1,721,004 research outputs found
Efficacy and Safety of Immunosuppressive Agents for Thyroid Eye Disease
No full textPurpose: To determine the reliability of 3 scales for assessing soft tissue inflammatory and congestive signs associated with thyroid eye disease.
Methods: This was a multicentered prospective observational study, recruiting 55 adults with thyroid eye disease from 9 international centers. Six thyroid eye disease soft tissue features were measured; each sign graded using 3 scales (presence/absence [0-1], 3-point scale [0-2], and percentage [0-100]). Each eye was graded twice by 2 independent raters. Accuracy (fraction of agreement) was calculated between the 2 trials for each rater (intrarater reliability) and between raters for all trials (interrater reliability) to determine the most sensitive scale for each feature that maintained a threshold of agreement greater than 0.70. Trial, intrarater reliability, and interrater reliability were determined by accuracy measurement of agreement for each inflammatory/congestive feature.
Results: Fifty-five patients had 218 assessments for 6 thyroid eye disease metrics. The intrarater reliability for each feature was consistently better than the interrater reliabilities. Using an agreement of 0.70 or better, for the interrater tests, conjunctival and eyelid edema could be reliably measured using the 0-1 or 0-2 scale while conjunctival and eyelid redness could only be reliably measured with the binary 0-1 scale. Caruncular edema and superior conjunctival redness could not be measured reliably between 2 raters with any scale. The percentage scale had poor agreement unless slippage intervals of >20% were allowed on either side of the measurements.
Conclusions: Of the specific periocular soft tissue inflammatory features measured between raters in the Clinical Activity Score and Vision, Inflammation, Strabismus, Appearance scales, edema of the eyelids and conjunctiva could reliably be measured by both 0-1 and 0-2 scales, erythema of the eyelid and bulbar conjunctiva could reliably be measured only by the 0-1 scale, and the other parameters of superior bulbar erythema and caruncular edema were not reliably measured by any scal
A case series of Merkel cell carcinoma of the eyelid: a rare entity often misdiagnosed
No full textMerkel cell carcinoma (MCC) is one of the rarest eyelid tumors, with high mortality rate due to lymphatic and metastatic spread. We hereby report six cases of patients with histological diag- nosis of MCC referred to our Orbit Unit between 2012 and 2018, focusing on diagnosis, treatment, and subsequent follow up. All patients underwent surgical excision and systemic work-up. Both MCC TNM and eyelid MCC TNM were used to stage lesions. MCC of the eyelid is usually misdiagnosed as benign or other malignant lesions. A prompt examination and a wide local excision are mandatory. A close follow-up of these patients is advised due to high recurrence rate and lymphatic sprea
Radiotherapy for the treatment of thyroid eye diseaseâa prospective comparison: Is orbital radiotherapy a suitable alternative to steroids?
No full textBACKGROUND AND AIMS: To evaluate the efficacy of orbital radiotherapy (OR) for
the treatment of thyroid eye disease (TED).
METHODS: Thirty-five consecutive patients with active TED with contraindications
to steroid therapy received a course of OR. Bilateral retrobulbar irradiation was
performed with a total dose of 20 Gy. 7-points clinical activity score (7-CAS),
ocular motility, visual acuity (VA), exophthalmos and eyelid retraction were
prospectively evaluated at 3, 6 and 12 months and compared with baseline data.
RESULTS: There was a statistically significant improvement in 7-CAS at 3, 6 and
12 months post-treatment (p < 0.05). Ocular motility disturbances improved at 6
and 12 months (p < 0.05). Visual acuity remained stable; there was no significant
change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid retraction (marginal
reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side
effects were registered.
CONCLUSIONS: This study suggests that OR might be effective in reducing 7-CAS and
ocular motility disturbances. No significant improvement in proptosis or eyelid
retraction should be expected from this treatment. OR might be considered a
suitable alternative treatment in TED for patients who cannot tolerate steroids
Simultaneous diagnosis of ipsilateral adenoid cystic carcinoma of the lacrimal gland and orbital cavernous hemangioma: case report
No full text
Ectopic Lacrimal Gland Tissue: A Systematic Review
No full textPurpose: To review the clinical and histopathological findings associated with ectopic lacrimal gland tissue. Methods: A systematic review of the literature on ectopic lacrimal gland tissue was performed. Studies which met clinical and histolopathological criteria for ectopic lacrimal gland tissue written in English and published in peer-reviewed journals were included. Results: Sixty-nine publications detailing 180 cases of ectopic lacrimal gland tissue were published between 1946 and 2018. Males were affected slightly more than females (57% vs. 43%) and 95% cases were unilateral. Patients presented at a mean age of 21 years, most commonly with a mass, although orbital lesions commonly presented with proptosis. The most common location for ectopic lacrimal gland tissue was epibulbar conjunctiva (62%), other locations included orbital (16%), eyelid (11%), intraocular (9%), lacrimal sac (2%), and nasal mucosa (0.6%) sites. Most lesions (86%) were locally resected. The most common histological types were complex choristomas (56%) and simple choristomas (38%). However, neoplastic transformation to pleomorphic adenoma (5%), adenocystic carcinoma (0.6%), and adenocarcinoma (0.6%) was reported. Conclusions: Ectopic lacrimal gland tissue is rare but should be considered in the differential diagnosis of masses in the epibulbar conjunctiva, eyelid, orbit, and lacrimal sac, particularly in childhood, as the diverse way it presents means that it may mimic more common choristomas. It can undergo neoplastic transformation in the same way as can the lacrimal gland and incomplete excision can result in recurrence
Epithelioid myoepithelioma of lacrimal gland.
No full textA rare case of myoepithelioma of the lacrimal gland composed exclusively of epithelioid cells is described.A 57-year-old female had been complaining for 1 month of progressive swelling of the temporal region of the left orbit. Computed tomography scan revealed a lesion involving the left lacrimal gland. The lesion was entirely removed en-bloc along with the lacrimal gland. Grossly, the tumour was a well-circumscribed 3.5×25×1.5 cm mass. An extensive sampling was performed. The surgical specimen was routinely formalin fixed and paraffin embedded. Sections 5-m thick were obtained and stained with haematoxylin-eosin. Immunostaining was performed on 5-m serial sections. Histologically, the lesion showed a solid pattern of growth and was composed exclusively of cells with epithelioid (plasmacytoid) features. Atypical myoepithelial cells, abnormal mitotic figures, necrosis and invasive growth throughout the tumour were absent.
Myoepithelioma of the lacrimal gland is extremely rare, and thus far only seven cases have been reported. Of these cases, two were considered malignant and one potentially malignant . All but one showed spindle to cuboidal cells arranged in a solid or trabecular pattern .
Myoepithelial cells are generally immunoreactive for S-100, vimentin, cytokeratin, desmin, m-actin and sm-actin. There is a considerable variation in the immunoreactivity for these antigens in our case, as in the seven previously reported cases. These differences may be dependent on the degree of differentiation .The size of the tumour prompted us to recommend a careful clinical follow-up. The patient had an uneventful post-operative course, and there has been no evidence of relapses over 24 months of follow-up
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