Intravascular papillary endothelial hyperplasia (Masson's tumor) of the conjunctiva. Unusual location of a rare vascular tumor.

Intravascular papillary endothelial hyperplasia (IPEH) is characterized by proliferation of endothelial cells usually occurring within a long-standing vascular malformation or tumor. IPEH usually affects neck, head and lower extremities, and few orbital and eyelid cases have been reported. We present a unique case, a 48-years-old man with a purple, elevated, multilobular conjunctival lesion of three-weeks duration that underwent an excisional biopsy. Pathological features revealed intravascular papillary endothelial hyperplasia (Masson's tumor).

Rapidly progressive orbital intravascular papillary endothelial hyperplasia in a newborn.

Intravascular papillary endothelial hyperplasia (IPEH), also known as "vegetant intravascular haemangioendothelioma", is a rare benign proliferation of vascular endothelial cells secondary to intravascular thrombosis and thrombus organisation. It can develop from vascular lesions such as haemangiomas, pyogenic granulomas or varicose veins. This vascular tumour of the skin and subcutaneous tissue may exhibit rapid and progressive growth, and is usually located in the neck or head. Ocular presentation is unusual and orbital involvement is even rarer. We report a case of a preterm newborn male with a rapidly growing left orbital mass that was histologically diagnosed as intravascular papillary endothelial hyperplasia. He was successfully managed with total excision of the tumour and propranolol therapy and remains recurrence free after an eight-year follow-up.

Hiperplasia endotelial papilar intravascular (tumor de Masson) de la conjuntiva. Ubicación inusual de un tumor vascular endotelial raro / Intravascular papillary endothelial hyperplasia (Masson's tumor) of the conjunctiva. Unusual location of a rare vascular tumor

La hiperplasia endotelial papilar intravascular (IPEH) se caracteriza por la proliferación de células endoteliales generalmente producida dentro de una malformación vascular previa o un tumor. La IPEH suele afectar cuello, cabeza y extremidades inferiores, se han publicado pocos casos en la órbita ocular y párpados. Presentamos un caso único, un hombre de 48 años con una lesión conjuntival púrpura, elevada y multilobular de tres semanas de duración que se sometió a una biopsia excisional. Las características patológicas revelaron una hiperplasia endotelial papilar intravascular (tumor de Masson) (AU)

Intravascular papillary endothelial hyperplasia (IPEH) is characterized by proliferation of endothelial cells usually occurring within a long-standing vascular malformation or tumor. IPEH usually affects neck, head and lower extremities, and few orbital and eyelid cases have been reported. We present a unique case, a 48-year-old man with a purple, elevated, multilobular conjunctival lesion of three-weeks duration that underwent an excisional biopsy. Pathological features revealed intravascular papillary endothelial hyperplasia (Masson's tumor) (AU)

Hiperplasia endotelial papilar intravascular orbitaria rápidamente progresiva en un recién nacido / Rapidly progressive orbital intravascular papillary endothelial hyperplasia in a newborn

La hiperplasia endotelial papilar intravascular (IPEH), también conocida como «hemangioendotelioma vegetante intravascular», es una proliferación benigna y rara de células endoteliales vasculares, secundaria a trombosis intravascular u organización del trombo. Puede desarrollarse a partir de lesiones vasculares como hemangiomas, granulomas piógenos o várices. Este tumor vascular de la piel y del tejido subcutáneo puede presentarse como crecimiento rápido y progresivo, y es usualmente localizado en cuello o cabeza. La presentación ocular es inusual y la afectación orbitaria es todavía más rara. Presentamos un caso de un varón recién nacido pretérmino, el cual presentó una masa orbitaria izquierda de crecimiento rápidamente progresivo y se obtuvo el diagnóstico por histología de hiperplasia endotelial papilar intravascular. El paciente fue exitosamente tratado mediante una escisión total del tumor y terapia con propranolol. Actualmente, después de un seguimiento de ocho años, ha permanecido sin recurrencias (AU)

Intravascular papillary endothelial hyperplasia (IPEH), also known as “vegetant intravascular haemangioendothelioma”, is a rare benign proliferation of vascular endothelial cells secondary to intravascular thrombosis and thrombus organisation. It can develop from vascular lesions such as haemangiomas, pyogenic granulomas or varicose veins. This vascular tumour of the skin and subcutaneous tissue may exhibit rapid and progressive growth, and is usually located in the neck or head. Ocular presentation is unusual and orbital involvement is even rarer. We report a case of a preterm newborn male with a rapidly growing left orbital mass that was histologically diagnosed as intravascular papillary endothelial hyperplasia. He was successfully managed with total excision of the tumour and propranolol therapy and remains recurrence free after an eight-year follow-up (AU)

Metástasis a iris como primera manifestación de adenocarcinoma pulmonar / Iris metastasis as a first manifestation of lung adenocarcinoma

OBJETIVO: Describir un caso de adenocarcinoma pulmonar que comenzó clínicamente como una metástasis en iris. CASO CLÍNICO: Paciente varón de 76 años de edad que acude a consulta por notar una pequeña «mancha rosada» en su ojo derecho. A la exploración con biomicroscopía se encontró una masa en el iris. La evaluación sistémica subsiguiente del paciente mostró un adenocarcinoma del pulmón izquierdo. DISCUSIÓN: A pesar de la infrecuencia de las metástasis de iris secundarias a cáncer pulmonar, debe de tomarse en cuenta en el diagnóstico diferencial de masas tumorales iridianas

OBJECTIVE: To describe a case of lung adenocarcinoma for which the first clinical manifestation was an iris metastasis. CASE REPORT: A 76-year-old male patient came for consultation referring a «pinkish speck» on his right eye. On biomicroscopy examination, a mass was found on the iris of the right eye. Subsequent systemic work-up of the patient revealed a left lung adenocarcinoma. DISCUSSION: Although uncommon, iris metastasis secondary to lung cancer should be part of differential diagnosis in iris tumours

Iris metastasis as a first manifestation of lung adenocarcinoma. / Metástasis a iris como primera manifestación de adenocarcinoma pulmonar.

OBJECTIVE: To describe a case of lung adenocarcinoma for which the first clinical manifestation was an iris metastasis. CASE REPORT: A 76-year-old male patient came for consultation referring a «pinkish speck¼ on his right eye. On biomicroscopy examination, a mass was found on the iris of the right eye. Subsequent systemic work-up of the patient revealed a left lung adenocarcinoma. DISCUSSION: Although uncommon, iris metastasis secondary to lung cancer should be part of differential diagnosis in iris tumours.

Características ultrasonográficas, histopatológicas y genéticas del melanoma uveal en población mexicana mestiza / Ultrasound, histopathological, and genetic features of uveal melanoma in a Mexican-Mestizo population

OBJETIVO: Describir las características ultrasonográficas, histopatológicas y genéticas del melanoma uveal en población mexicana mestiza. MATERIAL Y MÉTODOS: Se estudiaron un total de 39 ojos enucleados con diagnóstico histopatológico de melanoma uveal, valorando los hallazgos clínicos, ultrasonográficos, histopatológicos y genéticos. RESULTADOS: Se observó una correlación alta de la altura tumoral por ultrasonografía y anatomía patológica. En nuestros casos, el tamaño tumoral y la reflectividad fueron mayores a lo reportado en la literatura. Los datos preliminares de la evaluación molecular de los tumores indican la presencia de un polimorfismo no reportado (T>C IVS5 + 34) y una muestra con mutación del gen GNAQ (A>C CAA>CCA Gln 209 Pro). CONCLUSIÓN: La ultrasonografía es un método confiable que nos permite determinar las dimensiones del tumor. La determinación del estado mutacional en nuestra población tiene trascendencia para el desarrollo de nuevos agentes terapéuticos dirigidos a pacientes con melanoma uveal metastásico o con fines preventivos para aquellos con factores de riesgo

OBJECTIVE: To describe the ultrasound, histopathological and genetic characteristics of uveal melanoma in a Mexican-Mestizo population. MATERIAL AND METHODS: A total of 39 enucleated eyes with a histopathological diagnosis of uveal melanoma were assessed by describing the clinical findings, and ultrasound, histopathological and genetic features. RESULTS: A high correlation was observed between tumour height measurement using ultrasound and histopathology. In our cases, tumour size and reflectivity were higher compared with those reported in the literature. The preliminary data on the molecular assessment of the tumours show the presence of an unreported polymorphism (T>C IVS5 + 34) and one sample with GNAQ mutation (A>C CAA>CCA Gln 209 Pro). CONCLUSION: Ultrasound is a reliable method to identify the size of the tumour. Furthermore, knowledge of the molecular mechanisms promises new perspectives for the development of new targeted therapeutics. Fortunately this leads to progress in the treatment of patients with metastatic disease or prevents it in those at high risk

Ultrasound, histopathological, and genetic features of uveal melanoma in a Mexican-Mestizo population. / Características ultrasonográficas, histopatológicas y genéticas del melanoma uveal en población mexicana mestiza☆.

OBJECTIVE: To describe the ultrasound, histopathological and genetic characteristics of uveal melanoma in a Mexican-Mestizo population. MATERIAL AND METHODS: A total of 39 enucleated eyes with a histopathological diagnosis of uveal melanoma were assessed by describing the clinical findings, and ultrasound, histopathological and genetic features. RESULTS: A high correlation was observed between tumour height measurement using ultrasound and histopathology. In our cases, tumour size and reflectivity were higher compared with those reported in the literature. The preliminary data on the molecular assessment of the tumours show the presence of an unreported polymorphism (T>C IVS5+34) and one sample with GNAQ mutation (A>C CAA>CCA Gln 209 Pro). CONCLUSION: Ultrasound is a reliable method to identify the size of the tumour. Furthermore, knowledge of the molecular mechanisms promises new perspectives for the development of new targeted therapeutics. Fortunately this leads to progress in the treatment of patients with metastatic disease or prevents it in those at high risk.

Granulomatosis con poliangeítis localizado en la glándula lagrimal, a propósito de un caso / Granulomatosis with polyangiitis confined to lacrimal gland, a case report

Caso clínico: Mujer de 43 años, consulta por aumento de volumen orbitario superolateral izquierdo, doloroso, eritematoso de 2 meses de evolución. Se realiza biopsia escisional revelando vasculitis con poliangeítis de glándula lagrimal. El estudio sistémico no reveló compromiso de otros órganos. Discusión: El compromiso orbitario ocurre hasta en el 60% de los pacientes con granulomatosis con poliangeítis. La afección de la glándula lagrimal es rara, y frecuentemente unilateral. Las pruebas serológicas generalmente son negativas, tanto en etapas iniciales, como en las formas localizadas de la enfermedad (AU)

Clinical case: A 43 year-old woman consulted due to 2 months of swelling on the superolateral side of the left orbit, with pain and erythema. An excisional biopsy was performed that revealed vasculitis with polyangiitis of the lacrimal gland. A systemic study showed that no other system was compromised. Discussion: Orbital involvement occurs in up to 60% of patients with granulomatosis with polyangiitis. The involvement of the lacrimal gland is rare and often unilateral. Serological tests are generally negative, both in initial stages, as in localized forms of the disease (AU)

Granulomatosis with polyangiitis confined to lacrimal gland, a case report. / Granulomatosis con poliangeítis localizado en la glándula lagrimal, a propósito de un caso.

CLINICAL CASE: A 43 year-old woman consulted due to 2 months of swelling on the superolateral side of the left orbit, with pain and erythema. An excisional biopsy was performed that revealed vasculitis with polyangiitis of the lacrimal gland. A systemic study showed that no other system was compromised. DISCUSSION: Orbital involvement occurs in up to 60% of patients with granulomatosis with polyangiitis. The involvement of the lacrimal gland is rare and often unilateral. Serological tests are generally negative, both in initial stages, as in localized forms of the disease.

Toxicidad de memantina intravítrea en retina de conejos / Intravitreal memantine retinal toxicity in rabbits

OBJETIVO: Valorar histopatológicamente si existe toxicidad en la retina de conejos, posterior a la aplicación intravítrea de memantina. MÉTODOS: Se utilizaron 16 ojos de 16 conejos raza Nueva Zelanda de 3 kg, divididos en 4 grupos de 4 conejos cada uno. Al grupo A se le aplicó una dosis de 70 ng/ml de memantina intravítrea, al grupo B se le aplicó una dosis de 150 ng/ml de memantina intravítrea, al grupo C se le aplicó una dosis de 400 ng/ml de memantina intravítrea, y al grupo D se le aplicó 1 ml de solución salina balanceada. Se enucleó el ojo inyectado en la mitad de cada grupo a los 15 días, y el resto del grupo se enucleó a los 30 días posterior a la inyección. Posterior a la enucleación, cada ojo fue colocado en formaldehido al 10%. Se realizó análisis histopatológico a cada uno de los ojos enucleados. Los animales fueron tratados de acuerdo a los estatutos de la Association for Research on Vision and Ophthalmology (ARVO). RESULTADOS: Los grupos A, B y D no presentaron alteraciones histopatológicas tras 15 y 30 días de enucleación. El grupo C presentó alteración a nivel de la capa de fotorreceptores a los 15 y 30 días posterior a la enucleación. CONCLUSIONES: La memantina intravítrea a dosis de 70 mg/dl y 150 mg/dl no es tóxica a nivel estructural en la retina. La memantina a dosis de 400 mg/dl es tóxica a nivel estructural en la retina. La memantina podría ser considerada en el futuro para el tratamiento de distrofias de retina. Diversos estudios deberán ser realizados al respecto

OBJECTIVE: To histologically evaluate whether the intravitreal application of memantine produces retinal toxicity in rabbits. METHODS: A cross-sectional design, experimental, descriptive study was performed on 16 eyes of 16 New Zealand rabbits of 3 kg, divided in 4 groups of 4 rabbits. A dose of 70 ng/ml of intravitreal memantine was administered in Group A, a dose of 150 ng/ml in Group B, a dose of 400 ng/ml in Group C, and Group D received 1 ml of balanced salt solution. The injected eye of half of each group was enucleated 15 days after the injection, and the rest within 30 days after injection. Following enucleation, each eye was placed in 10% formaldehyde. Histopathological analysis was performed on all enucleated eyes. The animals were treated according to the guidelines of the Association for Research on Vision and Ophthalmology (ARVO). RESULTS: Groups A, B and D did not show any histopathological changes after their enucleation at 15 and 30 days. Group C showed changes in the photoreceptor layer after enucleation at 15 and 30 days. CONCLUSIONS: In our study, it was observed that memantine concentrations at 70 ng/ml and 150 ng/ml are safe when administered intravitreally; however, doses of 400 ng/ml produced retinal structural changes. This research should continue to assess its clinical usefulness

Retinoblastoma in the adolescent. Unusual clinical and histopathology findings.

CASE REPORT: A 17-year- old male with 2years history of an intraocular mass and progressive visual loss of the left eye. Spontaneous sclera rupture occurred during enucleation. Microscopic evaluation with H-E, PAS and immunohistochemistry (NSE, GAFP, SYN, CD99) revealed a small blue round cell malignant neoplasm with extensive necrosis and apoptosis. The optic nerve, ciliary body, choroid, anterior chamber, and sclera were infiltrated. SYN was positive and CD99 was negative in neoplastic cells, consistent with a poorly differentiated retinoblastoma. DISCUSSION: Retinoblastoma is the most frequent primary intraocular malignant tumour in childhood, but occasionally older patients can be affected. Immunohistochemistry is mandatory in poorly differentiated retinoblastomas.

Intravitreal memantine retinal toxicity in rabbits.

OBJECTIVE: To histologically evaluate whether the intravitreal application of memantine produces retinal toxicity in rabbits. METHODS: A cross-sectional design, experimental, descriptive study was performed on 16 eyes of 16 New Zealand rabbits of 3 kg, divided in 4 groups of 4 rabbits. A dose of 70 ng/ml of intravitreal memantine was administered in Group A, a dose of 150 ng/ml in Group B, a dose of 400 ng/ml in Group C, and Group D received 1 ml of balanced salt solution. The injected eye of half of each group was enucleated 15 days after the injection, and the rest within 30 days after injection. Following enucleation, each eye was placed in 10% formaldehyde. Histopathological analysis was performed on all enucleated eyes. The animals were treated according to the guidelines of the Association for Research on Vision and Ophthalmology (ARVO). RESULTS: Groups A, B and D did not show any histopathological changes after their enucleation at 15 and 30 days. Group C showed changes in the photoreceptor layer after enucleation at 15 and 30 days. CONCLUSIONS: In our study, it was observed that memantine concentrations at 70 ng/ml and 150 ng/ml are safe when administered intravitreally; however, doses of 400 ng/ml produced retinal structural changes. This research should continue to assess its clinical usefulness.

Choroidal melanoma in a 6-year-old female: ultrasonographic diagnosis.

A 6-year-old girl presented with right divergent strabismus that had been noticed by her parents 3 weeks before. On examination, she had visual acuity of counting fingers at 3 meters on her right eye and retinal non-regmatogenous bullous detachment with subretinal tumor. Echographic examination disclosed retinal detachment in temporal side from optic disk to equator, a medium reflectivity rounded, homogeneous lesion with rapid growing and positive signs of vascularity. Enucleated eye revealed mixed cell uveal melanoma. This case is a rare presentation of uveal melanoma in which echographic appearance was decisive for diagnosis and treatment.

Colecistectomía laparoscópica en una unidad de cirugía mayor ambulatoria y corta estancia / No disponible

Introducción: La colecistectomía laparoscópica ambulatoria puede ser llevada a cabo de manera segura en sujetos seleccionados con alto nivel de satisfacción para el paciente, sin embargo, su uso no se ha generalizado por temor del cirujano a las complicaciones postoperatorias. Los objetivos de este estudio son analizar nuestros resultados y la satisfacción y recuperación de los pacientes sometidos a colecistectomía laparoscópica electiva durante más de 8 años. Pacientes y método: Se analizan prospectivamente los 1.892casos de colecistectomía programada realizadas entre mayo de2002 y diciembre de 2010. Los criterios de exclusión fueron pacientes inestables ASA III, VIH, drogodependientes, con problemas psiquiátricos severos y cirugía previa en el compartimento supramesocólico. Se analizan las características de la cirugía, morbilidad, hospitalización prolongada, efectos adversos y calidad de vida de cada paciente. Resultados: La tasa de conversión a laparotomía fue 0,5%. El95,1% de los pacientes fueron dados de alta en las primeras 24 horas postoperatorias. El 47,5% de los pacientes refirieron ausencia de dolor y el 34% dolor leve. La recuperación de las actividades de la vida diaria se produjo durante la primera semana en la mayoría de los pacientes, con excelentes tasas de satisfacción. Conclusiones: La colecistectomía laparoscópica ambulatoria reduce el consumo de recursos hospitalarios con mínimo impacto estético y alto nivel de calidad de vida. Una mejor información a los pacientes y cooperación con médicos de atención primaria optimizan el proceso (AU)

Background: Although ambulatory laparoscopic cholecystectomy can be performed safely for selected individuals with high level of patient satisfaction, it has not been generalized due to the fear of postoperative complications by surgeon. The aims of this study are to analyze our results and the satisfaction and recovery in patients undergoing elective laparoscopic cholecystectomy during more than 8 years. Patients and methods: A prospective study was carried outon the 1,892 elective cholecystectomy cases performed between may 2002 and december 2010. The exclusion criteria were unstable ASA III, VIH, drug addiction, severe psychiatric problems and supramesocolic surgery. We collected data on the characteristics of the surgery, morbidity, prolonged hospitalization, adverse effects and quality of life from each patient. Results: The conversion to open laparotomy rate was 0.5%.95.1% of patients were discharged on the first 24 postoperative hours. 47.5% of patients reported absent pain and 34% light pain. Recovery of daily physical activity didn’t exceeded 1 week in most patients with excellent satisfaction rates. Conclusion: Ambulatory laparoscopic cholecystectomy decreases the use of hospital resources with minimal aesthetic impact and high level of quality of life in selected patients. Better patient information and cooperation with general practitioners optimize the outpatient procedure (AU)

[Atypical frontal sinus mucocele. A case report]. / Mucocele del seno frontal de presentación atípica. Informe de un caso.

CLINICAL CASE: We report a case of a 46-year-old woman who developed a tender, painful mass in the left superior eyelid over a period of about 6 months. This was a frontal mucocele with atypical clinical and histopathologic features. DISCUSSION: Most mucoceles arise from the frontal or ethmoidal sinuses. Frontal mucoceles usually cause outward and downward displacement of the globe, and are often associated with fullness in the supero-nasal and medial canthal region and a palpable mass.

[Corneal macular dystrophy: clinical, histopathologic and ultrastructural features]. / Distrofia macular corneal: características clínicas, histopatológicas y ultraestructurales.

OBJECTIVE: To assess the main clinical, genetic, histopathological and ultrastructural features of Mexican patients with macular corneal dystrophy, and to compare the results with those previously reported. METHOD: We analyzed six cases where a histopathologic diagnosis of macular corneal dystrophy had been made between 1957 and 2004. RESULTS: Clinically, all corneas showed focal grayish-white stromal opacities with diffuse edges. Histopathologically, intrastromal granules stained strongly positive with Alcian blue and colloidal iron. Transmission electron microscopy showed enlargement of smooth endoplasmic reticulum and the presence of intracytoplasmic vacuoles that corresponded to glycosaminoglycans. Genetic analysis showed novel mutations in the CHST6 gene in 2 of the patients. CONCLUSIONS: Females were more affected than males and the mean age at the time of diagnosis was older than that reported previously, however the clinical, histopathological and ultrastructural features were similar to those of previous reports. As described in other cases in the literature, in some instances a disorder is found in CHST6 gene as a basis for this condition.

[Seborrheic keratosis of conjunctiva: a case report]. / Queratosis seborreica de la conjuntiva: informe de un caso.

CASE REPORT: Pigmented conjunctival lesions are a diagnostic challenge for the clinician. A 37-year-old man presented with a pigmented mass involving the conjunctiva of his right eye. Clinically, a diagnosis of malignant melanoma was made and a wide excision of the tumor was performed. The histopathologic diagnosis was seborrheic keratosis. DISCUSSION: Seborrheic keratosis is a benign lesion which occurs on the eyelids and face of middle-aged and elderly individuals. The occurrence of this lesion on the conjunctiva is rare, however there are 2 cases reported in the world literature. Seborrheic keratosis should be considered in the differential diagnosis of conjunctival pigmented lesions.

Queratosis seborreica de la conjuntiva: informe de un caso / Seborrheic keratosis of conjunctiva: a case report

Caso clínico: Las lesiones conjuntivales pigmentadasrepresentan un reto diagnóstico para el clínico.Hombre de 37 años de edad quien presentó unamasa conjuntival pigmentada en su ojo derecho.Clínicamente se diagnosticó como melanoma, porlo que se realizó escisión completa del tumor. Eldiagnóstico histopatológico fue de queratosis seborreica.Discusión: La queratosis seborreica es una lesiónbenigna que se presenta en los párpados y en la carade individuos de edad media y adultos mayores. Eldesarrollo de esta lesión en la conjuntiva es pocofrecuente, solo se han informado 2 casos en la literatura.La queratosis seborreica debe ser consideradaen el diagnóstico diferencial de lesiones conjuntivalespigmentadas

Case report: Pigmented conjunctival lesions are a ;;diagnostic challenge for the clinician. A 37-yearold ;;man presented with a pigmented mass involving ;;the conjunctiva of his right eye. Clinically, a diagnosis ;;of malignant melanoma was made and a wide ;;excision of the tumor was performed. The histopathologic ;;diagnosis was seborrheic keratosis. ;;Discussion: Seborrheic keratosis is a benign lesion ;;which occurs on the eyelids and face of middleaged ;;and elderly individuals. The occurrence of this ;;lesion on the conjunctiva is rare, however there are ;;2 cases reported in the world literature. Seborrheic ;;keratosis should be considered in the differential ;;diagnosis of conjunctival pigmented lesions