ABSTRACT
PURPOSE: Orbital invasion of pituitary tumors is rare and usually accompanied by optic nerve head pallor and visual loss. We describe a case of unilateral massive orbital invasion by a recurrent pituitary tumor with preserved visual acuity and normal optic nerve appearance. METHODS: Case report. RESULTS: Progressive proptosis developed 15 years after transphenoidal removal of a pituitary tumor. Based on the radiological appearance and the clinical history, the patient was suspected to have a sphenoid wing meningioma secondary to previous radiation treatment. A combined neurosurgical and orbital approach was used to remove the intraorbital mass, which extended from the cranial cavity through the superior orbital fissure and the optic canal. Histopathologic examination demonstrated a recurrent nonsecreting pituitary adenoma. CONCLUSIONS: Orbital extension of a recurrent pituitary adenoma should be considered in the differential diagnosis of progressive proptosis even in the absence of significant optic neuropathy.
Subject(s)
Adenoma/pathology , Orbital Neoplasms/diagnosis , Pituitary Neoplasms/pathology , Adenoma/surgery , Diagnosis, Differential , Exophthalmos/diagnosis , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Orbital Neoplasms/surgery , Pituitary Neoplasms/surgeryABSTRACT
OBJECTIVE: The authors describe the clinical findings and surgical treatment of two patients affected by chronic eyelid lymphedema associated with facial acne rosacea. DESIGN: Two interventional case reports. METHODS AND INTERVENTION: The clinical diagnosis of acne rosacea was based on the physical examination and confirmed by the histopathologic findings obtained from biopsy of the involved tissue. Surgical treatment was required to address the disfiguring chronic eyelid lymphedema and to correct the resultant mechanical lower eyelid ectropion in both patients. RESULTS: Surgical debulking of the affected soft tissue resulted in very satisfactory cosmetic and functional improvement in both patients. CONCLUSIONS: To our knowledge, this is the first series of cases of chronic eyelid lymphedema secondary to acne rosacea reported in the ophthalmic literature. Six similar cases have been described previously in the dermatologic literature; all of which had been treated medically without satisfactory results. Surgical debulking of the involved eyelids should be considered in patients affected by persistent symptomatic rosacea lymphedema.
Subject(s)
Eyelid Diseases/etiology , Lymphedema/etiology , Rosacea/complications , Aged , Chronic Disease , Eyelid Diseases/pathology , Eyelid Diseases/surgery , Female , Humans , Lymphedema/pathology , Lymphedema/surgery , Middle AgedABSTRACT
PURPOSE: To describe the clinical features and management of a patient with an extralacrimal dacryolith. METHODS: Case report. RESULTS: A 43-year-old woman remarked at a routine eye examination that a small, firm mass located for several years on the right side of her nose had recently become slightly larger. The mass had remained firm and nontender during this enlargement. She explicitly denied having any past or current lacrimal outflow problems. Surgical excision disclosed a mass external to the lacrimal sac and duct, adherent to its lateral wall. The histopathologic features were consistent with a dacryolith surrounded by a chronic inflammatory reaction and no epithelial lining. CONCLUSION: We presume that the dacryolith must have formed within the lacrimal sac and then migrated laterally into the surrounding soft tissue.
