1
|
Magalhães Paiva C, da Costa Pereira MR, Bellas AR, Protzenko T. Congenital orbital teratoma: a rare case with intracranial extension. Childs Nerv Syst 2024; 40:2653-2657. [PMID: 38953912 DOI: 10.1007/s00381-024-06510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Teratoma is the most common congenital tumor, but the orbital location is rare. It is composed of tissues from ectoderm, mesoderm, and endoderm. CLINICAL PRESENTATION Congenital orbital teratoma commonly presents as unilateral proptosis, with rapid growth, leading to exposure keratopathy. DIAGNOSIS Prenatal ultrasound may detect the orbital mass, computed tomography (CT) scans, and magnetic resonance (MR) imaging are better in demonstrating multilocular cystic and solid mass, without bone erosion. Laboratory tests should include alfa-fetoprotein (AFP) and B-human chorionic gonadotropin (B-HCG), and histopathologically, it contains all three germ cell layers components. The management is surgical removal of the lesion, the mature teratoma has a benign behavior, and the immature has a poor prognostic. We describe a rare case of congenital orbital teratoma with intracranial extension of the lesion, in which was treated with orbital exenteration. After surgery, AFP levels decreased, the middle face displacement has improved and development milestones were appropriate.
Collapse
Affiliation(s)
- Clara Magalhães Paiva
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, Fernandes Figueira National Institutes of Health for Women, Children, and Adolescents, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, Brazil.
| | - Maristella Reis da Costa Pereira
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, Fernandes Figueira National Institutes of Health for Women, Children, and Adolescents, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, Brazil
| | - Antônio Rosa Bellas
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, Fernandes Figueira National Institutes of Health for Women, Children, and Adolescents, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, Brazil
| | - Tatiana Protzenko
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, Fernandes Figueira National Institutes of Health for Women, Children, and Adolescents, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Tsoutsanis PA, Charonis GC. Congenital orbital teratoma: a case report with preservation of the globe and 18 years of follow-up. BMC Ophthalmol 2021; 21:456. [PMID: 34963454 PMCID: PMC8715611 DOI: 10.1186/s12886-021-02229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Congenital orbital teratomas are extremely rare, usually benign neoplasms, comprised of cells originating from all three germ cell layers. Clinically the tumor appears solid, most of the times is intraconal and presents as a rapidly growing mass leading to a massive unilateral axial proptosis, chemosis, exposure keratopathy, markedly distended eyelids and often, loss of vision. To prevent these complications, tumor excision usually involves enucleation or even orbital exenteration. Case presentation We report a case of a 1-day old infant who presented with dramatic proptosis at birth due to a true congenital orbital teratoma. We describe the clinical findings, the preoperative neuroimaging, the surgical management which included complete tumor resection with preservation of the globe to allow for optimal orbital growth, the histopathological evaluation, and the clinical course during 18 years of follow up. Conclusion Every effort to salvage the globe should be made to achieve the best possible orbito-facial development. Furthermore, the value of prompt surgical management with a less invasive transconjunctival globe sparing procedure can be appreciated in our case.
Collapse
|
3
|
Surgical resection of antenatally diagnosed orbital teratoma resulting in preservation of the globe. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
4
|
Prenatal Exophthalmia Revealing a Postnatal Orbital Teratoma. Case Rep Ophthalmol Med 2020; 2020:1597353. [PMID: 32765918 PMCID: PMC7374210 DOI: 10.1155/2020/1597353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Teratomas are congenital tumors of stem cells derived from the three germ layers. They are frequently located in the sacrococcygeal region. Orbital teratoma is rare with less than 70 cases reported until 2016. We report the case of prenatal exophthalmia discovered by ultrasound exam which turned out to be a teratoma postnatally. The newborn in our case was female, just as described in the literature. Treatment consisted of total removal of the teratoma and the eyeball. Reconstructive surgery remains a big challenge since our medical technology is limited. Conclusion A prenatal exophthalmia on fetal ultrasound should make us think of a teratoma, even if it is very rare. Fetal orbital teratoma may be associated with fetal survival. The infant will benefit from a reconstructive surgery of the orbit.
Collapse
|
5
|
Prakash MV, Indira R, Radhakrishnan M, Leela G. Malignant orbital teratoma in a neonate: A clinicopathological case report. J Postgrad Med 2019; 63:203-205. [PMID: 28695872 PMCID: PMC5525488 DOI: 10.4103/jpgm.jpgm_629_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Teratoma of the orbit is rare; very few cases have been published in literature. A case of orbital teratoma in a neonate is presented where the proptosis was massive enough to obscure the eyeball. Clinically, the diagnosis of teratoma was considered. As there was no possibility of salvaging the eye, exenteration of the orbit was done. Orbital teratomas are generally benign. Histopathological examination revealed the features of malignant teratoma.
Collapse
Affiliation(s)
- M Vs Prakash
- Department of Orbit and Oculoplasty, Regional Institute of Ophthalmology, Chennai, Tamil Nadu, India
| | - R Indira
- Department of Orbit and Oculoplasty, Regional Institute of Ophthalmology, Chennai, Tamil Nadu, India
| | - M Radhakrishnan
- Department of Orbit and Oculoplasty, Regional Institute of Ophthalmology, Chennai, Tamil Nadu, India
| | - G Leela
- Department of Orbit and Oculoplasty, Regional Institute of Ophthalmology, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Rao R, Honavar SG, Mulay K. Primary lacrimal gland teratoma in an adult: A clinicopathologic and radiological correlation. Indian J Ophthalmol 2019; 67:1238-1240. [PMID: 31238481 PMCID: PMC6611252 DOI: 10.4103/ijo.ijo_1764_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 20-year-old male presented with a gradually growing mass in the left lateral brow region for 2 years. On imaging, the mass appeared to arise from the lacrimal gland, was cystic, without any bony abnormality. With a diagnosis of dermoid cyst, an excision biopsy was performed. The histopathology revealed an epithelium-lined cyst, with the wall of the cyst comprising dermal adnexa and inflammatory cells. The wall also contained fragments of skeletal muscle, nerve bundles, adipose tissue, exocrine and secretory acini, few blood vessels with occasional hair shafts, with the lacrimal gland in the periphery of the tumor. There were no immature elements, atypia, and malignant cells, thus confirming the diagnosis of a mature cystic teratoma. Primary lacrimal gland teratoma is a rare diagnosis and its presentation in adults is extremely uncommon.
Collapse
Affiliation(s)
- Raksha Rao
- Ocular Oncology Service, Centre for Sight, Asoka Capitol Building, Road No 2, Banjara Hills, Hyderabad, Telangana, India
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight, Asoka Capitol Building, Road No 2, Banjara Hills, Hyderabad, Telangana, India
| | - Kaustubh Mulay
- Ocular Pathology Service, Centre for Sight, Asoka Capitol Building, Road No 2, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
7
|
Abstract
To describe a unique case of a non-germinomatous germ cell tumor, a giant orbital dermoid, present in adulthood. A 31-year-old male presented in our clinic with gradual, painless, progressive proptosis in the left eye since 28 years associated with gradual loss of vision. The left eye showed gross proptosis. Ocular structures could not be made out. Computed tomography scan showed a well-circumscribed oval heterogeneous mixed solid and cystic lesion completely filling the left orbit with calcification. The differential diagnosis was that of either teratoma or optic nerve glioma. The patient underwent excision of the lesion. Histopathology revealed a capsulated tumor with multiple cystic components filled with blood and eosinophilic material suggestive of a dermoid cyst. Non-germinomatous germ cell tumors may present atypically in adults and neglected benign dermoid cysts can attain massive size mimicking malignant lesions.
Collapse
Affiliation(s)
- Bipasha Mukherjee
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Akruti Desai
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| |
Collapse
|
8
|
Kamal S, Kaliki S, Sreedhar A, Mishra DK. Primary orbital yolk sac tumor: report of a case and review of literature. Int Ophthalmol 2015; 36:435-44. [DOI: 10.1007/s10792-015-0142-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/15/2015] [Indexed: 11/27/2022]
|
9
|
Pahwa S, Sharma S, Das CJ, Dhamija E, Agrawal S. Intraorbital Cystic Lesions: An Imaging Spectrum. Curr Probl Diagn Radiol 2015; 44:437-48. [DOI: 10.1067/j.cpradiol.2015.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/22/2022]
|
10
|
Aiyub S, Chan W, Szetu J, Sullivan LJ, Pater J, Cooper P, Selva D. Congenital orbital teratoma. Indian J Ophthalmol 2014; 61:767-9. [PMID: 23619505 PMCID: PMC3917402 DOI: 10.4103/0301-4738.111219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present a case of mature congenital orbital teratoma managed with lid-sparing exenteration and dermis fat graft. This is a case report on the management of congenital orbital teratoma. A full-term baby was born in Fiji with prolapsed right globe which was surrounded by a nonpulsatile, cystic mass. Clinical and imaging features were consistent with congenital orbital teratoma. Due to limited surgical expertise, the patient was transferred to Adelaide, Australia for further management. The patient underwent a lid-sparing exenteration with frozen section control of the apical margin. A dermis fat graft from the groin was placed beneath the lid skin to provide volume. Histopathology revealed mature tissues from each of the three germ cell layers which confirmed the diagnosis of mature teratoma. We describe the successful use of demis fat graft in socket reconstruction following lid-sparing exenteration for congenital orbital teratoma.
Collapse
|
11
|
Abstract
A 12-year-old girl presented with a left infraorbital lesion, causing upward globe displacement. Imaging confirmed a mass between the globe and the orbital floor. The lesion was removed via a sub-ciliary approach and histology revealed a a mature tooth along with a periodontal ligament, oral-type mucinous glands and bone. Six years later a mass recurred at exactly the same site and on this occasion, revealed cysts containing mucin and lined by Schneiderian type epithelium. A rather complex combination of a tooth, lamellar bone, mucinous oral type glands and Schneiderian cystic epithelium is highly unusual and we have called the lesion "ossifying cystic odontogenic and Schneiderian choristoma of the orbit."
Collapse
Affiliation(s)
- Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service, Dept of Histopathology, Royal Hallamshire Hospital, Sheffield , England , United Kingdom
| | | |
Collapse
|
12
|
Singh M, Singh U, Gupta A, Zadeng Z. Primary orbital teratoma with tooth in an adult: a rare association with cataract and corectopia. Orbit 2013; 32:327-329. [PMID: 23895389 DOI: 10.3109/01676830.2013.814682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Orbital teratoma is a known cause of proptosis in neonates but it is rare in adults. CASE REPORT An adult female presented with primary orbital teratoma with a well formed tooth inside the multicystic mass. Anterior orbitotomy with cyst excision was done with retrieval of a canine tooth. COMMENT This report documents a unique case of orbital teratoma presenting in an adult with well formed canine tooth inside. Microcornea, corectopia and cataract were other distinctive coexisting features of our case.
Collapse
Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | | | | | | |
Collapse
|
13
|
Watson S, Sarris M, Kuishek M, McKelvie P, Figueria E, McCluskey P, Coroneo M, Wakefield D. Limbal dermoid epithelium shares phenotypic characteristics common to both hair epidermal and limbal epithelial stem cells. Curr Eye Res 2013; 38:835-42. [PMID: 23573994 DOI: 10.3109/02713683.2013.780625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine putative limbal epithelial stem cell marker expression in human limbal dermoids compared to stem cell niches in normal limbus and hair follicles of normal human dermis. METHODS Human limbal dermoids (n = 7), normal skin (n = 2) and normal limbal (n = 7) tissue were examined. Immunohistochemistry was performed on paraffin embedded specimens using automated and manual immunostaining with primary antibodies to CK15, CK14, Cadherin-P (CDH3), Wnt-3, Wnt-4, Wnt-5a, Dickkopf (DKK)-3, Sox-2, Sox-10, Sox-13, PEDF, NGFR p75 and β-catenin. RESULTS Positive immunostaining was found for CK15, CK14, CDH3, NGFR p75, PEDF, Sox-2, Sox-10 and Wnt 4 in the basal dermoid epithelium, limbus and hair follicles. Suprabasal epithelium was immunostained with PEDF, Sox-2 and Wnt-4 in these tissues. The sebaceous and sweat glands, vascular endothelium and nerves of the limbal dermoid immunostained with PEDF and Sox-2. Sebaceous and sweat glands stained for Sox-10. DKK-3 immunostaining occurred in the dermoids' suprabasal epithelium and vascular endothelium but not in the limbus or hair follicle. CONCLUSION Human limbal dermoids share a similar antigenic expression profile similar to the basal limbal epithelium and to the stem cell niche of hair follicles. This supports the notion that limbal dermoids could have properties in common with limbal and/or dermal epithelial stem cells.
Collapse
|
14
|
Anami A, Fukushima K, Fujita Y, Satoh S, Matsumoto E, Endo M, Oda Y, Wake N. Antenatally diagnosed congenital orbital teratoma in which rupture was associated with intrauterine fetal death. J Obstet Gynaecol Res 2012; 38:578-81. [PMID: 22381109 DOI: 10.1111/j.1447-0756.2011.01738.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of a fetus with a congenital orbital teratoma (COT), in which rupture of the tumor was associated with an intrauterine fetal demise. An ultrasound scan at 27 weeks' revealed a solid and cystic, complex mass in the orbital region with extensive vascularization suggestive of an orbital cystic teratoma. Magnetic resonance imaging (MRI) supported this diagnosis and clarified tumor localization. At 32 weeks', the patient presented with fetal demise and rupture of the mass was noted. Fetal COTs, like sacrococcygeal teratomas, carry the risk of rupture. MRI in utero is useful for evaluating the extent of disease.
Collapse
Affiliation(s)
- Ai Anami
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Frenkel S, Trese MT, Walsh MK, O'Malley ER, Poulik JM, Abramson DH, Folberg R. Intraocular teratoma in association with sacrococcygeal teratoma: a clinicopathologic report. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-4. [PMID: 21214154 DOI: 10.3928/01913913-20100324-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 07/03/2008] [Indexed: 11/20/2022]
Abstract
A benign sacrococcygeal teratoma was resected from an infant at birth. Four weeks later, intraocular tumors were identified in the right eye. The eye expanded in size and was removed at 16 weeks. A benign cystic intraocular teratoma was identified.
Collapse
Affiliation(s)
- Shahar Frenkel
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Salzman KL, Rojiani AM, Buatti J, Quisling RG, Marcus RB, Maria BL, Mickle JP, Kedar A. Primary Intracranial Germ Cell Tumors: Clinicopathologic Review of 32 Cases. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Mehta M, Chandra M, Sen S, Bajaj MS, Pushker N, Meel R, Ghose S. Orbital teratoma: a rare cause of congenital proptosis. Clin Exp Ophthalmol 2009; 37:626-8. [PMID: 19702717 DOI: 10.1111/j.1442-9071.2009.02077.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Prause JU, Børgesen SE, Carstensen H, Fledelius HC, Jensen OA, Kirkegaard J, Lauersen H, Naeser P, Nehen JH. Cranio-orbital teratoma. ACTA OPHTHALMOLOGICA SCANDINAVICA. SUPPLEMENT 2009:53-6. [PMID: 8741121 DOI: 10.1111/j.1600-0420.1996.tb00388.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A new-born baby presented with a large, rapidly growing tumour. The tumour involved the right orbit, the anterior half of the right intracranial space and extended through the skull of the temporal region. The proptotic eye ruptured due to exposure. The tumour was extirpated when the patient was 12 days old. A large recurrence was extirpated two months later. The tumour was firmly bound to the medial aspect of the superior orbital fissure which probably was the location of origin of the tumour. Based on the size of the intracranial-and the orbital part of the tumour, it was classified as a secondary orbital teratoma. The tumour was macroscopically composed of cystic and solid areas. Microscopically it was seen to be a benign teratoma with tissue from all three germinal layers.
Collapse
Affiliation(s)
- J U Prause
- Eye Pathology Institute, University of Copenhagen, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Jakobiec FA, Nguyen J, Mandell K, Fay A. Complex palpebral odontogenic choristoma: A reappraisal of the origin of teeth-bearing periocular lesions. Am J Ophthalmol 2009; 147:531-543.e1. [PMID: 19217956 DOI: 10.1016/j.ajo.2008.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/25/2008] [Accepted: 09/26/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the findings observed in a congenital ectopic tooth of the lower inner eyelid and explain its origin. DESIGN Retrospective and interventional clinicopathologic study. METHODS Histopathologic evaluation of sequentially excised specimens over 4 years and radiographic study of any associated dental abnormalities, compared with critical reevaluation of similar reported cases in the literature. RESULTS The ectopic eyelid tooth clinically created a dome-shaped mass and microscopically displayed advanced cytodifferentiation but incomplete morphogenesis with clearly identifiable ameloblasts, enamel, odontoblasts, and dentin, surrounded by an intact dental sac. Swollen oral mucosal epithelium with associated sebaceous Fordyce nodules, residual ciliated odontogenic epithelium, embryonic epithelial rests, and accessory mucinous and sero-mucinous accessory salivary glands were discovered in place of normal conjunctiva. The tarsus with meibomian glands was absent but islands of cartilage were present. CONCLUSIONS Because of the variety of the ectopic tissues that were exhibited, a causative displacement of oral embryonic epithelium with extensive differentiating potentialities is posited. Two previously reported palpebral dental choristomas also had identical locations in the inferomedial eyelid. This is the site where the phakomatous choristoma may be encountered, but this unencapsulated mass creates an eyelid thickening without a globoid configuration and infiltrates the inferior orbit. After a careful re-appraisal of published reports of orbital cysts bearing a tooth that were formerly diagnosed as "teratomas," we have concluded that they developed from similar embryonic oral (buccal) epithelial displacements rather than from aberrant germ cells, based on the cysts' linings and the associated accessory salivary glands in their walls. This view is further supported by the absence of heterologous teratomatous elements of endodermal or neuroectodermal derivation. A clinical and surgical approach to management and a new diagnostic schema for odontogenic choristomas are proposed.
Collapse
Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, the David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
| | | | | | | |
Collapse
|
20
|
Ahmad Z, Khurshid A, Qureshi A. Primary orbital yolk sac tumour in a 14-year-old girl. BMJ Case Rep 2009; 2009:bcr04.2009.1821. [PMID: 22096462 DOI: 10.1136/bcr.04.2009.1821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Yolk sac tumour is a common malignant germ cell tumour, which usually occurs in the testes or ovaries of infants. It can occasionally arise from a number of extragonadal sites. Extragonadal germ cell tumours of the head and neck region account for 5% of all benign and malignant germ cell tumours. The orbit is an extremely unusual location for development of primary yolk sac tumour. The present report concerns the case of a yolk sac tumour in a 14-year-old girl, arising as a primary tumour of the orbit with invasion of periorbital and intracranial spaces.
Collapse
Affiliation(s)
- Zubair Ahmad
- Aga Kahn University, Stadium Road Karachi, Karachi, 74800, Pakistan
| | | | | |
Collapse
|
21
|
Perrini P, Ventura L, Ricci A, Galzio R. Primary Germinoma of the Orbit. Neurosurgery 2005. [DOI: 10.1227/01.neu.0000175859.76645.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
22
|
Abstract
BACKGROUND/PURPOSE Germ cell tumors are relatively common in the fetus and neonate and are the leading neoplasms in some perinatal reviews. The purpose of this study is to focus on the fetus and neonate in an attempt to determine the various ways germ cell tumors differ clinically and morphologically from those occurring in the older child and adult and to show that certain types of tumors have a better prognosis than others. METHODS The author conducted a retrospective review of perinatal teratomas and other germ cell tumors reported in the literature and of patients treated and followed up at Children's Hospital San Diego and Children's Hospital Los Angeles. Only fetuses and infants less than 2 months of age with adequate clinical and pathologic data were accepted for review. RESULTS Five hundred thirty-four fetuses and neonates presented with teratomas diagnosed prenatally (n = 226) and at birth (n = 309). The most common initial finding was a mass, noted either by antenatal sonography or by physical examination during the neonatal period, with signs and symptoms referable to the site of origin. Overall polyhydramnios was next followed by respiratory distress and stillbirth. The number of mature and immature teratomas was approximately the same. The incidence of teratoma with yolk sac tumor either at presentation or at recurrence was 5.8%, and the survival rate was 39%. Sacrococcygeal teratomas had the highest incidence of yolk sac tumor at 10%. Recurrent disease in the form of either teratoma or yolk sac tumor developed in 5% of patients. All individuals with teratomas who survived received surgical resection. CONCLUSIONS Some germ cell tumors of the fetus and neonate have a better prognosis than others. Neonates with gastric teratomas have the best survival rates, and those with intracranial germ cell tumors the worst. Fetuses with teratomas detected antenatally have 3 times the mortality rate compared with postnatally diagnosed neonates. Although perinatal teratomas have a relatively low recurrence rate of 5%, close follow-up with imaging studies and serum alpha-fetoprotein determinations is is strongly recommended. Surgical resection alone may be adequate therapy for teratomas with nonmetastatic, microscopic foci of yolk sac tumor. In the nonteratoma group, patients with pure yolk sac tumor and gonadoblastoma have a much better outcome than those with choriocarcinoma, which has a very low survival of rate of 12%. Currently, the use of platinum-based combination chemotherapy has significantly improved the survival rate of infants with advanced malignant germ cell tumor disease.
Collapse
Affiliation(s)
- Hart Isaacs
- Department of Pathology, Children's Hospital San Diego, San Diego, CA 92123, USA
| |
Collapse
|
23
|
Abstract
There is little in the literature about the clinical spectrum of orbital cysts of childhood and no comprehensive classification has been proposed. The authors propose a classification of orbital cysts of childhood and review their clinical features, pathology, and management. The major categories in the classification include cysts of surface epithelium, teratomatous cysts, neural cysts, secondary cysts, inflammatory cysts, and noncystic lesions with cystic component. Cysts of the surface epithelium are further divided into simple epithelial cyst (epidermal, conjunctival, respiratory, and apocrine gland), and dermoid cyst (epidermal and conjunctival). Epidermal dermoid cyst (dermoid) is by far the most common orbital cystic lesion in children, accounting for over 40% of all orbital lesions of childhood and for 89% of all orbital cystic lesions of childhood that come to biopsy or surgical removal. Neural cysts include those associated with ocular maldevelopment (congenital cystic eye and colobomatous cyst) and those associated with brain and meningeal tissue (cephalocele and optic nerve meningocele). The most important secondary cyst is mucocele that can occur in children with cystic fibrosis. Inflammatory cysts are generally due to parasitic infestations and are more common in tropical areas of the world. Noncystic lesions that can have a cystic component include adenoid cystic carcinoma, rhabdomyosarcoma, lymphangioma, and others. Each type of cyst has rather characteristic, but not pathognomonic, clinical features. Computed tomography and magnetic resonance imaging can help differentiate a cystic lesion from a solid tumor, suggest the type of cyst, and help in planning management. The pathology varies with the cells that line the cyst and with the inflammatory agent. Management varies from local excision to observation, depending on the location and type of cyst. Orbital cysts of childhood can be classified into categories, based mainly on their histopathology. The clinical, radiologic, and histopathologic features can be correlated with the classification in order to better evaluate a child with a cystic lesion in the orbit.
Collapse
Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | | |
Collapse
|
24
|
Paikos P, Papathanassiou M, Stefanaki K, Fotopoulou M, Grigorios S, Tzortzatou F. Malignant ectomesenchymoma of the orbit in a child: Case report and review of the literature. Surv Ophthalmol 2002; 47:368-74. [PMID: 12161212 DOI: 10.1016/s0039-6257(02)00313-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Malignant ectomesenchymoma is a rare soft tissue tumor of childhood composed of both mesenchymal and neuroectodermal elements. Reported sites of origin are head and neck, abdomen, perineum, scrotum, and extremities. A new case of an orbital ectomesenchymoma in a 7-year-old boy is presented. The clinical picture of the tumor, radiological findings, and its histopathologic and immunohistochemical characteristics are described. The patient was successfully treated with combined surgical resection and chemotherapy. All the other reported cases of malignant ectomesenchymoma with various sites of origin are also reviewed.
Collapse
Affiliation(s)
- Peter Paikos
- Department of Ophthalmology, Agia Sofia Children's Hospital, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
Orbital teratoma is a rare, rapidly growing tumour that usually presents with congenital proptosis. Visual outcome is usually poor. A case is described of orbital teratoma presenting in an 18-month-old child as an inferior orbital mass with normal vision and intermittent hypertropia. Computed tomography demonstrated a cystic mass containing a tooth adjacent to the inferior orbital fissure. Histology revealed tissues derived from all three germ cell layers. The tumour was removed with preservation of vision and resolution of the strabismus. Late presentation of an orbital teratoma with a good visual outcome is exceptional.
Collapse
Affiliation(s)
- Jared J Mee
- Anatomical Pathology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
26
|
Yen MT, Tse DT. Congenital orbital cyst detected and monitored by prenatal ultrasonography. Ophthalmic Plast Reconstr Surg 2001; 17:443-6. [PMID: 11766026 DOI: 10.1097/00002341-200111000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE High-resolution prenatal ultrasound can allow for early detection and monitoring of many fetal anomalies, including those involving the globe and orbit. We describe a case of a congenital orbital cyst detected and monitored by prenatal transvaginal ultrasonography. METHODS After detection of a congenital orbital cyst, serial transvaginal ultrasound examinations were performed through the remainder of the pregnancy to monitor the growth and development of the fetus and the orbital cyst. RESULTS A large retrobulbar orbital cyst causing extreme proptosis was detected at 23 weeks of gestation and monitored through the remainder of the pregnancy. Lack of growth, benign behavior, and appropriate interval fetal growth without destruction of adjacent structures was noted. After birth, early surgical intervention allowed for complete surgical excision of the cyst without the need for enucleation or exenteration. Fifteen months after excision, the patient wore a scleral shell and had a good cosmetic appearance with good ocular motility. CONCLUSIONS Prenatal ultrasound may allow for early detection of orbital masses. To our knowledge, this report describes the first case of a congenital orbital cyst detected and monitored by prenatal ultrasonography.
Collapse
Affiliation(s)
- M T Yen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33136, USA
| | | |
Collapse
|
27
|
Alexandrakis G, Hubbell RN, Aitken PA. Nasolacrimal duct obstruction secondary to ectopic teeth. Ophthalmology 2000; 107:189-92. [PMID: 10647741 DOI: 10.1016/s0161-6420(99)00023-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed. DESIGN Two interventional case reports and literature review. PARTICIPANTS A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative. INTERVENTION A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed. MAIN OUTCOME MEASURES Nasolacrimal system function and response to treatment at the last follow-up were recorded. RESULTS In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up. CONCLUSIONS These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction.
Collapse
Affiliation(s)
- G Alexandrakis
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida
| | | | | |
Collapse
|
28
|
Lee GA, Sullivan TJ, Tsikleas GP, Davis NG. Congenital orbital teratoma. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1997; 25:63-6. [PMID: 9107398 DOI: 10.1111/j.1442-9071.1997.tb01277.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The occurrence of proptosis at birth is unusual and may be associated with a variety of tumours and structural abnormalities. Congenital orbital teratoma is a rare cause of congenital proptosis. METHODS A case report is presented of a female infant with gross right proptosis. RESULTS Computed tomography demonstrated a characteristic multicystic structure with no intracranial involvement. Histological examination found tissues derived from all three germ cell layers, consistent with a congenita orbital teratoma. The tumour was successfully removed preserving the globe and vision. CONCLUSIONS This report is an example of how early surgical intervention may allow preservation of the globe and vision in some patients with congenital orbital teratoma.
Collapse
Affiliation(s)
- G A Lee
- Royal Brisbane Hospital, Herston, Queensland, Australia
| | | | | | | |
Collapse
|
29
|
Steinkuller PG, Font RL. Congenital malignant teratoid neoplasm of the eye and orbit: a case report and review of the literature. Ophthalmology 1997; 104:38-42. [PMID: 9022102 DOI: 10.1016/s0161-6420(97)30364-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Medulloepithelioma is a tumor of the primitive medullary epithelium overlying the ciliary body. Most become evident early in life, and they may be malignant, although distant metastases are rare. The purpose of this report is to describe a unique case of congenital malignant teratoid neoplasm of the eye and orbit. METHOD A patient with a congenital malignant teratoid tumor of the eye and orbit is described, and a detailed histopathologic study of the ocular findings with a review of the literature is presented. RESULTS Histopathologic study showed that the lesion was a malignant teratoid neoplasm with a large orbital extension. Several intracranial structural abnormalities were identified. CONCLUSION The tumor described herein must be added to the differential diagnosis of congenital orbital masses. The clinician should be alert to the association of this lesion with complex intracranial abnormalities.
Collapse
Affiliation(s)
- P G Steinkuller
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
30
|
|
31
|
Jou JR, Patel S, Yo C, Sadun AA, Jou JR. Orbital coccidioidomyosis presenting as a lacrimal gland fossa mass. Br J Ophthalmol 1995; 79:1145-6. [PMID: 8562559 PMCID: PMC505364 DOI: 10.1136/bjo.79.12.1145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
32
|
Yih JP, Sullivan P, Taylor D. Alpha fetoprotein as marker for a case of orbital yolk sac tumour. Br J Ophthalmol 1995; 79:787-8. [PMID: 7547794 PMCID: PMC505257 DOI: 10.1136/bjo.79.8.787-a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|