Apocrine adenocarcinoma of the eyelid: case series and review.

PURPOSE: To report 2 patients with apocrine adenocarcinoma of the eyelid and review the literature. DESIGN: Noncomparative, retrospective case series and review. PARTICIPANTS: Clinical data of 2 patients with histopathologic diagnoses of apocrine adenocarcinoma of the eyelid were obtained from medical records. The histopathology and immunohistochemistry data for the 2 cases were studied. A retrospective review was performed on all reported cases of eyelid apocrine carcinoma. MAIN OUTCOME MEASURES: Clinical features, histopathology, immunohistochemistry, and clinical course following treatment are reported. The results of a retrospective review of clinical presentations, local and systemic spread, treatment method, and prognosis from published case reports on eyelid apocrine adenocarcinoma are discussed. RESULTS: One patient had orbital invasion at presentation. This patient had radiotherapy alone and had no systemic or local recurrence at 2 years. One patient underwent a 4-mm margin wide surgical excision. This patient had no local or systemic recurrences at 1 year. A review of the literature suggests that the prognosis of adnexal apocrine tumors is indeterminate and variable. Most patients have successful outcomes following local surgical excision. Radiotherapy has been used as an adjunctive treatment for local metastatic disease. CONCLUSIONS: Apocrine adenocarcinoma is a rare adnexal tumor of the eyelid, which may present with orbital invasion.

Orbital metastasis: clinical features, management and outcome.

PURPOSE: To review the clinical features, treatment, outcome and survival of metastatic tumors of the orbit. MATERIALS AND METHODS: Retrospective, non-comparative, chart review of 80 patients with orbital metastasis treated in four tertiary orbital centres in Australia. RESULTS: The study included 80 patients of which, 44 were male with a mean age of 60 years. Orbital involvement commonly presented late in a multisystemic disease; however, the orbit was the first presentation in 15% of the cases. Diplopia (48%), pain (42%), and visual loss (30%) were the commonest symptoms at presentation; whereas proptosis (63%), strabismus (62%), and visual loss (41%) were the most frequent clinical signs. Computed tomography commonly showed a solid enhancing mass (42 cases) located within the orbital fat (43%), or enlarging an extraocular muscle (28%). Breast carcinoma (29%), melanoma (20%), and prostatic cancer (13%) were the most frequent histological types. Treatment was often multi-disciplinary and modalities included radiotherapy, chemotherapy, hormone therapy, surgery, and immunotherapy. Survival was limited to 1.5 years after diagnosis independent of the histological type, with 29% of patients alive after 17 months follow-up. CONCLUSIONS: A high index of suspicion and appropriate intervention with histological diagnosis can help in the management and quality of life in patients with metastatic orbital disease. Overall survival is limited and we encountered statistical limitations proving differences in the survival based on the sub-type of primary tumour involved. Metastatic orbital melanoma presented a higher incidence when compared with previous studies, probably due to the increase frequency of skin found in the Australian population.

Abnormal cytogenetics in orbital lipoma.

Orbital lipoma is a rare entity with only a small number of cases previously described. The authors describe a case of orbital lipoma in a 56-year-old man, which was treated with surgical excision. Cytogenetic analysis of the lesion demonstrated abnormalities of chromosome 12, consistent with chromosomal abnormalities in lipomas found elsewhere in the body. Therefore, cytogenetic analysis may be useful to differentiate lipomatous tumors from normal orbital fat.

Eyelid contracture may indicate recurrent basal cell carcinoma, even after Mohs' micrographic surgery.

Mohs' micrographic surgery (MMS) is an effective means of margin control in the management of periocular basal cell carcinomas (BCC). We describe three cases of recurrent BCC that presented with progressive eyelid contracture after MMS. They illustrate high-risk factors for recurrence, namely large tumor size, medial canthal location, previous treatment, and aggressive histological features. Careful long-term surveillance with serial photography may identify early eyelid contracture and thus assist in the detection of recurrent BCC after MMS and improve patient outcome.

Recurrent orbital cholesterol granuloma.

Cholesterol granuloma is an uncommon entity, occurring typically in the supero-temporal orbit. Recurrence has only rarely been reported. We describe a case of recurrent cholesterol granuloma in a 48-year-old-man to illustrate the clinical features of the condition, and to highlight the importance of complete resection to prevent recurrence.

The silent sinus syndrome: a case with normal predisease imaging.

The silent sinus syndrome is a cause of spontaneous enophthalmos associated with unilateral chronic maxillary atelectasis. It remains an under-recognised condition in both the ophthalmological and otolaryngological community. We present a case of a 46-year-old lady with a six-month history of enophthalmos to illustrate the clinical features and radiological findings of this condition. Four years prior to presentation, she had normal maxillary sinuses on magnetic resonance imaging.