Reconstrucción palpebral luego de una resección total por cáncer / Palpebral reconstruction after total resection due to cancer

Introducción: La incidencia de los tumores malignos palpebrales varía según las diferentes razas. Su frecuencia aumenta con la edad y su aparición está relacionada con factores genéticos, virales y ambientales. Objetivo: Presentar un caso con una lesión tumoral en el párpado inferior al que se le realizó la reconstrucción palpebral luego de una resección parcial por cáncer con técnica combinada que incluyó Mustardé e injerto de mucosa. Presentación de caso: Paciente masculino de 76 años de edad con antecedentes de salud. Hace un año atrás comenzó a presentar una lesión endurada en el párpado inferior izquierdo hacia el canto interno del ojo, que fue aumentando de volumen, con una ulceración posterior. En el examen físico se observó una lesión ulcerada y sucia de aproximadamente 2 ( 2,5 cm, que comprometía los 2/3 mediales del parpado inferior, incluyendo la vía conducto lagrimal. Tras la intervención quirúrgica la extirpación creó un defecto correspondiente a la ausencia en todos los planos anatómicos en casi la totalidad del párpado inferior izquierdo, por lo que se planeó un colgajo de avance de la mejilla. El estudio histopatológico confirmó un carcinoma epidermoide completamente resecado. Conclusiones: Esta cirugía combinada permitió una exéresis amplia del tumor con el margen oncológico requerido y la sustitución aproximada de las estructuras del párpado. Se lograron una funcionabilidad adecuada y una cubierta del globo ocular óptima en su porción inferior, además de armónico con el contralateral(AU)

Introduction: The incidence of palpebral malignant tumors varies according to different races. Its frequency increases with age and its occurrence is related to genetic, viral and environmental factors. Objective: To present a case with a tumor lesion in the lower eyelid, who underwent palpebral reconstruction after a partial resection due to cancer with a combined technique including Mustardé and mucosal graft and its clinical evolution. Case presentation: 76-year-old male patient with a medical history. One year ago he began to present an indurated lesion on the left lower eyelid towards the inner canthus of the eye that was increasing in volume, with subsequent ulceration. Physical examination revealed an ulcerated and dirty lesion of approximately 2 ( 2.5 cm involving the medial 2/3 of the lower eyelid, including the lacrimal duct. After surgery the excision created a defect corresponding to the absence in all anatomic planes in almost the entire left lower eyelid, so a cheek advancement flap was planned. Histopathologic study confirmed a completely resected epidermoid carcinoma. Conclusions: This combined surgery allowed wide excision of the tumor with the required oncologic margin and approximate replacement of the eyelid structures. Adequate functionality and optimal eyeball cover was achieved in its lower portion, as well as harmonic with the contralateral one(AU)

Largest case series of Latin American eyelid tumors over 13-Years from a single center in Sao Paulo, Brazil / A maior série de casos de tumores de pálpebra na América Latina ao longo de 13 anos de um único centro em São Paulo, Brasil

ABSTRACT Purpose: Malignant lesions of the eyelid are the most common eye cancers. Although rarely lethal, late diagnosis can lead to serious visual morbidity. Definitive diagnosis of neoplastic lesions is pathological. Indications and types of eyelid lesions in a single high-volume ophthalmic reference center in Sao Paulo, Brazil, were analyzed. Methods: The surgical pathological reports of patients who underwent eye removal procedures between January 2000 and December 2012 were retrieved from the electronic database of the Ophthalmology Department and retrospectively reviewed. Data regarding the final anatomopathological diagnosis, sex, and age were analyzed via the χ2 test with Yates' correction. Results: Of the 1,113 eyelid tumors resected over the 13-year study period, 324 (29%) lesions were malignant. The most prevalent lesions were basal cell, squamous cell, and sebaceous gland carcinomas. The median ages of patients (females, n=165, 51%; males, n=159, 49%) with a diagnosis of basal cell, squamous cell, and sebaceous gland carcinomas were 65, 75, and 70 years, respectively. Conclusion: This is the largest retrospective cohort analysis of eyelid tumors in a Latin American population. These findings are in agreement with those from large centers in other countries and regions.

RESUMO Objetivo: As lesões malignas de pálpebras são os cânceres oftalmológicos mais frequentes. Embora raramente letal, o diagnóstico tardio pode levar a diversas complicações severas e a uma alta taxa de morbidade visual. O diagnóstico definitivo de lesões neoplásicas é patológico. No presente estudo, revisamos casos de um único centro de referência oftalmológica de maior volume em São Paulo, Brasil. Métodos: Avaliação retrospectiva de todos os tumores palpebrais operados entre os anos de 2000 e 2012 no Departamento de Oftalmologia. Dados incluindo diagnóstico anatomopatológico final, sexo e idade - foram analisados através do método χ2 YATES. Resultados: Dentre os 1.113 tumores palpebrais ressecados no período de estudo de 13 anos, 324 (29%) dos pacientes com lesões únicas eram malignas. A lesão mais prevalente foi Carcinoma Basocelular (CBC), seguido por carcinoma espinocelular (CEC) e carcinoma de células sebáceas (CCS). A média da idade dos pacientes com diagnóstico de CBC, CCS e CEC foi 65, 75 e 70 respectivamente distribuídos entre 165 (51%) mulheres e 159 (49%) homens. Conclusão: Essa é a maior análise de coorte retrospectivo de tumores palpebrais da América Latina. Nossos achados estão de acordo com outros grandes centros de outros países e continentes.

Comportamiento de los tumores malignos de los párpados en el Instituto Nacional de Oncología y Radiobiología / Behavior of malignant eyelid tumors treated at the National Institute of Oncology and Radiobiology

Objetivo: evaluar el comportamiento clínico-histopatológico de los tumores malignos palpebrales y las modalidades de tratamiento aplicadas en el Instituto Nacional de Oncología y Radiobiología. Métodos: se realizó un análisis retrospectivo de 255 pacientes tratados consecutivamente en el periodo de enero 1995 a julio 2010. Los casos fueron evaluados según localización del tumor, modalidad de tratamiento, recurrencias, recidivas, complicaciones y sobrevida. El estadiamiento se realizó según los criterios de la la Unión Internacional contra el Cáncer como T1N0M0, T2N0M0, T3N0M0, T4N0M0. Resultados: del total de pacientes, 54,1 por ciento fueron masculinos y 45,9 por ciento femeninos con rangos de edad entre 18 y 80 años. La localización más frecuente fue en el párpado inferior (35 por ciento), y el canto externo, la variedad histopatológica predominante fue el carcinoma basocelular (47,8 por ciento). El tratamiento de elección fue la cirugía, la que se realizó a 198 pacientes. El 50,2 por ciento de los casos tratados tuvieron persistencia tumoral con infiltración de los bordes de sección quirúrgicos, los cuales recibieron tratamiento radiante adyuvante. Se presentaron recurrencias en el 3,5 porciento entre 3 y 5 meses y recidivas en el 7,1 por ciento de los casos, a partir del primer año después de terminado el tratamiento inicial, las complicaciones más frecuentes encontradas fueron los pobres resultados cosméticos, disminución de la visión, úlceras corneales, entre otras. La sobrevida fue de 86,3 porciento. Conclusiones: se hace necesaria la introducción de modernos y conservadores tratamientos como alternativa a la cirugía que sean capaces de controlar el tumor y mejorar la calidad de vida de los pacientes con cáncer palpebral en casos específicos

Objective: to evaluate the clinical and histopathological behavior of malignant eyelid tumors and the treatment options followed at the National Institute of Oncology and Radiobiology. Methods: a retrospective analysis of 255 patients consecutively treated from January 1995 to July 2010 was carried out. The cases were evaluated according to location of tumor, treatment modality, recurrence, relapse, complications and survival rate. The staging of each case followed the criteria of the International Union against Cancer such T1N0M0, T2N0M0, T3N0M0, T4N0M0. Results: of the total number of patients, 54.1percent were males and 45.9percent females with age ranging 18 to 80 years. The most frequent location was the lower eyelid (35percent) and the outer border, the predominant histopathological type was basocellular carcinoma (47.8 percent). The treatment of choice was surgery which was performed in 198 patients. In the study group, 50.2 percent of the treated cases showed tumoral persistence with infiltration of surgical section borders, which received adjuvant radiant treatment. Recurrences occurred in 3.5 percent of cases after 3 to 5 months and relapses appeared in 7.1 percent of patients after the first year of the end of the initial treatment. The most common complications were poor esthetic results, reduced vision, corneal ulcers and others. Survival rate was 86.3 percent. Conclusions: it is necessary to implement modern and conservative treatments as alternative to surgery, which may be able to control tumor and to improve the quality of life of specific eyelid cancer cases

Frequência de ocorrência de carcinoma basocelular palpebral na região Centro-Oeste paulista e características dos portadores / Frequency of occurrence of eyelid basal cell carcinoma in the centralwest region of São Paulo State and carriers characteristics

OBJETIVO: Observar a frequência de ocorrência do carcinoma basocelular palpebral na região Centro-Oeste paulista e descrever o perfil demográfico dos portadores. MÉTODOS: Estudo transversal, de amostragem aleatória, realizado em doze cidades da região Centro-Oeste do Estado de São Paulo. Foram examinados 11.167 indivíduos. Os pacientes foram avaliados em uma Unidade Móvel, com atendimento oftalmológico completo. O diagnóstico de carcinoma basocelular palpebral foi feito através do exame clínico e biomicroscópico da lesão. Os pacientes diagnosticados foram encaminhados ao Ambulatório de Plástica Ocular da Faculdade de Medicina de Botucatu para tratamento. Os dados foram submetidos à análise de frequência de ocorrência. RESULTADOS: Cinco casos de carcinoma basocelular palpebral foram identificados na amostra, correspondendo a uma frequência de ocorrência de 0,045 por cento. Quatro pacientes eram do sexo feminino, a maioria com idade maior ou igual a 70 anos e todos os casos tinham a cor da pele branca. Apenas três indivíduos encaminhados compareceram ao serviço para exérese da lesão e confirmação diagnóstica. CONCLUSÃO: O carcinoma basocelular palpebral acomete 0,045 por cento dos habitantes da região Centro-Oeste paulista, afetando principalmente o sexo feminino, na faixa etária próxima dos 70 anos.

PURPOSE: To observe the frequency of occurrence of eyelid basal cell carcinoma in the centralwest region of São Paulo State and to describe the demographic profile of the basal cell carcinoma carriers. METHODS: Transversal study, using a random sampling, carried out in 12 cities in the centralwest region of São Paulo State evolving 11,167 individuals. Patients were evaluated in a Mobile Unit, with complete ophthalmologic evaluation. The diagnosis of eyelid basal cell carcinoma was done through clinical examination and biomicroscopy of the lesion if desirable. The basal cell carcinoma carriers diagnosed were referred to Oculoplastic Clinic of Faculdade de Medicina de Botucatu for treatment. Data were submitted to analysis of frequency of occurrence. RESULTS: Five cases of eyelid basal cell carcinoma were identified in the sample, corresponding to a frequency of occurrence of 0.045 percent. Four patients were female, most with age equal or greater than 70 year-old and all the cases had white skin color. Only three individuals conveyed attended the service for excision of the lesion and diagnostic confirmation. CONCLUSION: The eyelid basal cell carcinoma affects 0.045 percent of the inhabitants of the centralwest region of São Paulo State, affecting mainly the 70 year-old female range.

A clinicopathological study of eyelid malignancies from central India.

BACKGROUND: Eyelid malignancies are completely treatable if detected early. The treatment depends on the invasiveness of the cancer which in turn depends on the type of malignancy. AIM: The aim of the study was to characterize the distribution of the types of eyelid malignancies in central India. SETTINGS AND DESIGN: The study was conducted in the Department of Plastic and Maxillofacial Surgery at a tertiary care hospital. MATERIALS AND METHODS: We report a series of 27 cases of eyelid malignancies. In the same case series, we also include a case of malignant hemangiopericytoma which is an extremely rare form of eyelid malignancy worldwide. STATISTICAL ANALYSIS: Depending on the underlying statistical distribution, either analysis of variance (ANOVA) or the Kruskal-Wallis (K-W) test was used to assess the differential distribution of these variables across the types of eyelid malignancies observed in this study. RESULTS: We observed that sebaceous cell carcinoma (approximately 37%) was almost as prevalent as basal cell carcinoma (approximately 44%) in the study subjects and had an earlier age of occurrence and a more rapid clinical course. CONCLUSIONS: Sebaceous cell carcinoma of the eyelid is almost as common as basal cell carcinoma in a large tertiary care centre in central India.

Eyelid tumors in Siriraj Hospital from 2000-2004.

OBJECTIVES: To determine the relative incidence of eyelid lesions seen in Siriraj Hospital from January 2000-April 2004. STUDY DESIGN: Retrospective charts review MATERIAL AND METHOD: Two hundred and ninety-seven cases of eyelid lesions seen in Siriraj Hospital from 2000 to 2004 were analyzed. RESULTS: There were 53 (17.8%) inflammatory conditions, 212 (71.4%) benign eyelid tumors and 32 (10.8%) malignant eyelid tumors. These 32 malignant eyelid tumors included 13 sebaceous gland carcinomas, 12 basal cell carcinomas, 3 malignant melanomas, 2 squamous cell carcinomas, 1 apocrine adenocarcinoma and 1 metastatic carcinoma. Various flaps techniques or primary closures were used for reconstruction in 20 cases. Six cases needed exenteration. CONCLUSION: The majority of eyelid lesions were benign eyelid tumors while malignant eyelid tumors contributed 10.8% of the total eyelid lesions. Sebaceous gland carcinoma was the most common eyelid tumor found in their present study that was consistent with other studies from Asian countries.

Tumores malignos de pálpebra / Malignant eyelid tumors

Objetivo: Estudar a incidência de tumores malignos de pálpebra no Hospital Banco de Olhos de Porto Alegre. Métodos: Estudo retrospectivo dos casos de tumores malignos de pálpebras no período de 1985 a 1997, que tiveram disgnóstico confirmado por exame anátomo-patológico. Resultados: Foram encontradas 54 neoplasias malignas, sendo 75,92 por cento carcinoma basocelular, 12, 96 por cento carcinoma espinocelular, 7,40 por cento melanoma e 1,85 por cento lentigo maligna. A maioria dos pacientes apresentava mais de 40 anos e näo houve prevalência de sexo. Conclusöes: O tumor de pálpebra mais frequente em nosso meio foi o carcinoma basocelular, seguido do carcinoma espinocelular. O melanoma foi o terceiro em frequência mais encontrado em nossa pesquisa.

Características clínicas y correlación clínico-histopatológica de lesiones palpebrales / Clinical features and clinical-histopathological correlation of eyelid injuries

Se realizó un estudio retrospectivo de 704 casos de lesiones tumorales palpebrales diagnosticadas histopatológicamente entre 1980 y 2000 en el Laboratorio de Patología Ocular del Hospital José Joaquín Aguirre. Se analizaron las incidencias relativas y características clínicas de las lesiones palpebrales, como edad, sexo, tiempo de evolución previo a la cirugía y tamaño de la lesión, poniendo énfasis en la concordancia clínico-patológica, de modo de establecer los diagnósticos diferenciales más frecuentes en nuestro medio. Se observó que las lesiones afectaban a individuos de todas las edades, con un promedio de 53,4 años. La lesión palpebral más frecuentemente diagnosticada fue el carcinoma basocelular, el que representó el 25,3 por ciento del total y el 91,3 por ciento de las lesiones malignas; le siguen el papiloma (15,2 por ciento) y el nevus (14,1 por ciento).

A retrospective study of 704 cases of eyelid tumors, diagnosed histopathologically, was carried out for the 1980 - 2000 period in the Ophthalmic Pathology Laboratory of the Jose Joaquin Aguirre Hospital. The relative incidence and clinical features such as age, sex, evolvement previous to surgery, and size of the eyelid lesions were assessed. Diagnostic accuracy was also tabulated so as to establish the differential diagnosis of the more frequent lesions in our country. Lesions were found in almost every age, with an average of 53.4 years. The most common lesion of the eyelid was basal cell carcinoma, which represented 25,3 percent of the total and 91.3 percent of the malignant lesions, followed by papilloma (15.2 percent) and nevus (14.1 percent).

Tumours of eyelid: a clinicopathologic study.

A retrospective study of 207 cases of eyelid tumours and tumour like lesions, diagnosed histopathologically, was carried out for the period 1957 to 1991. There was a slight preponderance of males as the male/female ratio was 1.3:1. The age of the cases ranged from one to 80 years. Benign tumours were usually seen in the first two decades whereas the malignant tumours were common in the age group of 40 to 60 years. Malignancy was noticed in 85 cases (41.1%). Of these cases of malignant tumours, basal cell carcinoma was the commonest (38.8%) followed by sebaceous carcinoma (27.1%), squamous cell carcinoma (22.4%), basisquamous cell carcinoma (8.2%) and melanoma (3.5%). The ratio of basal cell carcinoma to squamous cell carcinoma was 1.74: 1. Of the 122 benign lesions common ones were vascular tumours (21.3%), neural tumours (18.0%), dermoid cysts (16.4%), squamous cell papilloma (13.1%) and naevi (12.3%).

Neoplasias malígnas das pálpebras na Faculdade de Medicina de Botucatu / Lid malign neoplasms in Botucatu Medical School

Estudou-se a ocorrência de neoplasias palpebrais malígnas na Faculdade de Medicina de Botucatu de 1978 a 1988. Neste período encontramos 89 tumores malígnos nas pálpebras, sendo 77,53//Ca basocelular, 12,36//Ca espinocelular, 7,86//Ca basoespinocelular e 2,25//Ca meibomiano. A maioria dos pacientes apresentava mais de 40 anos, trabalhava ao sol e 55,05//eram masculinos. O exame histopatológicos foi importante para esclarecimento diagóstico em vários casos

Clinical analysis of tumors of the eye and its adnexa

The authors reviewed 250 cases of tumors in the eye and its adnexa diagnosed histopathologirally at the Department of Ophthalmology, Seoul National University Hospital during the last 10 years (Jan. 1976 - Dec. 1985). The results were summarized as follows: 1. The sex distribution revealed 130 males (52%) and 120 females (48%). 2. The tumors of the eye and its adnexa involved the lid 73 cases (29.2%), epibulbar tissue 72 cases (28.8%), the orbit 56 cases (22.4%), and intraocula. tissue 49 cases (19.6%) in decreasing order. 3. There were 159 cases (63.6%) of benign tumors and 91 cases (36.4%) of malignant tumors. 4. The most frequent malignant tumor of the eye and its adnexa was retinoblastoma, and the most frequent benign tumor was nevus. 5. Of the intraocular malignant tumors, the incidence of retinoblastoma was impressively higher than that of malignant melanoma in Koreans. 6. Of the primary malignant lid tumors, the relative incidence of squamous cellcarcinoma and sebaceous gland carcinoma to basal cell carcinoma in Koreanswas high in comparison with that of Caucasians.

Tumores Palpebrales. Estudio de 64 casos / Eyelid Tumors

Se presenta un estudio de 64 tumores palpebrales, incluyendo su incidencia el sexo afectado, edad, localización, diagnóstico clínico y, en los casos donde se pudo realizar, un diagnóstico anatomopatológico. Se observó un mayor número de tumores benignos (53) que de malignos (11), el sexo femenino fue afectado con más frecuencia (45) y no hubo diferencia significativa en cuanto a la localización en párpados superior e inferior. En la mitad de los casos (32) se efectuó estudio histopatológico, confirmándose en 17 de ellos diagnóstico clínico correcto (12 benignos y 5 malignos). Los tumores con mayor incidencia fueron: nevos (15, granulomas piógenos (9), papilomas (8), carcinomas basocelulares (8), quistes dermoides (6), quistes sebáceos (3) y queratosis seborreica (3).

Estudio de 179 casos de tumores malignos de los parpados en el INOR / Study of 179 cases of malignant tumors of the eyelids treated at INOR

En este trabajo se presentaron 179 casos que se trataron en el INOR durante los años 1972 a 1980. El carcinoma basal fue el tumor maligno más frecuente. El sitio de mayor incidencia correspondió al parpado inferior. El tratamiento que se utilizó fue radioterapia y corugía. La supervivencia es mayor del 90

Tumores de párpados y conjuntiva: estudio estadístico del Servicio de Oftalmología del Hospital Arzobispo Loayza / Tumors of the lids and conjunctiva: statistical study of the Servicio de oftalmología del Hospital Arzobispo Loayza

Se estudiaron 56 pacientes con tumores de párpados y conjuntiva tanto lesiones malignas como benignas operados en el Servicio de Oftalmología del Hospital Arzbispo Loayza entre enero de 1982 hasta mayo de 1987. Todas estas neoplasias tuvieron diagnóstico anatomopatológico.la incidencia de tumores de párpados y conjuntiva, en pacientes atendidos quirúrgicamente es de 5.7 por ciento de los cuales el 25.6 por ciento tienen estudio histopatológico. La incidencia de Pterigion y Chalazion en pacientes atendidos quirúrgicamente es de 94 por ciento de los cuales el 65 por ciento son casos de Pterigion y el 35 por ciento son casos de Chalazion. En general el diagnóstico de los tumores de párpados y conjuntiva es tardío respecto a su tiempo de evolución, asistiendo solo el 45 por ciento a la primera consulta dentro del primer año. En este estudio se encontró que la localización de los tumores de párpados, se encuentra preferentemente en el párpado superior y a los tumores de conjuntiva, en la conjuntiva bulbar, sin diferencia estadísticamente significativa si el ojo es derecho o izquierdo, los síntomas y signos más frecuentemente encontrados en tumores de párpados y conjuntiva son: congestión ocular, lagrimero y arder. Sin embargo un 57 por ciento, entre la segunda y tercera década de vida.para los tumores malignos se encuentra un pico de incidencia de 67 por ciento en mayor de 51 años. Lla incidencia tumoral es mayor en el sexo femenino con un 86 por ciento debido principalmente al tipo de atención preferencial que se tiene en el hospital. En las lesiones tumorales que tiene en el hospital. En las lesiones tumorales que tienen estudio histopatológico se encontró un acierto en la presunción diagnóstica del 54 por ciento