The role of infectious agents in the etiology of ocular adnexal neoplasia

Kaposi's Sarcoma of the Bulbar Conjunctiva in an Immunocompetent Patient

Kaposi's sarcoma is an uncommon endothelial malignant tumor, first described by Moricz Kaposi in 1872. It is commonly encountered in patients with acquired immunodeficiency syndrome (AIDS), immunosuppression or organ transplantation. Conjunctival Kaposi's sarcoma is a rare tumor, mostly in patients with AIDS. We present a selected case with a superior bulbar conjunctival lesion in a patient who is HIV negative and immunocompetent, with an unremarkable general medical history. The lesion was surgically excised with no adjunctive treatment, and histological examination confirmed the diagnosis. There was no recurrence or metastasis 5 years after surgery.

Multiple Conjunctival Papillomas of Eyelid Margins in Pemphigus vulgaris

Ocular involvement in pemphigus vulgaris (PV) ranges from mild conjuctivits to conjunctival blisters and rarely prominent erosions of the bulbar and palpebral conjunctiva which may be found at the eyelid margin. We report two unusual cases of PV patients presenting with multiple conjunctival papillomatous lesions of the eyelids margins.

Recurrent subconjunctival hemorrhages leading to the discovery of ocular adnexal lymphoma

BACKGROUND

Subconjunctival hemorrhages commonly occur idiopathically or from causes including ocular surgery, trauma, anticoagulation medications, or a Valsalva maneuver. When a hemorrhage persists or recurs, a more extensive list of differential diagnoses must be considered. This report details a case in which persistent subconjunctival hemorrhages led to the discovery of ocular adnexal lymphoma.

CASE REPORT

A 68-year-old white man presented with a 7- to 8-month history of a recurrent red left eye. There was no associated pain, discharge, or change in vision over that time. The right eye was never involved. An ocular examination of the left eye found a mild nasal subconjunctival hemorrhage and a salmon-pink-colored lesion involving the superior conjunctiva. Clinical findings, photos, magnetic resonance images, and histopathology results are presented and reviewed. The signs, symptoms, incidence, pathophysiology, treatment, and prognosis of ocular adnexal lymphoma are also discussed.

CONCLUSION

Lymphomas can occur in a variety of sites in the body. It is well documented that primary tumors can originate in the ocular adnexa. Although not typical, the first sign in this case was a recurrent subconjunctival hemorrhage. The importance of a thorough ocular examination is paramount for a patient's ocular health and possibly the patient's life.

[PET-scan in orbital Malt lymphoma and its value in diagnosis and management: a series of four cases]

INTRODUCTION

The orbital location of mucosa associated lymphoid tissue (Malt) lymphoma (ML) is rare and can appear in very different forms. Biopsy is decisive for diagnosis. Although the positron emission tomography (PET) scan is rarely used in ophthalmology, it appears useful in our experience. We report four cases illustrating the diversity of the orbital localization in ML. Case 1 is a 41-year-old woman presenting unilateral corticosteroid-resistant dacryoadenitis. The PET-scan clearly fixed at the orbit. After anatomopathologic confirmation, a 36-Gy orbital radiotherapy was carried out, leading to the clinical and tomographic remission.

CASE REPORTS

Case 2 is a 61-year-old patient, presenting a small cell carcinoma of the lung, initially referred for unilateral exophthalmia. MRI highlighted a bilateral orbital infiltration, with a hot spot on the PET-scan. The clinical suspicion of orbital metastasis was not confirmed: the biopsy concluded in ML. Case 3 is a 64-year-old woman, referred for unilateral and resistant conjunctival hyperemia. Clinical diagnosis was myositis of the superior rectus muscle. The PET-scan did not fix in the orbit but revealed a pleural location. The muscular biopsy concluded once again in ML. Case 4 is a 68-year-old woman who had a history of sinusal ML. Diplopia with a second orbital location, non specific in CT but fixed in PET, was found. The biopsy concluded in ML with transformation toward an aggressive lymphoma.

CONCLUSION

Although the lacrimal gland location is well-known, unspecific orbital infiltration and orbital myositis are less common, which highlights the value of a non invasive exploration before biopsy. The advantages of the PET scan in orbital ML has not been sufficiently studied. In our experience, it was useful in these four cases. Orbital ML can take on different aspects that are sometimes misleading. PET is very useful in diagnosis before the biopsy, in therapeutic decisions, and in follow-up after treatment even if it does not always fix in the orbit.

The role of microbial flora on the ocular surface

PURPOSE OF REVIEW

Presence and interplay of microbial flora at the ocular surface reveal dynamic and evolving interactions with implications for both ocular surface health and disease. Data in this area are scarce or non-existent. The purpose of this review is to provide a snapshot of new and emerging developments in this area over the last 12 months.

RECENT FINDINGS

Recent findings signal potential roles for ocular surface microbial flora in both the preservation and extension of ocular surface health and in the initiation of new or escalation of common surface disorders. Contributions range from priming surface epithelial immune cells to regulating mucin composition and production. Other findings explore the emergent role of ocular microbial flora cross talk with pattern recognition receptors to protect and strengthen local and adaptive mucosal immunity while preserving vision.

SUMMARY

Deciphering the functional role of microbial communities at the ocular surface could bring new insights into and clarify the epidemiology and pathology of ocular surface dynamics in health and disease.

Identification of Chlamydia trachomatis in a patient with ocular lymphoma

Accumulating evidence suggests that infectious agents may play a role in ocular adnexa lymphomas (OALs) of MALT-type [1-4]. In particular, Chlamydia psittaci, the causative agent of psittacosis, has been detected by PCR in most patients from Italy or isolated eastern Asiatic countries with OALs in absence of other Chlamydia species [4-8]. These patients have also been shown to have a complete or partial response to doxycycline, recognized to be a cheap and safe treatment in these patients [5,6]. In contrast, OAL patients from other geographic areas and with different genetic background were found to be negative for C. psittaci DNA or had a quite variable response to antibiotic treatment, assuming that this pathogen might not play a ubiquitous role in OALs and that bacterial infection is not associated with OAL [8-12].

Ocular surface tumors

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, mucoepidermoid, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Ocular surface tumors include a variety of neoplasms originating from squamous epithelium, melanocytic tumors and lymphocytic resident cells of the conjunctival stroma. In this review, we highlight clinical features of these lesions, important diagnostic and investigative tools and standard care of management.