Lacrimal sac lymphoma: a case series and literature review.

AIM: To study the clinical and pathological characteristics of the lacrimal sac lymphoma, which is rare but it is the major type of non-epithelial malignant tumor in the lacrimal sac region. METHODS: Sixty-four cases of malignant lacrimal sac tumors in our hospital from 1986 to 2020 were retrospectively reviewed. Eight cases of lacrimal sac lymphoma were carefully reviewed. RESULTS: There were five mucosal-associated lymphoid tissue (MALT) lymphomas, one diffused large B-cell lymphoma, one NK/T cell lymphoma, and one mantle cell lymphoma. All eight patients represented symptoms of epiphora with swelling in the lacrimal sac for a certain period of time and showed no signs of systemic involvement at the first time of clinical visits. They had received either chemotherapy or radiotherapy after surgery. Long-term follow-up (from 11 to 220mo) showed that, except one patient with MALT lymphoma died for unknown reasons at 104mo after surgery, the other 7 patients were all alive with no signs of local recurrence, neither in other organs. CONCLUSION: Non-epithelial malignant tumors of the lacrimal sac are rare and lymphoma is the major subtype.

Clinical and laboratory features of PCR-confirmed periocular tuberculosis in China.

Experts lack knowledge of periocular tuberculosis (TB) in China. Nested polymerase chain reaction (PCR) shows advantages in diagnosis of extrapulmonary TB. Our study aims to explore the clinical and laboratory features of PCR-confirmed periocular TB. We retrospectively reviewed medical records of presumptive periocular TB and performed nested PCR test to confirm diagnosis. Nine cases were recruited. Clinical symptoms were chronic and insidious. Eight cases achieved favorable visual acuity, while one underwent enucleation due to fungal-TB panophthalmitis. Sensitivity of caseous necrosis, acid-fast bacilli (AFB) staining and interferon γ release assay (T-SPOT) test are 33.3%, 44.4% and 85.7% respectively. Low lymphocyte percentage (P=0.019) and high monocyte-lymphocyte ratio (P=0.042) positively correlate with AFB staining. Male gender (P=0.048) and Langhans giant cell (P=0.048) positively correlate with caseous necrosis. To conclude, traditional TB ancillary tests are not as sensitive as nested PCR technique. Several factors facilitate diagnosis including male gender, decreased lymphocytes, and typical Langhans giant cells.

Evaluation of the Goldmann-Witmer coefficient in the immunological diagnosis of ocular toxocariasis.

Ocular toxocariasis (OT) is a zoonotic parasitic infection mainly caused by the intraocular tissue invasion of second-stage Toxocara canis or Toxocara cati larva. Measuring specific anti-T. canis antibodies in the intraocular fluid (IF) can increase OT diagnosis accuracy using Goldmann-Witmer coefficient (GWC). However, there is no systemic evaluation of GWC application in the immunological diagnosis of OT. To assess GWC for the immunodiagnosis of ocular toxocariasis, paired IF and serum samples from 72 patients diagnosed with OT were retrospectively analyzed for specific anti-T. canis IgG by enzyme linked immunosorbent assay (ELISA). GWC values were calculated to determine intraocular specific IgG production. Clinical features and other laboratory data were recorded, and their correlations with GWC evaluated. Of the 72 OT patients, 60 (83.33%) showed intraocular specific IgG production confirmed by GWC, while intraocular nonspecific IgE production was found in 64/69 (92.75%) cases. No significant correlation was found among clinical features and IF specific IgG production. Values for peripheral blood samples were lower than those of intraocular fluid regarding OT screening, and vitreous humor samples showed increased local specific IgG and nonspecific IgE production compared with aqueous humor samples. Overall, our results indicate that GWC and intraocular IgE production have referential values in diagnosing ocular toxocariasis.

[Clinicopathologic features of retinoblastoma and expression of VEGF and Ki-67 after comprehensive treatment].

OBJECTIVE: To investigate the clinic pathologic features of retinoblastoma (RB) after comprehensive treatment, and study the expression of vascular endothelial growth factor (VEGF) in retinoblastoma treated with chemotherapy prior to enucleation. METHODS: Retrospective analysis was performed on retinoblastoma specimens obtained consecutively between 2006 and 2008 by enucleation, and patients' clinical information and clinic pathologic features were also collected. Immunohistochemical staining and real-time PCR were performed for the expression of VEGF. Immunohistochemical staining was also performed for Ki-67. RESULT: Among the 9 chemotherapy-treated cases, six belonged to group D and three to group E of IIRC. The reasons for enucleation included extensive vitreous seeds, RB recurrence, extensive subretinal fluid/seeds, vitreous hemorrhage and total tractional detachment of the retina. During the comprehensive treatment, the main tumors regressed in all eyes. The main tumors showed a mean decrease of 43.7% in the largest basal diameter and a mean decrease of 57.9% in thickness. The average interval between the end of chemotherapy and enucleation was 5.7 months. The reason for enucleation was the recurrence of main tumor, recurrence of new tumors, recurrent vitreous seed or subretinal seed. Three eyes showed a type 1 regression pattern, one eye showed a type 2 pattern, and the other five eyes showed type 3 clinical regression patterns. The expression of VEGF was lower in eyes that underwent planned enucleation than eyes that suffered from RB recurrence. CONCLUSIONS: The main reason for enucleation was extensive subretinal fluid/seeds after the comprehensive treatment. The type 3 clinical regression patterns were most common. In retinoblastoma, higher expression of VEGF may play an important role in the recurrence of retinoblastoma after comprehensive treatment.

[Clinical therapeutic efficiency of chemoreduction and local therapy for children with retinoblastoma].

OBJECTIVE: To evaluate the therapeutic efficiency of customized combined therapy for retinoblastoma. METHODS: Retrospective case series. Twenty nine patients (40 eyes) with retinoblastoma were accepted customized combined therapy between Jan. 2005 and Dec. 2007 in our hospital. The combined therapy included chemoreduction using vincristine, etoposide, and carboplatin (VEC) combined with local cryotherapy and/or transpupillary thermotherapy (TTT). The average follow-up duration was 38 months and ranging from 12 to 50 months. RESULTS: Twenty five patients had bilateral retinoblastoma, 4 patients had unilateral retinoblastoma. The stages of 40 eyes were classified according to the International Intraocular Retinoblastoma Classification, 14 eyes (35%) were group A, 9 eyes (22.5%) were group B, 4 eyes (10%) were group C, 10 eyes (25%) were group D, and 3 eyes (7.5%) were group E. Seventeen eyes had vitreous and/or subretinal seeds. The overall globe preservation rate was 75% (30/40); and was 100% (14/14) in group A, 100% (9/9) in group B, 75% (3/4) in group C, 40% (4/10) in group D and 0% (0/3) in group E. A progressive decrease of globe preservation rate was observed in eyes with advanced stages. Tumor recurrence was detected in 4 eyes after chemoreduction, leading to the enucleation. Ten eyes were enucleated in the present series, with 1 eye in group C, 6 eyes in group D and 3 eyes in group E. None of 29 patients died during the follow-up. No patients had any serious side effect of chemotherapy such as leukemia. CONCLUSIONS: The customized combined therapy can effectively preserve certain patients' eyeballs and even obtain useful visual function. The International Intraocular Retinoblastoma Classification is useful in the clinical management of retinoblastoma.

[Orbital solitary fibrous tumor: a clinicopathologic analysis].

OBJECTIVE: To study clinicopathologic features, histologic characteristics, differential diagnosis and the treatment of orbital solitary fibrous tumor (SFT). METHODS: Clinical, radiographic and pathologic findings of 6 cases of SFT were retrospectively analyzed. Immunohistochemistry were performed on selected samples. RESULTS: Four patients were males and 2 were females. Patients age ranged from 19- to 57-years-old. The location of the tumor was in the muscle cone (case 1 and case 5), medial (case 3), lateral (case 4), superior (case 2) and inferolateral (case 6) portion of the orbit, respectively. The presenting symptom was proptosis in 3 cases and was mass of subconjunctival or orbit margin in other 3 cases. Image examination: SFT appeared as a round (case 6 showed irregular) and well-circumscribed parenchymatous mass that could be homogenously enhanced by contrast. Histologically, SFT displayed as a mass of spindle cells in an irregular arrangement Sometime, tumor cells could be storiform or sarciniform. Mitotic figures were infrequent and usually there were 0 to 3 mitotic figures per 10 high-power fields. Hyalinization and staghornform blood vessels were frequently observed. SFT was immunoreactive for markers such as Vim, CD34 and CD99. Two cases were recurred. CONCLUSIONS: SFT is a rare orbital tumor and could be confused with other types of orbital tumors. This tumor can be diagnosed by pathological and immunocytochemical studies, these characteristics can be used to differentiate it from other types of orbital tumors.

[Clinical and pathological analysis of primary lacrimal sac tumors].

OBJECTIVE: To investigate the clinical features and pathological classification of primary lacrimal sac tumors. METHODS: A retrospective study of 96 cases of primary lacrimal sac tumors in past 50 years from EENT Hospital (Jan. 1956 to Dec. 2005) was performed to investigate the clinical features, radiological manifestation, histopathological classification and treatment. RESULTS: Primary lacrimal sac tumors were more common in men than in women (1.8:1.0) and the median age at presentation was 46 years (ranged 11 - 80 years). The most common sign and symptom were epiphora and lacrimal sac mass, respectively. Among these primary lacrimal sac tumors, 94.8% were malignant tumors (91/95). All epithelial lacrimal sac tumors (83 cases, 86.5%) were malignant and squamous cell carcinoma was the most common tumor (64 cases, 66.7%), followed by undifferentiated carcinoma (10 cases, 10.4%), mucoepidermoid carcinoma (4 cases, 4.2%), adenocarcinoma (4 cases, 4.2%) and transitional cell carcinoma (1 case, 1.0%). The nonepithelial tumors consisted of mucosa-associated lymphoid tissue (MALT) lymphoma (5 cases, 5.2%), melanoma (3 cases, 3.1%), neurilemoma (2 cases, 2.1%), hemangiopericytoma (2 cases, 2.1%) and cavernous hemangioma (1 case, 1.0%). CONCLUSIONS: Primary lacrimal sac tumors are extremely rare, but most of them are malignant tumors and are often misdiagnosed as dacryocystitis and lacrimal sac obstruction. Therefore, ophthalmologists should pay more attention to the diagnosis of lacrimal sac tumors.

[Clinical and pathological analysis of 151 cases of tumors in lacrimal fossa].

OBJECTIVE: To investigate the clinical features and pathological classification of tumors in lacrimal fossa. METHODS: A retrospective study of 151 cases of tumors in lacrimal fossa in recent 8 years from EENT hospital was performed to investigated the clinical features, histopathological classification and prognoses. RESULTS: In 69 cases of benign lacrimal epithelial tumors, pleomorphic adenoma was the most common tumor (63 cases, 41.7%), followed by myoepithelioma (3 cases, 1.2%), lacrimal duct cyst (2 cases, 1.3%). In 34 cases of malignant lacrimal epithelial tumors, adenoid cystic carcinoma was the most common tumor (15 cases, 9.9%), followed by pleomorphic adenocarcinoma (14 cases, 9.3%), adenocarcinoma (4 cases, 2.6%). There were 48 cases of lacrimal non-epithelial lesions. Mucosa-associated lymphoid tissue (MALT) lymphoma was the most common tumor (17 cases, 11.3%), followed by pseudotumor (12 cases, 7.9%), benign lymphoepithelial lesion (7 cases, 4.0%). CONCLUSIONS: There are a variety of tumors in lacrimal fossa. The treatment of pleomorphic adenoma and the diagnosis of MALT lymphoma are the most difficult tasks in present clinical work.