Histopathological classification of 272 primary epithelial tumors of the lacrimal gland

272 primary epithelial gland tumors were classified pathologically. These tumors were sampled from 70% of 390 lacrimal fossa lesions out of 1530 orbital tumors from one hospital. Benign mixed tumors ranked the first in frequency (52%) to be followed by adenocystic carcinomas (25%) and malignant mixed tumors (9%). From the other less common tumor types, we identified, for the first time 3 polymorphous low-grade adenocarcinomas, 2 spindle celled myoepitheliomas and one carcinosarcoma of the lacrimal gland. The diagnosis and differential diagnosis of polymorphous low-grade adenocarcinoma and spindle cell myoepithelioma were discussed.

[Histopathologic classification of 1422 orbital tumors]

The authors analyzed 1422 orbital tumors examined 1955-1986 in the eye pathology laboratory. The 5 leading malignant orbital tumors were adenocarcinoma (207 cases), squamous cell carcinoma (135 cases), rhabdomyosarcoma (52 cases), lymphosarcoma (39 cases), and malignant mixed tumor (29 cases). The 5 leading benign orbital tumors were cavernous hemangioma (304 cases), benign mixed tumor (109 cases), inflammatory pseudo-tumor of the orbit (101 cases), dermoid cyst (100 cases), and optic meningioma (65 cases). Rare tumors of the orbit included 1 case each of alveolar soft tissue sarcoma, chondrosarcoma, mesenchymal chondrosarcoma, synovial sarcoma, giant cell tumor, granular myoblastoma, metastatic leiomyosarcoma of the uterus and metastatic lymphoepithelioma. The criteria for pathological classification and differential diagnosis are discussed.

Histological types of spindle cell carcinoma of the cornea and conjunctiva. A clinicopathologic report of 8 patients with ultrastructural and immunohistochemical findings in three tumors

We analysed the clinical and pathological features of 8 patients with spindle cell carcinoma of the conjunctiva and/or cornea. Four tumors arose from the cornea of atrophic eyes that had previous corneal ulcers. The tumors could be divided into 3 types according to their histopathological findings: fibrosarcomatous type, fibro-histiocytomatous type, and rhabdomyosarcomatous type. The 8 patients were misdiagnosed clinically and pathologically. Careful retrospective histopathologic examination using serial sections and in some tumors the addition of ultrastructural and immunohistochemical studies revealed the correct diagnosis. Follow-up data were obtained in 5 patients. Four of them were alive for 20, 10, 3, and 2 years respectively after surgery. One conjunctival tumor recurred 10 months after local excision.

[Influence of calcar femoral on stress distribution of the upper femur and its clinical application]

Relation between the integrity of the internal structure of upper femur and femoral neck fracture was investigated by means of photo-electric technique. It was found that the stress increased significantly in the upper femur when its calcar femoral was defective, and that the nearer the defective area to the femoral head the greater was the stress. This increased stress was especially significant at the heel strike period of stance phase during walking. As a result of osteoporosis and deficit of the calcar femoral in the elderly, upper femur fracture, mostly subcapital or transcervical type is commonly seen in the aged. The feasibility and principle of internal fixation with thread-screw pins for subcapital and transcervical fracture have been discussed in conjunction with the distribution of tensile and compressive stresses.

Spindle cell carcinoma of cornea and conjunctiva with pseudosarcomatous metaplasia. Light microscopic, electron microscopic and immunohistochemical findings in 2 patients

We studied the electron microscopic and immunohistochemical findings in two elderly patients with spindle cell carcinoma of the cornea and conjunctiva. By light microscopy, correct diagnosis was made by finding the transition between the pleomorphic spindle shaped tumor cells and the overlying squamous epithelium. Ultrastructural findings indicated that squamous cell origin included tonofilament-associated desmosomes and keratohyaline granules in the tumor cells. Positive immunohistochemical staining with antikeratin antibodies provided further evidence to prove the origin of spindle cell carcinoma. Follow-up of the two patients showed the malignant tumor to be quite aggressive in terms of intraocular invasion in the first patient and local recurrence in the second.

Tumours of the Moll's glands

Four cases of tumours arising from Moll's glands, two benign mixed tumours of the skin (chondroid syringomas) and two adenocarcinomas, are reported. Three of the patients were over 40 years old. Contrary to the common assumption that malignant Moll's gland tumours are of low-grade malignancy, the two adenocarcinomas described here were highly malignant. Despite vigorous treatment, including orbital exenteration and lymph node resection, one was rapidly fatal and the other recurred with extensive involvement of the paranasal sinuses.

Oxyphil cell adenomas. Three case reports

The clinical and histopathologic features of three cases of oxyphil cell adenomas (oncocytomas) include two cases involving the lacrimal sac and one involving the caruncle. These lesions generally occur in the caruncle of elderly women, although they have been reported to involve the conjunctiva, lacrimal sac, and rarely the lacrimal gland. They are usually controlled by wide local excision.

Intraocular paragonimiasis

A case of intraocular paragonimiasis is reported in a 13-year-old Chinese boy. The disease manifested as repeated attacks of acute intraocular pain associated with panuveitis. A combination of inflammatory reaction and ocular findings mimicking both perforating and contusion injuries caused by the migration of the fluke within the eye characterises the infection. The living fluke was successfully extracted from the anterior chamber and identified as Paragonimus westermani.

Orbital fistula. Causes and treatment of 20 cases

A retrospective analysis of 20 cases of orbital fistula in Shanghai showed the causes to be trauma with foreign-body retention, osteomyelitis, mucocele, and dermoid cyst. Half the patients were children younger than 10 years old. Cicatricial ectropion, ptosis, and extraocular motility disturbance constituted the common clinical findings. Treatment according to the various causes included surgical removal of the foreign body, oral administration of antibiotics combined with local irrigation, radical extraction of all the epithelium lining the fistula, and excision of the fistula.

Mucoepidermoid carcinomas of the lacrimal sac

Mucoepidermoid carcinoma is a malignant tumor containing both neoplastic mucin-producing cells and epidermoid cells. To the only reported case arising in the lacrimal sac, we add three additional cases. All three were locally aggressive and required orbital exenterations. No deaths from metastatic disease occurred.

Intravitreous silicone injection. Histopathologic findings in a human eye after 12 years

Histopathologic changes occurred in a human eyeball enucleated 12 years after intravitreous silicone injection for the treatment of complicated retinal detachment with massive preretinal membrane. Silicone "bubbles" (droplets) were found in the chamber angle, iris, ciliary body, retina, and preretinal and subretinal membrane, as well as in the optic nerve. Clinically, glaucoma developed in the eye. A review of the literature indicates that the common late complications of intravitreous silicone injection are cataract, glaucoma, and retinal changes.

Sustained release of carmustine (BCNU) for treatment of experimental intraocular malignancy

Sustained release of carmustine (1,3-bis[2-chloroethyl]-1-nitrosourea, or BCNU) via an episcleral implanted silicone device was used to treat Greene hamster melanoma implanted in the anterior chamber of rabbit eyes. Group 1 animals received carmustine intravenously; group 2 received the drug by local sustained release via an episcleral implanted silicone device; group 3 received the drug by both local sustained release and intravenous injection (a total dosage more than twice that in group 1); and group 4 was not treated. The effectiveness of the various administration routes was compared by clinical observation of tumour size and systemic and local toxic reactions, and by histopathological examination. Carmustine delayed the growth of Greene melanoma in all 3 treated groups, but was most effective when a lower dose of the drug administered intravenously was combined with an additional higher dose administered by local sustained release. Local side effects included corneal clouding and conjunctival oedema and congestion at the early stage of local drug delivery via the episcleral implanted device.

Hematoporphyrin phototherapy for experimental intraocular malignant melanoma

Administration of a hematoporphyrin derivative (HpD) followed by photoradiation with red light completely or partially destroyed Greene hamster melanoma developed in the anterior chamber of rabbit eyes. Tumor-bearing eyes were divided into two groups. Twenty-two eyes received an HpD injection followed by exposure to red light from a slide projector with a 500-W quartz halogen lamp and a red filter (intensity to the tumor was about 4.0 mW/sq cm). In the control group (six eyes), eyes were exposed either to red light only or to HpD injection only. Local complications after therapy included edema and congestion of the conjunctiva, clouding of the cornea, and hemorrhage on the iris surface. The HpD itself has no cytotoxic effect, is preferentially retained in tumor cells, and causes a destructive photodynamic effect as a result of the production of cytotoxic singlet oxygen in the tumor. Accordingly, it may be a safe and potentially therapeutic procedure in the treatment of uveal melanoma.

Rabbit model of uveal Greene melanoma: morphologic studies of metastatic lesions

We studied the morphology of metastatic tumors in three rabbits with implanted choroidal Greene melanoma. The tumor-bearing eyes were perforated and destroyed by the expanding tumors 10 to 12 weeks after implantation. The animals then lost body weight and became cachectic; they were suspected of having metastases and were sacrificed. The interval between the destruction of the eye and the discovery of metastases was 1 to 14 weeks. Widespread metastases involved the liver, lungs, kidneys, and subcutaneous tissue, with the greatest number of tumors in the liver and lungs. Histopathologic findings in the metastases and primary tumors were identical. This model may be considered appropriate for study of human uveal melanoma because (1) the biological behavior is similar to that of human uveal melanoma, (2) the primary and metastatic tumors are histologically similar, and (3) the large size of the rabbit's eye facilitates observation and manipulation.

Histopathologic changes following carmustine treatment of uveal Greene melanoma in rabbits

Uveal Greene melanoma was produced in the anterior chamber of 47 eyes in 29 rabbits. One group of rabbits was untreated and served as controls. One group was treated with carmustine (1,3-bis(2-chloroethyl)-1-nitro-sourea; BCNU) intravenously and one group was treated with BCNU both intravenously and locally via an implanted silicone device. Tumor specimens were studied histopathologically with light and electron microscopy. Compared with controls, the treated tumors were smaller, more necrotic, and contained more spindle-shaped cells intermingled with inflammatory cells. Changes were particularly striking in the combined-treatment group. Treated tumors of both groups also showed less invasion into surrounding ocular tissues. Morphologic changes after treatment included the development of numerous degenerative tumor cells with calcium deposition, fragmentation of nuclei, degeneration of mitochondria, accumulation of fat droplets, and disorganization of cytoplasm. These changes may indicate that the drug, particularly following combined delivery, has a cytotoxic effect directly on the tumor cells.

Sympathetic ophthalmia: a comparison of the histopathological features from a Chinese and American series

The importance of this comparison between two large series of cases of sympathetic ophthalmia lies in its confirmation of our previous findings, which differ somewhat from the classical pathological description. Sympathetic ophthalmia remains a clinicopathological diagnosis, relying on a history of perforating injury to one eye, followed after a variable incubation period by inflammation in the fellow eye. The inflammatory changes in both eyes consist of a diffuse, granulomatous proliferation throughout the uveal tract, which involves the choriocapillaris and the retina late in its course. The infiltrate is composed predominantly of lymphocytes and plasma cells, with a variable number of epitheloid and giant cells. Corticosteroid therapy may modify this picture. The epithelioid cells contain phagocytosed pigment granules, but there is not sign of necrosis. Eosinophils appear early in the course of the disease and disappear late. The granulomatous inflammation may spread to involve the optic nerve sheath, the nerve itself, the scleral emissaria, and the scleral stroma. Dalén-Fuchs nodules appear early peripherally, and it is over these nodules that retinal granulomas, when present, usually are found. In the Shanghai series, it was found that corticosteroid therapy and prompt enucleation of the exciting eye reduced the number of exacerbations experienced by these patients but did not improve visual prognosis. The MEEI data, while they did show a bimodal distribution to the visual result, seemed to indicate that prompt enucleation of a blind eye combined with aggressive corticosteroid therapy may improve visual prognosis.