 mm were selected, each lasting 1 minute. When necessary, the treatment was repeated at 8- to 10-week intervals. Disappearance of the tumor was the main outcome measure. RESULTS The primary sites of carcinomas were breast, prostate, and lungs. The largest basal diameters of ocular tumors varied between 5 mm and 10 mm and the thickness ranged between 2 mm and 4.5 mm. A mean power of 612 mW was used in one to four treatment sessions. In six eyes the tumors were reduced into flat scars whereas in one case the tumor continued to grow necessitating external beam radiotherapy. In three eyes the visual acuity decreased and in three eyes the vision became better. In one eye the vision was restored after external beam radiotherapy with the disappearance of extensive subretinal fluid. There were no immediate postoperative complications. CONCLUSIONS Transpupillary thermotherapy can be a reliable, convenient, and cost-cutting option in the management of small, solitary choroidal metastatic tumors with a thickness of less than 3.5 mm and which have minimal subretinal fluid. Although successful in terms of tumor control, treatment close to the fovea or optic nerve head may cause a permanent decrease in visual acuity. (Eur J Ophthalmol 2004; 14: #-9).

Expression of vascular endothelial growth factor-A, matrix metalloproteinase-9, and extravascular matrix patterns and their correlations with clinicopathologic parameters in posterior uveal melanomas.

PurposeTo assess extravascular matrix patterns (EMP) and expression of vascular endothelial growth factor-A (VEGF-A) and matrix metalloproteinase-9 (MMP-9) in posterior uveal melanomas and their correlations with histopathologic parameters and metastasis.MethodsThis study was conducted on 100 consecutive eyes enucleated for posterior uveal melanomas. All tumors were examined by immunohistochemical techniques for VEGF-A and MMP-9 expression, and the presence of EMPs was assessed on routine paraffin sections stained with reticulin. Cell type, tumor localization, degree of pigmentation, necrosis, mitotic index, lymphocytic infiltration, and scleral and optic nerve invasion were analyzed by using light microscopy. No eyes had received prior treatment such as radiotherapy or transpupillary thermotherapy.ResultsIdentified histopathologically, cell types were spindle cells in 60% of the cases, mixed cells in 14%, and epithelioid cells in 26% of tumors. Positive reaction for VEGF-A and MMP-9 was present in 84% and 72% of the tumors, respectively. Microvascular loops and/or networks were seen in 34% of the tumors, with the remaining 16% of the tumors displaying an arc pattern, 21% displaying a parallel pattern, and 29% displaying the normal pattern. The relationships between VEGF-A and MMP-9 expression and necrosis, the degree of lymphocyte infiltration, mitotic rate, and the formation of loop and network patterns were found to be statistically significant (P < 0.05). Metastatic disease developed in 14 patients during follow up.ConclusionsThe incidence of metastatic melanoma increased with the increasing expression of VEGF-A and MMP-9. Our data suggest that increasing VEGF-A and MMP-9 expression and the EMP can be used as independent prognostic factors in the management of posterior uveal melanoma following enucleation. Jpn J Ophthalmol 2007;51:325–331