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Graef S, DeAngelis D, Gupta AA, Wan MJ. Ocular manifestations and long-term complications of rhabdomyosarcoma in children. Eye (Lond) 2024:10.1038/s41433-024-03175-1. [PMID: 38907018 DOI: 10.1038/s41433-024-03175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND/OBJECTIVES The purpose of the study was to describe the ocular manifestations of rhabdomyosarcoma in a large cohort of children. SUBJECT/METHODS This was a retrospective observational cohort study. The medical records of all pediatric patients with head and neck rhabdomyosarcoma diagnosed between 1997 and 2021 at a tertiary-care pediatric hospital were analyzed. The main outcome measures were the incidence and prognostic role of ocular findings at presentation and long-term ocular complications. RESULTS There were 77 children with head and neck rhabdomyosarcoma in the study cohort with 38 patients showing ocular manifestations at presentation. Median age at diagnosis was 6.0 years, the median follow-up was 5.7 years and 54.5% were male. At last follow-up, 70.1% had no evidence of progression, 26.0% were deceased, and 2.6% were on palliative treatment. Orbital signs were common (44.2%). The most common ocular findings were proptosis (18.2%), restriction of extraocular motility (28.6%), strabismus/diplopia (22.1%) and ptosis (16.9%). The most common long-term complications were bony hypoplasia/facial asymmetry (40.3%) and keratopathy/dry eye (31.2%). Poor visual acuity (≤20/200) was noted in 13 (16.9%) patients with 5 (6.5%) patients requiring an exenteration. Survival was 100% in primary orbital RMS (p = 0.02), whereas any or a combination of cranial nerve palsies carried a poor prognosis (42% survival, p = 0.008). CONCLUSIONS In our cohort, half of children with rhabdomyosarcoma had ocular manifestations at presentation with about one-third showing orbital tumor involvement. Cranial nerve involvement carried a significantly worse prognosis for survival.
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Affiliation(s)
- Sybille Graef
- Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Dan DeAngelis
- Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Abha A Gupta
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada.
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2
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Hameed S, Yu AC, Almadani B, Abualkhair S, Ahmad K, Zauli G. Genetic Risk Factors and Clinical Outcomes in Childhood Eye Cancers: A Review. Genes (Basel) 2024; 15:276. [PMID: 38540335 PMCID: PMC10970510 DOI: 10.3390/genes15030276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 06/15/2024] Open
Abstract
Childhood eye cancers, although rare, present substantial health challenges, affecting the pediatric population with a remarkable impact on their lives and families. This comprehensive review provides insights into the various types of ocular tumors, primarily focusing on malignant eye tumors, their genetic predispositions, and advancements in managing these conditions. Understanding the genetic risk factors is crucial for early detection, risk assessment, and the development of targeted therapies. This review discusses genome-wide association (GWAS) and next-generation sequencing (NGS) studies to find common and rare genetic variants. Furthermore, it also explores the outcomes and implications of these genetic discoveries in treating pediatric ocular cancer. These findings underscore the significance of genetic research in guiding early interventions and improving outcomes in children with ocular cancers.
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Affiliation(s)
- Syed Hameed
- Research Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia; (B.A.); (S.A.); (K.A.); (G.Z.)
| | - Angeli Christy Yu
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Bashaer Almadani
- Research Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia; (B.A.); (S.A.); (K.A.); (G.Z.)
| | - Shereen Abualkhair
- Research Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia; (B.A.); (S.A.); (K.A.); (G.Z.)
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia; (B.A.); (S.A.); (K.A.); (G.Z.)
| | - Giorgio Zauli
- Research Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia; (B.A.); (S.A.); (K.A.); (G.Z.)
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Logan J, Mohite A, Kemp O, George S, Mcloone E. A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years. Eye (Lond) 2024; 38:553-557. [PMID: 37752343 PMCID: PMC10858281 DOI: 10.1038/s41433-023-02727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Paediatric conjunctival lesions are rare and diverse. Though often indolent and asymptomatic, they can in some cases be sight or life-threatening. Awareness of concerning features of conjunctival lesions is key to optimal management. We aim to provide insight into management of paediatric conjunctival lesions though a review of cases in our service in last 12 years. METHODS We present a retrospective analysis of our population-based cohort of children with conjunctival lesions presenting to our regional service in Belfast between 2011 and 2022 inclusive. We detail three rare cases of paediatric conjunctival lesions; a congenital intrascleral cyst leading to astigmatic amblyopia, a rapidly changing salmon-pink lesion confirmed as an embryonal rhabdomyosarcoma and an unusual presentation of a chronic granuloma arising from the caruncle. RESULTS 85 conjunctival lesions were identified in <16 year olds giving a cumulative incidence of 27 cases per 100,000 population over 12 years. Mean age at presentation was 7 years old. Most common lesions were naevi (40%), limbal dermoids (21%), conjunctival melanosis (14%), conjunctival cysts (7%) and phlycten (6%). When seen at presentation 8% of cases were immediately listed for surgery, 28% were discharged and 64% entered a phase of observation. CONCLUSION Paediatric conjunctival lesions have potential to cause visual manifestations, whilst some may undergo malignant transformation. Anterior segment photography is crucial in monitoring change and facilitating early discharge in the absence of sinister features. Malignant transformation must be considered in changing lesions which ought to have histological diagnosis obtained to prevent potentially sight and life-threatening conditions.
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Affiliation(s)
- John Logan
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Northern Ireland, UK.
| | - Ajay Mohite
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Northern Ireland, UK
| | - Oliver Kemp
- Southmead Hospital, North Bristol NHS Trust, England, UK
| | - Sonia George
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Northern Ireland, UK
| | - Eibhlin Mcloone
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Northern Ireland, UK
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Douch C, Merve A, Mankad K, Jorgensen M. Primary orbital rhabdoid tumour masquerading as atypical persistent foetal vasculature. BMJ Case Rep 2024; 17:e250776. [PMID: 38195193 PMCID: PMC10806956 DOI: 10.1136/bcr-2022-250776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
We present a case of primary rhabdoid tumour of the orbit. Presenting features at birth included congenital ptosis, conjunctival injection, hyphaema and microphthalmia. The unique presentation caused a late diagnosis following the development of rapid proptosis 6 months later. We suggest that orbital rhabdoid tumour be considered in the differential diagnoses of patients presenting with atypical persistent foetal vasculature features.
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Affiliation(s)
- Catherine Douch
- Neonatal Unit, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Ashirwad Merve
- Neuropathology, Great Ormond Street Hospital for Children, London, UK
| | - Kshitij Mankad
- Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | - Mette Jorgensen
- Oncology, Great Ormond Street Hospital for Children, London, UK
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Karakosta C, Liaskou M, Kattamis A, Rigatou E, Paraskevopoulos K. Orbital Rhabdomyosarcoma Masquerading as a Dermoid Cyst: A Case Report and Review of the Literature. Cureus 2023; 15:e50332. [PMID: 38205487 PMCID: PMC10780156 DOI: 10.7759/cureus.50332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
The purpose of this report is to present a case of orbital rhabdomyosarcoma (RMS) masquerading as a dermoid cyst. A six-year-old boy with an unremarkable medical history presented in the outpatient department with a palpable mass in the superonasal region of the right orbit, which had rapidly grown in the past month. The most likely diagnosis was dermoid cyst and the patient was scheduled for surgical excision. A high index of suspicion was raised intraoperatively based on the appearance of the lesion due to the presence of a feeder vessel. The histopathology examination identified alveolar RMS. The patient was referred to a pediatric oncology department and commenced intravenous chemotherapy. RMS may masquerade as various conditions, including dermoid cysts and chalazion. A high index of suspicion should be raised in cases with rapidly growing lesions.
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Affiliation(s)
- Christina Karakosta
- Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Maria Liaskou
- Department of Ophthalmology, Penteli General Hospital for Children, Athens, GRC
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Efthymia Rigatou
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Nhung TH, Minh VL, Tuyet TT, Cuong TM, Lam NL, Trang HT, Quy NX, Thong PM, Thanh DK, Duc NM. Orbital rhabdomyosarcoma in a 19-year-old male patient: A case report and literature review. Radiol Case Rep 2023; 18:2744-2749. [PMID: 37334324 PMCID: PMC10275731 DOI: 10.1016/j.radcr.2023.05.032] [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: 04/07/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common mesenchymal tumor in children and adolescents, with 10% of cases occurring in the orbits. RMS should be suspected whenever children present with rapidly progressing unilateral exophthalmos. Its symptoms depend on the lesion's origin and location. We report the clinical case of a 19-year-old male patient admitted to the hospital because of blurred vision and bulging eyes that gradually increased over several months. Magnetic resonance imaging showed a mass located mainly in the left orbit, pushing and deforming but not invading the eyeball. The lesion had grown into the left ethmoid sinus wall. The histopathological incisional biopsy results were with alveolar RMS.
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Affiliation(s)
- Ta Hong Nhung
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Vu Le Minh
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Tran Thi Tuyet
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Thieu Manh Cuong
- Pathology and Molecular Biology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Ngo Le Lam
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Hoang Thu Trang
- Department of Pediatric Oncologist, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Ngo Xuan Quy
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Pham Minh Thong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Doan Kim Thanh
- Department of Ophthalmology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 Distric…, Ho Chi Minh City, 700000, Vietnam
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7
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Yadav U, Singh A, Sinduja D, Arora RK, Singh A, Kumar B. Total external ophthalmoplegia and orbital apex syndrome as first presenting feature of Rhabdomyosarcoma involving petrous part of the temporal bone: A case report. Int J Surg Case Rep 2023; 106:108303. [PMID: 37163795 DOI: 10.1016/j.ijscr.2023.108303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Rhabdomyosarcoma (RMS) can have various unusual presentations. We report an unusual presentation of RMS as orbital apex syndrome in a six-year-old boy involving the petrous part of the temporal bone. CASE PRESENTATION A six-year-old boy presented with drooping of the left eyelid for seven days associated with headache, left-sided hearing loss, and nasal blockage. Contrast-enhanced magnetic resonance imaging (CE-MRI) brain and orbit revealed an ill-defined expansile vascular lesion centered at the petrous part of the left temporal bone with extension to the cavernous sinus, which was confirmed as RMS on histopathology and immunohistochemistry. The patient was managed by chemotherapy and radiotherapy. CLINICAL DISCUSSION RMS is the most common aggressive malignant soft tissue tumor in the pediatric population. It accounts for 4-8 % of all malignancies in children below 15 years of age, with strong male preponderance. The most common site for RMS is head and neck (45 %), having maximum incidence during the first decade of life. CONCLUSION Total external ophthalmoplegia in a child is an acute emergency; it should be properly worked up, and neuroimaging should always be advised. Prompt diagnosis and management by a multidisciplinary team can be both life and sight-saving.
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Affiliation(s)
- Umesh Yadav
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh 249203, India.
| | - Divya Sinduja
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Ashok Singh
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh 249203, India
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8
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Shrestha T, Mainali S, Poudel S, K.C N, Dulal A. A rare case of pediatric orbital rhabdomyosarcoma in Nepal: a case report. Ann Med Surg (Lond) 2023; 85:1247-1253. [PMID: 37113866 PMCID: PMC10129160 DOI: 10.1097/ms9.0000000000000501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
Orbital rhabdomyosarcoma (RMS) is a highly malignant, mesenchymal orbital tumor of childhood with a predilection in children less than 20 years of age. It presents as a space-occupying lesion in the orbit, most commonly over the superior nasal quadrant of the orbit. The patient usually presents with rapid onset unilateral proptosis and eyelid edema. Case Ppresentation In this article, a 14-year-old male presented with rapidly progressive swelling of the right orbit. On ocular examination, there was nonaxial inferolateral proptosis of the right eye. Computed tomography revealed a large soft tissue density tissue lesion in the right nasal cavity and meati measuring at least 3.2×2.7×5.4 cm in size with the erosion of the right orbit along with extension of the lesion in the extraconal compartment of the orbit. An MRI of the brain with contrast showed a heterogeneously enhancing altered signal intensity lesion. Debulking was planned, and a biopsy of the mass was sent that gave an impression of alveolar RMS. He also received radiotherapy and chemotherapy at one of the cancer hospitals in Nepal. Postsurgical follow-up showed gradual improvement in the visual acuity of the right eye. No evidence of metastasis and recurrence was found upon subsequent follow-up. Conclusion Thus, early diagnosis and prompt treatment is most for a favorable prognosis in the case of RMS. The main aim of this article was to briefly overview a rare case of RMS, its clinical presentation, diagnosis, treatment modalities, and its prognosis.
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Affiliation(s)
| | - Sumina Mainali
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
- Corresponding author. Address: Kathmandu University School of Medical Sciences, Dhulikhel, Kavre 44600. Tel.: 9843497998. E-mail address: (S. Mainali)
| | | | - Narendra K.C
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | - Aliza Dulal
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
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9
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Simon B, Wogram E, Camp AT, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 43-year-old Patient Presenting with a Right-sided, Slowly Progressing, Painless Exophthalmos and Ptosis. Clin Neuroradiol 2023; 33:255-260. [PMID: 36805296 PMCID: PMC10014779 DOI: 10.1007/s00062-023-01267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Affiliation(s)
- B Simon
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - E Wogram
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - A T Camp
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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Sadik Taju S, Kalekirstos T. Congenital alveolar rhabdomyosarcoma - case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 2022; 6:035-037. [DOI: 10.29328/journal.ijceo.1001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood and is very rare in the neonatal period. At this age, the alveolar type is a remarkably uncommon variety. We report a 56 days old female with alveolar RMS of the right eye noted since the age of 7 days with fast progression and unfavorable prognosis. Congenital alveolar RMS is an important cause of neonatal onset rapidly progressive proptosis. Early onset, alveolar type, and late diagnosis were poor prognostic factor.
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Nichols FR, Nguyen MT, Ekpenyong A, Pade KH. Point-of-Care Ultrasound Assessment of Orbital Rhabdomyosarcoma in a Pediatric Patient. Pediatr Emerg Care 2022; 38:339-341. [PMID: 35580192 DOI: 10.1097/pec.0000000000002761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Rhabdomyosarcoma is the most common soft tissue tumor in children and orbital lesions account for 10% of these diagnoses. This case describes a young boy who presented with eyelid swelling that was initially concerning for an expanding hematoma given a history of recent trauma to the eye. Point-of-care ultrasound identified 2 distinct lesions surrounding the globe, which prompted further investigation, including ophthalmology consult and computed tomography. The case presented highlights the initial misdiagnosis on both point-of-care ultrasound and computed tomography and the importance of using color Doppler on ultrasound to distinguish an orbital rhabdomyosarcoma from a posttraumatic hematoma.
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Affiliation(s)
- Francesca R Nichols
- From the Rady Children's Hospital San Diego, UCSD School of Medicine, San Diego, CA
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12
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Ren MY, Li J, Li RM, Wu YX, Han RJ, Zhang C. Primary orbital monophasic synovial sarcoma with calcification: A case report. World J Clin Cases 2022. [PMID: 35211602 DOI: 10.12998/wjcc.v10.i5.1623 ren my, li j, li rm, wu yx, han rj, zhang c. primary orbital monophasic synovial sarcoma with calcification: a case report. world j clin cases 2022; 10(5): 1623-1629 [pmid: 35211602 doi:10.12998/wjcc.v10.i5.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial sarcoma is a malignant mesenchymal neoplasm with variable epithelial differentiation. Most synovial sarcoma cases are reported in young adults and can arise in any body site. Notably, primary orbital synovial sarcoma is rare. CASE SUMMARY An 8-year-old east Asian girl with 1-month history of gradual painless proptosis and lacrimation of the right eye was admitted. The patient presented with painless proptosis, downward eyeball displacement, and upward movement disorders. According to clinical manifestations, imaging examinations and postoperative immunohistochemical examinations, the diagnosis was monophasic synovial sarcoma with calcification. The patient underwent anterior orbitotomy procedure for removal of the right orbital mass under general anesthesia. The diagnosis of monophasic synovial sarcoma with calcification was confirmed finally through histological and immunohistochemical exam. The follow-up period was 6 mo, and no recurrence was observed during this period. CONCLUSION Primary orbital monophasic synovial sarcoma with calcification is a rare sarcoma, and clinical manifestations and imaging results are not specific. The tumor may present similar features as a benign tumor. Comprehensive analysis of clinical, radiological, and pathological findings is critically important for making the right diagnosis. Conventional treatment approach for synovial sarcoma is surgical resection with adjuvant or neoadjuvant radiotherapy, which is highly effective for localized tumors.
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Affiliation(s)
- Ming-Yu Ren
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China.
| | - Jing Li
- Intensive Care Unit, Xingtai Third Hospital, Xingtai 054001, Hebei Province, China
| | - Rui-Miao Li
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Yi-Xiang Wu
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Rui-Juan Han
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Chi Zhang
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
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13
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Ren MY, Li J, Li RM, Wu YX, Han RJ, Zhang C. Primary orbital monophasic synovial sarcoma with calcification: A case report. World J Clin Cases 2022; 10:1623-1629. [PMID: 35211602 PMCID: PMC8855275 DOI: 10.12998/wjcc.v10.i5.1623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/28/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial sarcoma is a malignant mesenchymal neoplasm with variable epithelial differentiation. Most synovial sarcoma cases are reported in young adults and can arise in any body site. Notably, primary orbital synovial sarcoma is rare.
CASE SUMMARY An 8-year-old east Asian girl with 1-month history of gradual painless proptosis and lacrimation of the right eye was admitted. The patient presented with painless proptosis, downward eyeball displacement, and upward movement disorders. According to clinical manifestations, imaging examinations and postoperative immunohistochemical examinations, the diagnosis was monophasic synovial sarcoma with calcification. The patient underwent anterior orbitotomy procedure for removal of the right orbital mass under general anesthesia. The diagnosis of monophasic synovial sarcoma with calcification was confirmed finally through histological and immunohistochemical exam. The follow-up period was 6 mo, and no recurrence was observed during this period.
CONCLUSION Primary orbital monophasic synovial sarcoma with calcification is a rare sarcoma, and clinical manifestations and imaging results are not specific. The tumor may present similar features as a benign tumor. Comprehensive analysis of clinical, radiological, and pathological findings is critically important for making the right diagnosis. Conventional treatment approach for synovial sarcoma is surgical resection with adjuvant or neoadjuvant radiotherapy, which is highly effective for localized tumors.
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Affiliation(s)
- Ming-Yu Ren
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Jing Li
- Intensive Care Unit, Xingtai Third Hospital, Xingtai 054001, Hebei Province, China
| | - Rui-Miao Li
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Yi-Xiang Wu
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Rui-Juan Han
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Chi Zhang
- Department of Orbital Disease and Ocular Tumor, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
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Syndrome d’inflammation orbitaire idiopathique (SIOI) avec myosite de l’enfant : à propos d’un cas. Ann Pathol 2022; 42:189-191. [DOI: 10.1016/j.annpat.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
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Niazmand MJ, Speckert M, Johnston D. Acute myeloid leukaemia presenting as proptosis in an infant. BMJ Case Rep 2021; 14:e247506. [PMID: 34972785 PMCID: PMC8720955 DOI: 10.1136/bcr-2021-247506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Paediatric patients with acute myeloid leukaemia (AML) often present with symptoms associated with the disruption of normal haematopoiesis and subsequent cellular deficiencies. Periosteal reactions are common in paediatric leukaemia, but typically manifest as a thin, laminated pattern along long bones. Aggressive periosteal reactions are much less frequently seen. Here, we report a case of paediatric AML initially presenting with proptosis and periorbital swelling caused by aggressive, sunburst periosteal reactions surrounding the sphenoid and zygomatic bones. This unique presentation emphasises the importance of considering leukaemic infiltration in the differential for sunburst periosteal reaction in paediatric patients.
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Affiliation(s)
| | - Matthew Speckert
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Donna Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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16
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Dávila-Camargo A, Samaniego-Novelo FF, Vidal-Muñoz M, Jiménez-López JM, López-Facio E. Multidisciplinary approach to orbital embryonic rhabdomyosarcoma: About a case. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:552-555. [PMID: 34620486 DOI: 10.1016/j.oftale.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 10/22/2022]
Abstract
Of the head and neck tumoral lesions in children and adolescents, 5%-10% are primary malignant tumors. Among these tumors, orbital rhabdomyosarcoma stands out, which is the most common primary soft tissue sarcoma in children. Its diagnosis requires a high degree of clinical suspicion, and it can be corroborated with a series of examinations, in order to stage it and carry out the appropriate treatment. Currently, surgery and chemotherapy are the primary treatments, and the use of conventional radiotherapy is limited to cases where previous treatments fail or there is a risk of recurrence. The following case report aims to expose the clinical picture, diagnosis, staging and integral treatment of orbital rhabdomyosarcoma, as well as the interdisciplinary management that was performed to improve the patient's prognosis.
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Affiliation(s)
- A Dávila-Camargo
- Departamento de Oftalmología, Hospital Ángeles, Torreón (Coahuila), Mexico.
| | | | - M Vidal-Muñoz
- Departamento de Radiooncología, Unidad Médica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), Mexico
| | - J M Jiménez-López
- Departamento de Radiooncología, Unidad Médica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), Mexico
| | - E López-Facio
- Departamento de Oncología Pediátrica, Unidad Médica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), Mexico
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17
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Goswami M. Deep learning models for benign and malign ocular tumor growth estimation. Comput Med Imaging Graph 2021; 93:101986. [PMID: 34509705 DOI: 10.1016/j.compmedimag.2021.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/04/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
Relatively abundant availability of medical imaging data has provided significant support in the development and testing of Neural Network based image processing methods. Clinicians often face issues in selecting suitable image processing algorithm for medical imaging data. A strategy for the selection of a proper model is presented here. The training data set comprises optical coherence tomography (OCT) and angiography (OCT-A) images of 50 mice eyes with more than 100 days follow-up. The data contains images from treated and untreated mouse eyes. Four deep learning variants are tested for automatic (a) differentiation of tumor region with healthy retinal layer and (b) segmentation of 3D ocular tumor volumes. Exhaustive sensitivity analysis of deep learning models is performed with respect to the number of training and testing images using eight performance indices to study accuracy, reliability/reproducibility, and speed. U-net with UVgg16 is best for malign tumor data set with treatment (having considerable variation) and U-net with Inception backbone for benign tumor data (with minor variation). Loss value and root mean square error (R.M.S.E.) are found most and least sensitive performance indices, respectively. The performance (via indices) is found to be exponentially improving regarding a number of training images. The segmented OCT-Angiography data shows that neovascularization drives the tumor volume. Image analysis shows that photodynamic imaging-assisted tumor treatment protocol is transforming an aggressively growing tumor into a cyst. An empirical expression is obtained to help medical professionals choose a particular model given the number of images and types of characteristics. We recommend that the presented exercise should be taken as standard practice before employing a particular deep learning model for biomedical image analysis.
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Affiliation(s)
- Mayank Goswami
- Divyadrishti Imaging Laboratory, Department of Physics, Indian Institute of Technology Roorkee, Roorkee, India.
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18
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Abstract
BACKGROUND There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. OBJECTIVE This article gives a summary of the possible treatment options for the most common orbital tumors in childhood and adulthood. METHODS A literature search was carried out and the possible treatment pathways are presented. RESULTS 1. Frequent orbital tumors in childhood: a systemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is a possible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5 years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2. Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is a very effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. CONCLUSION There are now very effective conservative treatment options for many orbital tumors. In some cases a surgical procedure can be avoided and a good visual function can be retained.
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19
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Jaru-Ampornpan P, Tansirisithikul C, Prukajorn M, Sampattavanich S, Pithukpakorn M. Germline ATM mutation and somatic PIK3CA and BCOR mutations found in an infant with aggressive orbital embryonal rhabdomyosarcoma. Am J Ophthalmol Case Rep 2021; 23:101189. [PMID: 34401606 PMCID: PMC8353380 DOI: 10.1016/j.ajoc.2021.101189] [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: 10/26/2020] [Revised: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To report a case of aggressive infantile orbital embryonal rhabdomyosarcoma harboring germline ATM mutation and 2 somatic mutations as revealed by next-generation sequencing and the potential application for personalized therapy. Observations A 7-month-old male developed a rapidly progressive left proptosis over 6 weeks due to a large medial orbital mass. Biopsy revealed embryonal rhabdomyosarcoma. After the first cycle of chemotherapy, re-imaging showed interval tumor enlargement with intracranial extension. Craniotomy, combined with orbital exenteration, was performed. Tumor specimens and blood samples were sent for 596 gene DNA sequencing panels with RNA-sequencing focused on actionable mutations as well as gene fusion detection. Sequencing revealed 3 clinically relevant mutations: a germline ATM loss-of-function (LOF) mutation, a somatic PIK3CA gain-of-function mutation, and a somatic BCOR LOF mutation. No chromosomal translocation was detected. Workup for metastasis was positive for bone marrow involvement. Despite standard high-dose adjuvant chemotherapy in combination with radiation therapy, the patient died 10 months later with metastatic diseases. Conclusions and importance This case highlights an aggressive form of embryonal rhabdomyosarcoma in an infantile orbit. The presence of germline mutation may explain the increased chemo-resistance and adverse prognosis, and may be used as the target for genomic-directed therapy.
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Affiliation(s)
- Pimkwan Jaru-Ampornpan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Manachaya Prukajorn
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somponnat Sampattavanich
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manop Pithukpakorn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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20
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Rodriguez-Beato F, De Jesus O, Sanchez-Ortiz J, Delgado P, Perez-Berenguer JL, Labat EJ. Alveolar rhabdomyosarcoma metastatic to the brain. BMJ Case Rep 2021; 14:14/3/e240516. [PMID: 33664037 PMCID: PMC7934719 DOI: 10.1136/bcr-2020-240516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Alveolar rhabdomyosarcoma (ARMS) has a predilection for the peripheral extremities, and brain metastases are rare, with only a few cases reported after the initial diagnosis. We present a 22-year-old male patient with a right orbital-ethmoidal ARMS who presented with a recurrence to the brain 1 year after the initial diagnosis. He was referred to our institution due to acute neurological deterioration. A brain MRI was performed, showing an enhancing bilateral parafalcine lesion centred about the bilateral cingulate gyri with extension into the corpus callosum. The patient was taken to the operating room for a stereotactic biopsy under general anaesthesia, which was compatible with metastatic ARMS. Our case is exceedingly rare, considering the initial diagnosis of an orbital/ethmoidal ARMS, its subsequent metastasis to the brain and its clinical sequelae after a biopsy. Prognosis after cerebral metastatic ARMS is dismal, with most patients expiring due to central nervous system metastatic disease.
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Affiliation(s)
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Javier Sanchez-Ortiz
- Pathology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Patricia Delgado
- Radiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Eduardo J Labat
- Radiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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21
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Chowdhury Z, Sharma JD, Kakoti LM, Sarma A, Ahmed S, Hazarika M. Experience with Orbital Tumors from a Tertiary Cancer Centre of North East India: A Pathology Perspective. J Lab Physicians 2020; 12:171-177. [PMID: 33268934 PMCID: PMC7684989 DOI: 10.1055/s-0040-1721148] [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: 11/01/2022] Open
Abstract
Background The orbit is an anatomically complex structure comprising the globe, extraocular muscles, fat, vascular, nervous, glandular, and connective tissues. A wide variety of neoplasms can arise from different orbital structures, which can create a diagnostic challenge to the pathologists. No formal study has been conducted in this regard in North East India. Aim and Objectives This article aims to document the pattern and prevalence of orbital tumors in our institute and assess the utility of histopathological examination (HPE) and immunohistochemistry (IHC) in the precise diagnosis of these neoplasms. Materials and Methods A retrospective analysis of orbital tumors was performed over a period of 5 years from 2013 to 2018 in the department of pathology at a tertiary cancer center of North East India following all the guidelines of the institutional ethics committee. Results A total of 35 cases of orbital neoplasms, evaluated by HPE and IHC, were found, all of them being malignant tumors. The age range was 4 months to 85 years. Male to female ratio was 1.5:1. The most common tumor found was lymphoma, accounting for 10 cases (28.6%), all of which were non-Hodgkin lymphoma (NHL). All these cases except one occurred in adults, thus making it the most common tumor in adults in this study. Diffuse large B cell lymphoma, not otherwise specified, was the most common NHL, followed by follicular lymphoma, mature T cell NHL, extranodal marginal zone lymphoma, and B cell lymphoblastic lymphoma. Rhabdomyosarcoma and poorly differentiated/undifferentiated carcinoma jointly were the second most common tumors, totaling seven cases (21.21%) each. This was followed by melanoma (three cases), myeloid sarcoma (three cases), Ewing sarcoma/peripheral neuroectodermal tumor (PNET) (three cases), neuroblastoma (one case), and angiosarcoma (one case). Among these, rhabdomyosarcoma, granulocytic sarcoma, Ewing sarcoma/PNET, and neuroblastoma exclusively troubled the children. IHC markers including the lymphoma panel, and soft tissue ones were crucial in the precise diagnosis of the neoplasms encountered. Conclusion A variety of malignant orbital tumors may be seen in clinical practice. Management of these tumors requires a multidisciplinary approach. HPE in conjunction with IHC evaluation is of utmost importance in the veracious recognition of orbital tumors for their proper management.
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Affiliation(s)
- Zachariah Chowdhury
- Department of Pathology, Homi Bhabha Cancer Hospital/MPMMCC (Tata Memorial Hospital), Varanasi, Uttar Pradesh, India
| | - Jagannath Dev Sharma
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Lopa Mudra Kakoti
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Anupam Sarma
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Shiraj Ahmed
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Munlima Hazarika
- Department of Medical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
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22
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Dávila-Camargo A, Samaniego-Novelo FF, Vidal-Muñoz M, Jiménez-López JM, López-Facio E. Multidisciplinary approach to orbital embryonic rhabdomyosarcoma: about a case. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 96:S0365-6691(20)30360-9. [PMID: 33153818 DOI: 10.1016/j.oftal.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/23/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Of the head and neck tumoral lesions in children and adolescents, 5 to 10% are primary malignant tumors. Among these tumors, orbital rhabdomyosarcoma stands out, which is the most common primary soft tissue sarcoma in children. Its diagnosis requires a high degree of clinical suspicion, and it can be corroborated with a series of examinations, in order to stage it and carry out the appropriate treatment. Currently, surgery and chemotherapy are the primary treatments, and the use of conventional radiotherapy is limited to cases where previous treatments fail or there is a risk of recurrence. The following case report aims to expose the clinical picture, diagnosis, staging and integral treatment of orbital rhabdomyosarcoma, as well as the interdisciplinary management that was performed to improve the patient's prognosis.
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Affiliation(s)
- A Dávila-Camargo
- Departamento de Oftalmología, Hospital Ángeles, Torreón (Coahuila), México.
| | | | - M Vidal-Muñoz
- Departamento de Radiooncología, Unidad Médica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), México
| | - J M Jiménez-López
- Departamento de Radiooncología, Unidad Médica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), México
| | - E López-Facio
- Departamento de Oncología Pediátrica, Unidad Medica de Alta Especialidad N.° 71 IMSS, Torreón (Coahuila), México
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23
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Thien HH, Kim Hoa NT, Duy PC, Carlos RG, Son NH. Pediatric primary orbital rhabdomyosarcoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Kalemaki MS, Karantanas AH, Exarchos D, Detorakis ET, Zoras O, Marias K, Millo C, Bagci U, Pallikaris I, Stratis A, Karatzanis I, Perisinakis K, Koutentakis P, Kontadakis GA, Spandidos DA, Tsatsakis A, Papadakis GZ. PET/CT and PET/MRI in ophthalmic oncology (Review). Int J Oncol 2020; 56:417-429. [PMID: 31939615 PMCID: PMC6959466 DOI: 10.3892/ijo.2020.4955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022] Open
Abstract
Orbital and ocular anatomy is quite complex, consisting of several tissues, which can give rise to both benign and malignant tumors, while several primary neoplasms can metastasize to the orbital and ocular space. Early detection, accurate staging and re-staging, efficient monitoring of treatment response, non-invasive differentiation between benign and malignant lesions, and accurate planning of external radiation treatment, are of utmost importance for the optimal and individualized management of ophthalmic oncology patients. Addressing these challenges requires the employment of several diagnostic imaging techniques, such as high-definition digital fundus photography, ultrasound imaging, optical coherence tomography, optical coherence tomography (OCT)-angiography, computed tomography (CT) and magnetic resonance imaging (MRI). In recent years, technological advances have enabled the development of hybrid positron emission tomography (PET)/CT and PET/MRI systems, setting new standards in cancer diagnosis and treatment. The capability of simultaneously targeting several cancer-related biochemical procedures using positron emitting-radiopharmaceuticals, while morphologically characterizing lesions by CT or MRI, together with the intrinsic quantitative capabilities of PET-imaging, provide incremental diagnostic information, enabling accurate, highly efficient and personalized treatment strategies. Aim of the current review is to discuss the current applications of hybrid PET/CT and PET/MRI imaging in the management of patients presenting with the most commonly encountered orbital and ocular tumors.
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Affiliation(s)
- Maria S Kalemaki
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | | | - Dimitris Exarchos
- Department of CT‑MRI and PET/CT, Evangelismos Hospital, 10676 Athens, Greece
| | - Efstathios T Detorakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Odysseas Zoras
- Department of Surgical Oncology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Kostas Marias
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Corina Millo
- Positron Emission Tomography Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Ulas Bagci
- Center for Research in Computer Vision (CRCV), University of Central Florida (UCF), Orlando, FL 32816, USA
| | - Ioannis Pallikaris
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Andreas Stratis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Ioannis Karatzanis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Kostas Perisinakis
- Department of Medical Physics, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Pavlos Koutentakis
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Georgios A Kontadakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Forensic Sciences and Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Georgios Z Papadakis
- Department of Radiology, Medical School, University of Crete, 71003 Heraklion, Greece
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25
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Tarnowski M, Tkacz M, Piotrowska K, Zgutka K, Pawlik A. Differential effect of adenosine on rhabdomyosarcoma migration and proliferation. Arch Med Sci 2020; 16:414-427. [PMID: 32190153 PMCID: PMC7069424 DOI: 10.5114/aoms.2018.75506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/03/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adenosine and its receptors are involved deeply in the regulation of tumour biology. Purine nucleotides are released from stressed cells in states of hypoxia or radiochemotherapy-induced cell damage. Adenosine exerts its effect through the P1 family of selective receptors. The purpose of the study was to evaluate the exact role of extracellular role on biology of Rhabdomyosarcoma (RMS) cells. MATERIAL AND METHODS Series of in vitro studies accompanied by immunohistochemical, RQ-PCR and shRNA methods have characterised adenosine receptor expression on Rhabdomyosarcoma cell lines, normal skeletal muscle and effect of adenosine on Rhabdomyosarcoma growth and migration. RESULTS Extracellular adenosine (highest at 50 μM, p < 0.05) and AMP (highest at 300 μM, p < 0.05) markedly enhanced chemotaxis in the Boyden chamber assay The reaction is mostly governed by the A1 receptor, which is greatly overexpressed in Rhabdomyosarcoma as compared with normal skeletal muscle. Cell migration induced by adenosine and AMP is blocked by pertussis toxin, phospholipase C and MAP kinase inhibitor, which demonstrates the importance of these signalling pathways. High doses of adenosine have a detrimental effect on cellular proliferation, in a receptor-independent manner (≥ 500 μM; p < 0.05). The blockage of adenosine transporter by dipyridamole abolishes this effect, indicating involvement of an intrinsic pathway. Further increase of adenosine concentration, induced by deaminase inhibitors, augment the effect. CONCLUSIONS Our results suggest that adenosine and AMP trigger cell migration by binding to P1 receptors and directing cancer cells to the sites of hypoxia or cellular damage. Specifically by A1 receptor which is overexpressed in RMS.
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Affiliation(s)
- Maciej Tarnowski
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Marta Tkacz
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Katarzyna Zgutka
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
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26
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Morales R L, Álvarez A, Esguerra J, Prada Avella MC, Rojas F. Primary Conjunctival Rhabdomyosarcoma in a Pediatric Patient. Cureus 2019; 11:e6310. [PMID: 31938602 PMCID: PMC6944172 DOI: 10.7759/cureus.6310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rhabdomyosarcomas are neoplasms with a high degree of malignancy and arise from the embryonic mesenchyme. They represent approximately 5% of all pediatric tumors and their main locations are the head and neck (45%), trunk (40%), and extremities (15%). Twenty-five percent to 30% of the head and neck rhabdomyosarcomas appear in the orbit; however, its origin from the conjunctiva is rare, with few case reports published in the literature. We present the case of a five-year-old girl with a diagnosis of primary embryonic rhabdomyosarcoma of the conjunctiva, treated with surgery and chemotherapy. After completing the treatment, it was followed up with controls for oncological ophthalmology, pediatric hematology-oncology, and radiotherapy oncology every six months with magnetic resonance of the orbits. Two years after the end of treatment, the patient is disease-free. Conjunctiva rhabdomyosarcoma is a rare lesion, with few previously reported cases. In the reported case, the histopathological findings and positivity of the different immunohistochemical markers allowed a definitive diagnosis of rhabdomyosarcoma. The excellent prognosis of this pathology is probably linked to the early diagnosis of the disease and the timely administration of radical treatment. It is essential to be able to identify conjunctival rhabdomyosarcoma from its clinical and histopathological characteristics in order to achieve early diagnosis and provide adequate treatment to patients.
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Affiliation(s)
- Laura Morales R
- Radiation Oncology, Instituto Nacional de Cancerologia, Bogota, COL
| | - Angelina Álvarez
- Radiation Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | - José Esguerra
- Radiation Oncology, Instituto Nacional de Cancerologia, Bogota, COL
| | | | - Fernando Rojas
- Oncological Ophthalmology, Instituto Nacional de Cancerologia, Bogota, COL
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27
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Hoogeveen RC, Hol MLF, Pieters BR, Balgobind BV, Berkhout EWER, Schoot RA, Smeele LE, Merks HJHM, Becking EAG. An overview of radiological manifestations of acquired dental developmental disturbances in paediatric head and neck cancer survivors. Dentomaxillofac Radiol 2019; 49:20190275. [PMID: 31714151 DOI: 10.1259/dmfr.20190275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES In paediatric cancer survivors treated with chemotherapy and radiotherapy therapy, late effects on dental development are quite common. Oral radiologists are not familiar with the radiographic images of these specific dental consequences of chemotherapy and radiotherapy. With the goal of educating colleagues, to raise awareness of the needs of survivors, and to identify directions for future research, we present dental radiographs of survivors treated for head and neck rhabdomyosarcoma with chemotherapy and radiotherapy. Also, based on the survivors reviewed, a radiographic inventory of commonly found late dental developmental effects seen in conjunction with treatment is presented. METHODS Panoramic radiographic findings of five illustrative cases are presented, from a group of 42 survivors of head and neck rhabdomyosarcoma treated at the Academic Medical Center Amsterdam, The Netherlands over the past 25 years. RESULTS Five cases showing dental developmental disorders are presented. These cases show an association of the location of the radiation field and the developmental stage of the teeth with the severity of the effect on dental development. We also report an inventory of severe and moderate effects of chemotherapy and radiotherapy on the development of molars and anterior teeth. CONCLUSIONS This paper presents five cases and a radiographic inventory to illustrate disturbances of dental development associated with chemotherapy and radiotherapy in children. Medical and dental professionals involved in the treatment of cancer survivors are relatively unaware of the dental consequences of radiation therapy and the age dependency of specific regional effects. These effects can be severe, with great impact on quality of life. Further research in this area could help improve planning of radiation therapy for children, potentially preventing or limiting dental or maxillofacial sequelae.
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Affiliation(s)
- Reinier C Hoogeveen
- Department of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam ACTA, Amsterdam, The Netherlands
| | - Marinka L F Hol
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erwin W E R Berkhout
- Department of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam ACTA, Amsterdam, The Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for paediatric oncology, Utrecht, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Hans J H M Merks
- Princess Máxima Center for paediatric oncology, Utrecht, The Netherlands
| | - Eddy A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
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28
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Amir SP, Kamaruddin MI, Akib MNR, Sirajuddin J. Orbital cellulitis clinically mimicking rhabdomyosarcoma. Int Med Case Rep J 2019; 12:285-289. [PMID: 31692563 PMCID: PMC6716584 DOI: 10.2147/imcrj.s201678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Proptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should always be considered by the clinician. This is a case report of a five-year-old boy presenting with an acute-onset of proptosis without a history of trauma and systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital rhabdomyosarcoma. Purpose To report a case of orbital cellulitis that clinically and radiologically mimics rhabdomyosarcoma. Case presentation A five-year-old boy presented with rapid-onset proptosis, periorbital edema, pain and visual loss in the left eye for two weeks without a history of trauma, upper respiratory tract infection, sinusitis or immunosuppression. Our clinical differential diagnosis includes rhabdomyosarcoma and orbital cellulitis. Complete blood count reveals a leukocytosis. Multislice computed tomography (MSCT) scan shows lesions involving the lateral orbit and the retro bulbar space. Antibiotics combination and adjunct anti-inflammatory intravenously shows excellent clinical resolution. Conclusions The study demonstrates difficulty in differentiating acute orbital cellulitis from rhabdomyosarcoma based on clinical findings. In addition, the case highlights that antibiotic combination of cephalosporin and aminoglycosides together with an adjuvant corticosteroid as an anti-inflammatory was effective in the case of acute orbital cellulitis.
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Affiliation(s)
- Suliati P Amir
- Department of Ophthalmology, Hasanuddin University, Makassar, South Sulawesi, Indonesia.,Department of Ophthalmology, Muslim University of Indonesia, Makassar, South Sulawesi, Indonesia
| | | | - Marliyanti Nur Rahmah Akib
- Department of Ophthalmology, Hasanuddin University, Makassar, South Sulawesi, Indonesia.,Department of Ophthalmology, Muslim University of Indonesia, Makassar, South Sulawesi, Indonesia
| | - Junaedi Sirajuddin
- Department of Ophthalmology, Hasanuddin University, Makassar, South Sulawesi, Indonesia
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Affiliation(s)
- Jiyeon Kim
- Canterbury District Health Board, Christchurch, New Zealand
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Nahon-Esteve S, Martel A, Maschi C, Caujolle JP, Baillif S, Lassalle S, Hofman P. The Molecular Pathology of Eye Tumors: A 2019 Update Main Interests for Routine Clinical Practice. Curr Mol Med 2019; 19:632-664. [DOI: 10.2174/1566524019666190726161044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
Over the last few years, we have seen constant development of molecular
pathology for the care of patients with cancer. The information obtained from molecular
data has transformed our thinking about the biological diversity of cancers, particularly in
the field of ophthalmic oncology. It has reoriented the way in which therapeutic decisions
and decisions concerning patient surveillance are made, both in the area of pediatric
cancers, including rhabdomyosarcoma and retinoblastoma, and adult cancers, such as
uveal melanoma and lymphomas. A better definition of the molecular classification of
these cancers and of the different biological pathways involved is essential to the
understanding of both the pathologist and the onco-ophthalmologist. Molecular tests
based on targeted or expanded analysis of gene panels are now available. These tests
can be performed with tumor tissue or biofluids (especially blood) to predict the
prognosis of tumors and, above all, the benefit of targeted therapies, immunotherapy or
even chemotherapy. Looking for the BAP1 mutation in uveal melanoma is essential
because of the associated metastatic risk. When treating retinoblastoma, it is mandatory
to assess the heritable status of RB1. Conjunctival melanoma requires investigation into
the BRAF mutation in the case of a locally advanced tumor. The understanding of
genomic alterations, the results of molecular tests and/or other biological tests predictive
of a therapeutic response, but also of the limits of these tests with respect to the
available biological resources, represents a major challenge for optimal patient
management in ophthalmic oncology. In this review, we present the current state of
knowledge concerning the different molecular alterations and therapeutic targets of
interest in ophthalmic oncology.
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Affiliation(s)
| | - Arnaud Martel
- Department of Ophthalmology, University Cote d'Azur, Nice, France
| | - Célia Maschi
- Department of Ophthalmology, University Cote d'Azur, Nice, France
| | | | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, University Cote d'Azur, Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, University Cote d'Azur, Nice, France
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Abstract
Primary pediatric orbital tumors requiring surgery are uncommon and often require multidisciplinary management. Commonly used surgical approaches to the orbit include transconjunctival, transcutaneous (eyelid), transcranial, or extracranial osteotomies. This paper reviews a 10-year experience of cases that required a transcranial or extracranial surgical approach at the Birmingham Children's Hospital. A total of 9 patients were identified between the years 2008 to 2017. Pathologies included rhabdomyosarcoma, juvenile ossifying fibroma, optic nerve glioma, and retinoblastoma. Surgical approaches to the orbit included supraorbital bar osteotomy (transcranial) or lateral orbitotomy (extracranial). Surgical team members included neurosurgery, craniofacial surgery, and ophthalmology. This study aims to review the role of surgery in management as well as the specific indications for performing transcranial or extracranial osteotomies. It also highlights the excellent access achieved with the use of these osteotomies in certain cases, especially when compared with transconjunctival or transcutaneous approaches.
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Cortes Barrantes P, Jakobiec FA, Dryja TP. A Review of the Role of Cytogenetics in the Diagnosis of Orbital Rhabdomyosarcoma. Semin Ophthalmol 2019; 34:243-251. [DOI: 10.1080/08820538.2019.1620802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Paula Cortes Barrantes
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA, USA
| | - Frederick A. Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA, USA
| | - Thaddeus P. Dryja
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA, USA
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Genetic profiling of rhabdomyosarcoma with clinicopathological and radiological correlation. Can J Ophthalmol 2019; 54:247-257. [PMID: 30975350 DOI: 10.1016/j.jcjo.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Orbital Rhabdomyosarcoma is a highly malignant tumor predominantly affecting children. Our study adds more understanding of this tumor to ophthalmologists from the clinicopathological, radiological and genetic aspects. DESIGN A retrospective clinicopathological and radiological study of ocular rhabdomyosarcoma with genetic profiling. PARTICIPANTS All the cases with confirmed tissue diagnosis of orbital rhabdomyosarcoma presenting at a tertiary eye hospital in Riyadh, Saudi Arabia during the period 1985-2015. METHODS Charts and histological slides of 26 patients were reviewed. DNA was extracted from paraffin-embedded biopsies and genotyping was performed to detect chromosomal abnormalities and Copy-number variations regions. RESULTS 18 males and 8 females were included with a mean age at presentation of 6.9 years (SD of 4.4). Proptosis and globe displacement were the commonest clinical presentations. Embryonal histopathological type was the commonest (73.1%) with superior orbital involvement (p = 0.024). Using magnetic resonance imaging, the embryonal type showed higher Apparent diffusion coefficient (ADC) value compared to the alveolar type (p = 0.98). Genetic profiling showed Copy-number gain in regions spanning PAX3, DDIT3, Gli, Wnt6 genes. DICER1 gene implication was found in 9 sporadic cases. CONCLUSION Rhabdomyosarcoma is rare and occurs with a mean age of 7 years, predominantly among males. The commonest embryonal type is significantly correlated with superior orbital involvement. Radiologically, it shows an ADC of 0.67-0.09 × 10-3mm2/s. (p = 0.98). The gain in PAX3, DDIT3, Gli1, Wnt6 genes is a new finding while the DICER1 gene implication in the absence of familial hereditary carcinoma is another interesting finding.
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Muralidhar A, Gupta R, Venugopal S, Geethamani V, Malhotra A. Mélange of orbital lesions – A histomorphologic study of 135 cases. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_104_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Stein AP, Norris RE, Shah JR. Pediatric acute lymphoblastic leukemia presenting with periorbital edema. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pennington JD, Welch RJ, Lally SE, Shields JA, Eagle RC, Shields CL. Botryoid Rhabdomyosarcoma of the Conjunctiva in a Young Boy. Middle East Afr J Ophthalmol 2018; 25:111-114. [PMID: 30122858 PMCID: PMC6071337 DOI: 10.4103/meajo.meajo_8_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Primary conjunctival rhabdomyosarcoma (RMS) is a rare entity that can present with or without papillomatous features. A 5-year-old Asian boy was referred for a rapidly growing conjunctival tumor in the superior fornix of the left eye. Surgical excision yielded a 28 mm multilobulated papillomatous specimen that exhibited histopathologic and immunohistochemical features consistent with embryonal (botryoid) RMS. Molecular analysis revealed the absence of the PAX3/FOXO1 fusion gene, indicating favorable prognosis. After surgery, he was promptly treated with systemic chemotherapy and proton beam radiotherapy.
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Affiliation(s)
- Justin D Pennington
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - R Joel Welch
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Sara E Lally
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jerry A Shields
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Carol L Shields
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Ahmad TY, Al Houri HN, Al Houri AN, Ahmad NY. Aggressive orbital rhabdomyosarcoma in adulthood: A case report in a public hospital in Damascus, Syria. Avicenna J Med 2018; 8:110-113. [PMID: 30090751 PMCID: PMC6057160 DOI: 10.4103/ajm.ajm_62_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Orbital rhabdomyosarcoma (RMS) is a highly malignant tumor that originates mainly from mesenchymal tissue. It is considered a rare childhood malignancy; therefore, presentation in adulthood is scarce. In this case report, a 36-year-old male patient presented with a rapidly progressive RMS of the left orbit. The patient was treated in a different institution with radiochemotherapy with good response. However, relapse occurred after 2 months of completing the course, as rapid growing proptosis. Computed tomography scan revealed a lesion in the left orbit with invasion of the left ethmoid cells and the left maxillary sinus. Exenteration of the left orbit with the left partial maxillectomy and ethmoidectomy was performed. RMS is a highly aggressive malignancy that should be considered in any orbital mass that progresses rapidly. Surgery should be the first line in treatment. Delay in diagnosis and inappropriate treatment negatively affects the outcome.
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Affiliation(s)
| | - Hasan Nabil Al Houri
- Department of Internal Medicine, Al Assad University Hospital and Al Mouwasat University Hospital, Damascus, Syria
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Bansal AG, Oudsema R, Masseaux JA, Rosenberg HK. US of Pediatric Superficial Masses of the Head and Neck. Radiographics 2018; 38:1239-1263. [DOI: 10.1148/rg.2018170165] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Anmol Gupta Bansal
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Rebecca Oudsema
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Joy A. Masseaux
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Henrietta Kotlus Rosenberg
- From the Department of Radiology, Kravis Children’s Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
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Jenner ZB, Husein N, Riascos R, Esquenazi Y. Orbital and nasal meningoencephaloceles secondary to chronic hydrocephalus: A rare cause of bilateral proptosis. Neuroradiol J 2018; 31:420-425. [PMID: 29882488 DOI: 10.1177/1971400918778145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Orbital meningoencephalocele formation is primarily a result of congenital defects in the pediatric population and trauma of the anterior cranial fossa in adults. We present a unique case of nontraumatic nasal and orbital meningoencephaloceles presenting as bilateral proptosis with exotropia secondary to chronic hydrocephalus. Clinical presentation A 20-year-old male with a history of tuberous sclerosis, X-linked intellectual disability, and epilepsy presented to the emergency department with two days of nausea, emesis, seizures, and two months of progressive proptosis. Initial radiographs of the skull showed a "copper beaten" appearance, indicating chronically elevated intracranial pressure. Computed tomography imaging of the head demonstrated bilateral defects in the cribriform plate and anterior cranial fossa. Magnetic resonance imaging of the brain revealed triventricular hydrocephalus with meningoencephalocele extension into the nasal cavity and frontal horn herniation into the extraconal space of the orbits. The hydrocephalus was managed with ventriculoperitoneal shunt placement with rapid and complete resolution of the proptosis. Conclusion No reports have described bilateral proptosis as the presenting finding of orbital and nasal meningoencephaloceles in the absence of trauma or congenital defect. This case study demonstrates the management of meningoencephalocele formation secondary to chronic hydrocephalus.
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Affiliation(s)
- Zachary B Jenner
- 1 McGovern Medical School at The University of Texas Health Science Center, USA
| | - Nuruddin Husein
- 2 Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center, USA
| | - Roy Riascos
- 3 Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center, USA
| | - Yoshua Esquenazi
- 2 Vivian L. Smith Department of Neurosurgery, McGovern Medical School at The University of Texas Health Science Center, USA
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Pennington JD, Lally SE, Shields CL. Lower eyelid pseudochalazion in a child. Indian J Ophthalmol 2018; 66:619. [PMID: 29676301 PMCID: PMC5939149 DOI: 10.4103/ijo.ijo_298_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Natarajan A, Chandra P, Purandare N, Agrawal A, Shah S, Puranik A, Rangarajan V. Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Various Orbital Malignancies. Indian J Nucl Med 2018; 33:118-124. [PMID: 29643671 PMCID: PMC5883428 DOI: 10.4103/ijnm.ijnm_135_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Orbital swelling comprises wide spectrum of pseudotumors, benign and malignant tumor. Malignant tumor may be primary or secondary tumor, and they constitute about 36% of orbital tumors in adult. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan is extensively used in hematological malignancies and in solid tumors for staging, treatment response, and restaging. Recently, the use of FDG-PET/CT in orbital malignancies has gained importance. The aim of this pictorial essay is to illustrate few important orbital malignancies detected in F-18 FDG-PET/CT and discuss its role in assessing the primary lesion and associated systemic finding.
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Affiliation(s)
- Aravintho Natarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Piyush Chandra
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Nair AG, Gore SS, Ganvir AY, Adulkar NG, Gopinathan I, Murthy AK, Potdar NA, Shinde CA. Giant Perivascular Epithelioid Cell Tumor of the Orbit: A Clinicopathological Analysis and Review of the Literature. Ocul Oncol Pathol 2018; 4:272-279. [PMID: 30320097 DOI: 10.1159/000484425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022] Open
Abstract
Aim To describe and review the clinical, radiological, and histopathological characteristics of an orbital perivascular epithelioid cell tumor (PEComa). Methods A systematic review of clinical records, radiological investigations, microscopic features, and immunohistochemical characteristics was done. Results A 9-year-old female child presented with a year-long history of a large orbital mass associated with painless, progressive proptosis of the right eye. Radiologically, a well-defined orbital mass was seen with no intracranial extension. Excision was performed and histopathological examination showed uniform epithelioid cells in nests separated by thin fibrovascular septae. The tumor cells stained positively for Human Melanoma Black-45, but neg-atively for desmin, S-100, smooth muscle actin, MyoD1, microphthalmia-associated transcription factor, vimentin, CD10, CD31, and CD34 with a low proliferation index of 5-7%. Based on the tumor's morphological and immuno-histochemical characteristics, a diagnosis of giant orbital PEComa was made. No recurrence was seen at the last follow-up. Conclusions PEComas are uncommon mesenchymal neoplasms that have typical histological features, with an immunohistochemical profile of negativity for epithelial markers and positivity for melanocytic markers. For benign PEComas, complete excision is advised. However, since PEComas elsewhere in the body have been known to be malignant, a close follow-up of such cases is recommended.
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Affiliation(s)
- Akshay G Nair
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, Navi Mumbai, India.,Aditya Jyot Eye Hospital, Mumbai, India
| | - Swaranjali S Gore
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Amol Y Ganvir
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | | | | | | | - Nayana A Potdar
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Chhaya A Shinde
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Roberts F, MacDuff E. An update on mesenchymal tumours of the orbit with an emphasis on the value of molecular/cytogenetic testing. Saudi J Ophthalmol 2018; 32:3-12. [PMID: 29755264 PMCID: PMC5944000 DOI: 10.1016/j.sjopt.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
Mesenchymal tumours of the orbit are uncommon. Beyond childhood primary sarcomas are extremely rare and the literature is limited to case reports and short case series. However there is a diverse assortment of benign and malignant soft tissue tumours that may involve the orbit. Techniques to identify tumour specific cytogenetic or molecular genetic abnormalities often resulting in over- expressed proteins are becoming an increasingly important ancillary technique for these tumours. This review focuses on 3 specific areas: 1. Orbital mesenchymal tumours where cytogenetics are important to reach the correct diagnosis. The majority of these are chromosomal translocations that often result in a fusion gene and protein product; 2. Orbital mesenchymal tumours where cytogenetics are important to identify patients who will do well versus those with a poorer prognosis. This is turn helps with therapeutic options. In some tumours e.g. synovial sarcoma the chromosomal translocations can occur with 2 different regions resulting in different fusion products that carry a different prognosis. Alternatively whilst the majority of alveolar rhadomyosarcomas are fusion positive a minority are fusion negative with a better prognosis; 3. Orbital mesenchymal tumours where the identification of specific cytogenetic abnormalities has resulted in overexpression of specfic proteins which are diagnostically useful biomarkers for immunohistochemistry.
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Affiliation(s)
- F. Roberts
- Department of Pathology, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, United Kingdom
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Reith W, Mühl-Benninghaus R. Orbita. Radiologe 2017; 57:473-494. [DOI: 10.1007/s00117-017-0250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gündüz AK, Yeşiltaş YS, Shields CL. Orbital tumors: a systematic review: part II. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1050381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Scott EM, Teixeira LBC, Flanders DJ, Dubielzig RR, McLellan GJ. Canine orbital rhabdomyosarcoma: a report of 18 cases. Vet Ophthalmol 2015; 19:130-7. [PMID: 25846977 DOI: 10.1111/vop.12270] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe clinical and pathological features of canine orbital rhabdomyosarcoma (COR). METHODS Retrospective review of patients with COR from the archives of the Comparative Ocular Pathology Laboratory of Wisconsin and the University of Wisconsin Veterinary Medical Teaching Hospital (1983-2014). RESULTS Eighteen cases of COR were identified, all diagnosed in an 8-year period (2006-2014). Affected dogs were typically young (range 1-8; median 2 years), and both sexes were equally represented. Common clinical signs included exophthalmos (16/18) with dorsolateral deviation of the globe (10/18) and elevation of the nictitans (12/18). Ultrasonography, performed in nine cases, revealed an orbital mass with mixed echogenicity and posterior globe indentation. Advanced imaging, performed in nine cases, demonstrated a soft tissue mass with variable contrast enhancement and lysis of the orbital bones (5/9). Histologically, all tumors were subclassified as embryonal rhabdomyosarcoma. All neoplasms demonstrated positive immunohistochemical labeling for desmin, and 14/18 were positive for skeletal muscle actin. Follow-up information was available for 15/18 cases. Older dogs, aged 6-8 years, had no clinical signs of recurrence or metastasis 8-13 months postdiagnosis (4/4). Most younger dogs (9/11), aged 1-4 years, were euthanized within 6 months (median 2.5 months) of diagnosis due to recurrence at the surgical site (5/9) and/or metastasis (5/9). CONCLUSIONS Canine orbital rhabdomyosarcoma is a highly malignant neoplasm in juvenile dogs, but may be amenable to surgical resection in older dogs. This duality in biologic behavior may reflect differences in tissue of origin between juvenile onset tumors and adult onset tumors.
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Affiliation(s)
- Erin M Scott
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Leandro B C Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA
| | | | - Richard R Dubielzig
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Gillian J McLellan
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA
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Hassan WM, Alfaar AS, Bakry MS, Ezzat S. Orbital tumors in USA: difference in survival patterns. Cancer Epidemiol 2014; 38:515-22. [PMID: 25052531 DOI: 10.1016/j.canep.2014.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is a wide range of tumors affecting the orbital adnexa. Key such tumors include lymphomas, carcinomas, melanomas and rhabdomyosarcomas. Several studies have proposed that these histological subtypes differ in their survival outcomes. In this study we aim to describe the difference in survival outcomes between such subtypes. METHODS The SEER database was used to gather patient information. All 18 SEER registries were used. Patients diagnosed from 1996 to 2005 were included in the analysis. Observed five-year survival rate was calculated using the SEER*Stat software version 8.1.2. Data were extracted into IBM SPSS version 20 to generate Kaplan Meier curve for each group. RESULTS There were 2180 patients in the SEER databases who met the selection criteria. Lymphomas were the most common histology in adults. The overall five-year observed survival for all lymphoma patients was 75.9% (95% CI: 73.7-78.1). There was statistically significant difference between observed survival rates of lymphoma subtypes. Carcinomas were the second most common tumors. Their five-year observed survival rate in our study was 60.4%. There was no statistically significant difference between carcinoma subtypes' observed survival rates in the 20-49 age group, while, in the older age group, the difference was found to be statistically significant. Rhabdomyosarcomas were the most common tumors in children. The overall five-year observed survival rate for rhabdomyosarcomas patients was 89.8%. There was no statistically significant difference between observed survival rates of rhabdomyosarcomas subtypes. There was no statistically significant difference between relative survival rates according to gender and treatment received except within melanomas. CONCLUSION In adults, lymphomas have better survival rates than carcinomas. Whereas the lymphoma subtype can be used as a determinant prognostic factor in any age, the carcinoma subtype can be used as such a determinant in older age groups only. In children, rhabdomyosarcomas are the predominant tumors affecting the orbital adnexa. Further studies are needed to determine if the difference between embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma observed survival rates are statistically significant.
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Affiliation(s)
- Waleed M Hassan
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Ahmad S Alfaar
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; Cairo University School of Medicine, Cairo, Egypt; Ulm University, 89069 Ulm, Baden-Württemberg, Germany.
| | - Mohamed S Bakry
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
| | - Sameera Ezzat
- Department of Research, Children's Cancer Hospital Egypt 57357, Cairo, Egypt; National Liver Institute, Menoufiya University, Shebin Elkom, Egypt.
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