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Abstract
Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma.
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Tsuchiya M, Masui T, Otsuki Y, Sakahara H. Mesenchymal chondrosarcoma of the orbit: imaging features of CT and MRI. Br J Radiol 2018; 91:20170579. [PMID: 29975155 DOI: 10.1259/bjr.20170579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Mesenchymal chondrosarcoma (MCS) of the orbit is a rare and aggressive form of chondrosarcoma. The purpose of this study was to retrospectively identify the imaging features of mesenchymal chondrosarcoma of the orbit. METHODS: This study included five patients with histologically confirmed MCS of the orbit who had undergone either CT, MRI, or both. Images were evaluated for the following: location, size, margin, CT density and presence or absence of calcification and/or ossification, MRI findings including dynamic contrast-enhancement and time-intensity curves. RESULTS: CT was performed in four of the five patients, and all four (100%) demonstrated calcification and ossification of the mass. MRI was performed in all five patients. In two patients (40%), the mass demonstrated areas of hyperintensity on T1 weighted images. CONCLUSION: The presence of a well-defined, orbital mass with calcification and ossification on CT and, marked heterogenous enhancement and a rapid-washout pattern on dynamic MRI indicate a high probability of MCS of the orbit. In addition, MCS of the orbit can demonstrate areas of hyperintensity on T1 weighted images, representing bone marrow fat tissue of ossification. ADVANCES IN KNOWLEDGE: MCS of the orbit is a highly malignant tumor, and early diagnosis by imaging is important. Radiologists should be aware of the imaging features of MCS of the orbit.
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Affiliation(s)
- Mitsuteru Tsuchiya
- 1 Department of Radiology, Seirei Hamamatsu General Hospital , Hamamatsu, Shizuoka , Japan
| | - Takayuki Masui
- 1 Department of Radiology, Seirei Hamamatsu General Hospital , Hamamatsu, Shizuoka , Japan
| | - Yoshiro Otsuki
- 2 Department of Pathology, Seirei Hamamatsu General Hospital , Hamamatsu, Shizuoka , Japan
| | - Harumi Sakahara
- 3 Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine , Hamamatsu, Shizuoka , Japan
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Alkatan HM, Eberhart CG, Alshomar KM, Elkhamary SM, Maktabi AM. Primary mesenchymal chondrosarcoma of the orbit: Histopathological report of 3 pediatric cases. Saudi J Ophthalmol 2018; 32:69-74. [PMID: 29755276 PMCID: PMC5943970 DOI: 10.1016/j.sjopt.2018.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
Mesenchymal chondrosarcoma (MCS) is an unusual tumor mainly found in the skeleton. Around third of the cases occur in extra-skeletal sites with the orbit being the third most common site in these cases. In previous reviews of the orbital cases, it has been concluded that orbital MCS tends to occur in women in the second or third decades of life. However, 8 cases of orbital MCS have been reported so far in the pediatric age group (age less than 18 years-old) one of which has been considered congenital MCS in a 5-days old newborn girl. We describe 3 additional pediatric cases with primary orbital MCS and they were all males. Our cases presented with proptosis and calcific orbital masses on imaging studies. Histopathological examination of the excised masses shared the typical presence of undifferentiated mesenchymal cells and immature areas of cartilage. The diagnosis of MCS was further confirmed by immunohistochemical staining. Brief review of the literature in relation to this diagnosis in the orbit is also presented.
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Affiliation(s)
- Hind M. Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pathology Department, King Saud University-Medical City, Riyadh, Saudi Arabia
| | - Charles G. Eberhart
- Departments of Pathology, Ophthalmology, and Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Sahar M. Elkhamary
- Diagnostic Imaging Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Egypt
| | - Azza M.Y. Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Jakhetiya A, Shukla NK, Muduly D, Kale SS. Extraskeletal orbital mesenchymal chondrosarcoma: surgical approach and mini review. BMJ Case Rep 2017; 2017:bcr-2016-218744. [PMID: 28258179 DOI: 10.1136/bcr-2016-218744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Extraskeletal orbital mesenchymal chondrosarcoma (MC) is an extremely rare and highly aggressive tumour. It has characteristic radiological features and pathognomic histological biphasic pattern. Radical resection with negative margins is the mainstay of treatment; role of adjuvant chemotherapy and radiotherapy is yet not well defined. We report a rare case of 18-year-old man who was diagnosed to have orbital MC. He presented with locally advanced disease with no vision in the affected eye. He underwent right orbital exenteration; a transcranial intradural approach was used to divide the optic nerve, and the temporalis muscle flap was utilised to fill the exenterated orbit. Though optic nerve involvement is rare in orbital MCs, a transcranial approach may be used effectively to avoid traction on optic chiasma and ensure margin-free resection in case of optic nerve involvement up to orbital apex. Unfortunately, prognosis remains dismal in MCs despite treatment.
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Affiliation(s)
- Ashish Jakhetiya
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Dillip Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Sadashiva N, Sharma A, Shukla D, Rajalakshmi P, Mahadevan A, Devi BI. Intracranial Extraskeletal Mesenchymal Chondrosarcoma. World Neurosurg 2016; 95:618.e1-618.e6. [PMID: 27565470 DOI: 10.1016/j.wneu.2016.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intracranial extraskeletal mesenchymal chondrosarcomas (MCSs) are rare tumors accounting for <0.16% of intracranial tumors. They are usually described as occurring in the age group of 20-30 years and are commonly found in the frontoparietal region arising from the falx and surrounding dura. We describe 3 cases at varying ages, locations, and outcomes. CASE DESCRIPTION A 42-year-old woman with anterior one third falx-based lesion; a 7-year-old boy with mid one third falcine lesion with hyperostosis of bone, presenting in comatose stage; and a 52-year-old woman with left posterior lateral frontal dural-based lesion are presented. Histopathology of all cases was confirmed with immunohistochemistry. All patients underwent complete excision but had varying outcomes. CONCLUSIONS Intracranial MCSs are rare malignant tumors with poor prognosis. Because of their rarity, it may not be considered as a differential diagnosis and it is often misdiagnosed radiologically, but the importance lies in the need of radical excision. The potential effect of postoperative radiotherapy and chemotherapy is controversial. This article sheds some light on variable prognosis of this tumor.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anil Sharma
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Poyuran Rajalakshmi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Xu J, Li D, Xie L, Tang S, Guo W. Mesenchymal chondrosarcoma of bone and soft tissue: a systematic review of 107 patients in the past 20 years. PLoS One 2015; 10:e0122216. [PMID: 25849226 PMCID: PMC4388572 DOI: 10.1371/journal.pone.0122216] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 02/19/2015] [Indexed: 12/27/2022] Open
Abstract
Background Mesenchymal chondrosarcoma(MCS) is a rare high-grade variant of chondrosarcoma. Consensus has not been reached on its optimal management. Resection with wide margins is usually recommended, but the effect of margins has been demonstrated by little positive evidence. Moreover, the effectiveness of adjuvant chemo- and/or radiotherapy remains controversial. Objectives To describe the clinical characteristics and outcomes of MCS of bone and soft tissue, to assess the efficacies of surgery, chemotherapy and radiation, and finally to deliver a more appropriate therapy. Materials and Methods We reviewed EMBASE-, MEDLINE-, Cochrane-, Ovid- and PubMed-based to find out all cases of MCS of bone and soft tissue described between April 1994 and April 2014. Description of treatment and regular follow-up was required for each study. Language was restricted to English and Chinese. Issues of age, gender, location, metastasis, and treatment were all evaluated for each case. Kaplan-Meier Method and Cox Proportional Hazard Regression Model were used in the survival analysis. Results From the 630 identified publications, 18 meeting the inclusion criteria were selected, involving a total of 107 patients. Based on these data, the 5-, 10-and 20-year overall survival are 55.0%, 43.5% and 15.7% respectively. The 5-, 10-, 20- year event-free survival rates are 45.0%, 27.2% and 8.1%, respectively. Treatment without surgery is associated with poorer overall survival and event-free survival. Negative surgical margins could significantly bring down the local-recurrence rate and are associated with a higher event-free survival rate. Chemotherapy regime based on anthracyclines does not benefit the overall survival. The addition of radiation therapy is not significantly associated with the overall or event-free survival. However, we recommend radiation as the salvage therapy for patients with positive margin so as to achieve better local control. Conclusions This review shows that surgery is essential in the management of MCS of bone and soft tissue. Appropriate adjuvant therapy may reduce local recurrence, but cannot benefit the overall survival.
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Affiliation(s)
- Jie Xu
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Dasen Li
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Lu Xie
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Shun Tang
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
- * E-mail:
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Gherman V, Tomuleasa C, Bungardean C, Crisan N, Ona VD, Feciche B, Irimie A, Coman I. Management of renal extraskeletal mesenchymal chondrosarcoma. BMC Surg 2014; 14:107. [PMID: 25511186 PMCID: PMC4289544 DOI: 10.1186/1471-2482-14-107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/27/2014] [Indexed: 11/11/2022] Open
Abstract
Background Primary mesenchymal chondrosarcoma of the kidney is an extremely rare malignant tumor. To our best knowledge, only 9 such cases have been reported so far. Case presentation In the current paper, we present the case of a 67 year-old patient with recurrent left lumbar pain, increased fatigability and intermittent macroscopic hematuria. He underwent a surgical resection of the left kidney and left hemicolon. The pathological diagnosis was primary extraskeletal renal mesenchymal chondrosarcoma. Overall survival was 9 months, with pulmonary metastasis and local recurrence at 6 months. The management of the patient is described, from the initial differential diagnosis, after the first clinical examination to the surgical resection, with a special emphasis on the surgical procedures that were carried out. Conclusion Extraskeletal chondrosarcoma of primary origin in the kidney are extremely rare tumors with a highly malignant potential and very poor prognosis. Because the role of chemotherapy or radiation therapy has not been evaluated properly yet, we underline the importance of surgery in the management of such cases as the main and best approach to achieve clinical remission and long-term survival, provided the patient is referred to a surgical consult in time.
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Affiliation(s)
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics and Translational Medicine at the Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj Napoca, Romania.
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Hanakita S, Kawai K, Shibahara J, Kawahara N, Saito N. Mesenchymal chondrosarcoma of the orbit--case report. Neurol Med Chir (Tokyo) 2013; 52:747-50. [PMID: 23095269 DOI: 10.2176/nmc.52.747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 20-year-old woman presented with a rare case of intraorbital mesenchymal chondrosarcoma manifesting as a 6-month history of progressive ptosis and exophthalmos of her left eye. Computed tomography and magnetic resonance imaging revealed a partially calcified round mass occupying the postbulbar space. Partial removal of the tumor via a left fronto-orbital approach was performed. The histological diagnosis was mesenchymal chondrosarcoma, and additional intraorbital exenteration was performed. Neither chemotherapy nor radiotherapy was performed. She was free from tumor recurrence at the 6-year follow-up examination. Radical resection, including exenteration if possible, is recommended for intraorbital mesenchymal chondrosarcoma.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
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Kiratli H, Dikmetaş O, Tarlan B, Onerci M. Orbital chondrosarcoma arising from paranasal sinuses. Int Ophthalmol 2012; 33:403-7. [PMID: 23129506 DOI: 10.1007/s10792-012-9668-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/22/2012] [Indexed: 11/29/2022]
Abstract
Orbital chondrosarcoma arising from paranasal sinuses or from the nasal cavity with orbital extension is highly unusual. The aim of this report is to describe our multidisciplinary experience in the treatment of three patients with extensive sino-orbital chondrosarcomas. The patients were aged 43, 75 and 63 years, and the tumors originated from the maxillary, sphenoidal, and ethmoidal sinuses, respectively. Magnetic resonance imaging studies showed homogeneously hypointense lesions on T1-weighted scans, which were hyperintense on T2-weighted images. Intranasal endoscopic surgery alone or in combination with other conventional surgical approaches was the main therapeutic choice. Two patients had recurrences treated with wider surgical removal. Fractionated stereotactic radiotherapy was used in two cases. Two patients had histopathological grade I tumor and one had grade III chondrosarcoma. No patient had regional spread or distant metastasis. All patients were disease-free at 4, 2, and 3 years, respectively, following their last therapeutic interventions. Endoscopic surgery results in lesser morbidity for chondrosarcomas arising from paranasal sinuses and extending into posterior parts of the orbit. However, because control of surgical margins may not be complete, recurrences may occur justifying more radical approaches.
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Affiliation(s)
- Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Sıhhiye, Ankara, Turkey.
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Kan Z, Li H, Zhang J, You C. Intracranial mesenchymal chondrosarcoma: case report and literature review. Br J Neurosurg 2012; 26:912-4. [PMID: 22731866 DOI: 10.3109/02688697.2012.697219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mesenchymal chondrosarcoma is a very rare malignant cartilaginous forming tumour in central nervous system (CNS), which is rarely encountered in clinical practice and generally occurs in young adults. This article describes a case of primary intracranial mesenchymal chondrosarcoma in a 31-year-old woman and reviews the literature on its manifestations and management. CASE REPORT This patient had suffered from severe headache, intermittent nausea and vomiting for 1 week. Systemic examination was unremarkable. Magnetic resonance imaging (MRI) demonstrated a giant, heterogeneous, intensely enhancing mass of 6 × 5 × 4 cm, occupying the bilateral frontal and based on the anterior falx cerebri, which was initially thought to be a simply meningioma. The patient underwent a bicoronal craniotomy and gross total resection of the tumour. Pathologic examination revealed the mesenchymal chondrosarcoma. CONCLUSION Intracranial mesenchymal chondrosarcoma is an extreme rare neoplasm, which should be considered in the differential diagnosis of intracranial mass like a meningioma. We emphasize the importance of surgical intervention and combination of microsurgical resection and radiotherapy, it should be the therapeutical choice of the future.
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Affiliation(s)
- Zhisheng Kan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Yang B, Wang Y, Wang X, Wang Z. Mesenchymal chondrosarcoma of the orbit: CT and MRI findings. Clin Radiol 2012; 67:346-51. [DOI: 10.1016/j.crad.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/29/2011] [Accepted: 10/10/2011] [Indexed: 10/14/2022]
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Shakked RJ, Geller DS, Gorlick R, Dorfman HD. Mesenchymal Chondrosarcoma: Clinicopathologic Study of 20 Cases. Arch Pathol Lab Med 2012; 136:61-75. [DOI: 10.5858/arpa.2010-0362-oa] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Mesenchymal chondrosarcoma is a rare, high-grade malignancy of bone or soft tissue with a unique, biphasic histology and poor prognosis. Because of its rarity and variable length of disease-free survival, the natural history of the disease remains poorly understood.
Objective.—To present clinical, radiographic, and histopathologic features of mesenchymal chondrosarcoma from one of the largest case series collected by a single, senior-level bone pathologist.
Design.—Twenty cases were reviewed in consultations spanning 45 years.
Results.—Eighteen tumors (90%) originated in bone, and 2 tumors (10%) were of extraskeletal origin. Of the skeletal tumors, locations included craniofacial bones (n = 9; 50%), ribs and chest wall (n = 4; 22%), sacrum and spinal elements (n = 3; 17%), and lower extremities (n = 2; 11%), whereas soft tissue tumors were located about the scapula (n = 1; 50%) and lower extremity (n = 1; 50%). Plain radiographs demonstrated calcified, osteolytic lesions with extraosseous extension. Typical histologic features were identified consisting of small, round or spindled cells, interspersed with hyaline cartilage islands. Seventeen patients (85%) were treated surgically, and 8 patients (40%) received adjuvant treatment. Seven patients (35%) were living at last follow-up, 1.8 to 12.5 years after diagnosis, and 8 patients (40%) died between 1.2 and 21.8 years after diagnosis.
Conclusions.—Mesenchymal chondrosarcoma presents multiple challenges. Diagnostic pitfalls include inadequate biopsy samples, which may result in sample error. Sox9 has been proposed as a unique marker for mesenchymal chondrosarcoma which may improve diagnostic specificity. Treatment and prognosis vary considerably. Patients who receive surgery and chemotherapy seem to fare better. Multicenter studies with higher sample numbers may improve our understanding of this malignancy.
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Liu M, Qin W, Yin Z. An unusual case of primary mesenchymal chondrosarcoma in orbit with intracranial extension. Clin Imaging 2011; 34:379-81. [PMID: 20813303 DOI: 10.1016/j.clinimag.2009.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 11/10/2009] [Indexed: 11/17/2022]
Abstract
An unusual case of primary orbital mesenchymal chondrosarcoma with intracranial extension is reported, with special emphasis on the radiological findings.
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Affiliation(s)
- Mingming Liu
- Southwest Eye Hospital, Southwest Hospital, Third Military Medical University, Chongqing, China
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Odashiro AN, Odashiro PRP, Fernandes PI, Leite LVO, Odashiro M, Maloney S, Fernandes BF, Di Cesare S, Burnier MN. Eyelid and conjunctival paracoccidioidomycosis simulating carcinoma. Int Ophthalmol 2010; 31:63-7. [PMID: 20967485 DOI: 10.1007/s10792-010-9407-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
Abstract
Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in immunocompetent individuals in Brazil. Ocular infection by PCM is rare; however, when infection does occur, the most common ocular sites involved are eyelid and conjunctiva. A 68-year-old white male presented with a 2-month history of a painless, ulcerated, infiltrative and diffuse whitish lesion located on the right inferior eyelid. A clinical diagnosis of malignant tumor, possibly squamous cell carcinoma, was made. The histopathologic examination showed a hyperplastic epithelium with inflammatory infiltrate of lymphocytes, plasma cells, neutrophils and histiocytes. Large numbers of giant cells were also present. Periodic acid Schiff and Grocott (silver methenamine) stains showed several large round structures with peripheral lateral small budding cells that resembled a "ship's wheel". No multinucleated fungi were seen. The fungi varied in size and small forms were round and single fungal structures. A diagnosis of paracoccidioidomycosis was made PCM eyelid infection is rare and can simulate carcinoma both clinically and histopathologically.
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Abstract
A 14-year-old girl presented with a 3-month history of proptosis of the left eye. Orbital MRI revealed a superiorly located, well-defined, large mass that was hyperintense on T1-weighted and T2-weighted images with heterogenous internal structure and contrast enhancement. The patient underwent superolateral orbitotomy with bone removal. The tumor was excised totally in a piecemeal fashion. Microscopic examination revealed hyaline cartilaginous nodules admixed with spindle cell stroma and bone formation. Immunohistochemically, the mesenchymal component was diffusely positive for vimentin, smooth muscle actin, and CD34. The cartilaginous nodules and stroma stained with S-100. Based on the histopathologic and immunohistochemical findings, a diagnosis of orbital chondromesenchymal hamartoma was made. The patient has been followed for 6 years with no sign of recurrence. A literature search from 1966 to present using the PubMed database yielded no prior reports of primary orbital chondromesenchymal hamartoma. This case demonstrates that chondromesenchymal hamartoma can occur as a primary orbital tumor in children. Awareness of the presence of this tumor is essential for correct diagnosis.
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