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Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

At least 361 records · Page 20Linked to original sources
PubMed1988

Tumors metastatic to the orbit.

A review of 35 consecutive cases of tumors metastatic to the orbit revealed that the primary tumor site was breast in 18 cases (51%), prostate in 6 cases (17%), lung in 2 cases (6%), gastrointestinal tract in 2 cases (6%), kidney in 1 case (3%), cutaneous melanoma in 1 case (3%), contralateral choroidal melanoma in 1 case (3%), and unknown in 4 cases (11%). The most common presenting signs and symptoms included diplopia with noncomitant strabismus, proptosis, and a palpable mass. In nine cases (26%), the orbital metastasis was detected in patients with no prior history of cancer. The average patient survival after the diagnosis of orbital metastasis was 13 months. Orbital metastasis from lung carcinoma carried the worst prognosis, with an average survival time of only 4 months. A summary of the clinical features of these 35 cases and a review of the literature on orbital metastatic disease will be presented.

Adolescent↗
PubMed1988

Primary eyelid malignant melanoma associated with primary conjunctival malignant melanoma.

Two patients presented with the unusual occurrence of isolated foci of malignant melanoma of the upper eyelid and ipsilateral inferior conjunctiva. Neither patient had clinical evidence of primary acquired conjunctival melanosis, but in one case there was histopathologic evidence of this condition. The clinical features, histopathologic findings, and possible significance of this unusual occurrence are discussed.

Aged↗
PubMed1988

Neonatal Graves' disease.

A newborn boy was noted by his mother to have a prominent left eye at birth, but an eye examination was delayed until age 7 months, at which time his ophthalmologist diagnosed exophthalmos. Computed tomography was interpreted as showing mild, diffuse, optic nerve thickening bilaterally suggestive of optic nerve gliomas. Subsequent examination in our clinic revealed pseudoproptosis secondary to retraction of the left upper eyelid. Magnetic resonance imaging demonstrated normal orbital structures. The mother was noted to be clinically hyperthyroid, and abnormal thyroid function tests confirmed the diagnosis. Although the infant was euthyroid, neonatal Graves' ophthalmopathy was diagnosed. He was managed by close observation while his mother was treated for her hyperthyroidism.

Graves Disease↗
PubMed1988

Metastasis of choroidal melanoma to the contralateral choroid, orbit, and eyelid.

A 52-year-old woman was found to have a small juxtapapillary pigmented lesion in the choroid of the left eye. This lesion remained clinically stationary for one year, but subsequent growth prompted enucleation of the eye. The tumour was diagnosed histologically as a choroidal malignant melanoma of mixed cell type. Approximately 52 months later the patient developed proptosis of the contralateral (right) eye. Orbital ultrasonography showed a large mass in the right orbit, which was confirmed by needle biopsy to be a melanoma. In addition the patient was found to have metastatic melanoma to the choroid, right lower eyelid area, and liver. The development of simultaneous orbital, choroidal, and eyelid metastases from a contralateral choroidal melanoma is of ophthalmic interest and appears to be unique.

Choroid Neoplasms↗
PubMed1988

Surgical approach to lamellar sclerouvectomy for posterior uveal melanomas: the 1986 Schoenberg lecture.

We describe a technique of surgically removing melanomas that involve the ciliary body and/or the choroid, while leaving intact the outer portion of the sclera and the overlying sensory retina. This procedure, called a partial lamellar sclerouvectomy, can be subclassified as a partial lamellar sclerocyclochoroidectomy in the case of ciliochoroidal melanomas, and as a partial lamellar sclerochoroidectomy in the case of pure choroidal melanomas.

Choroid Neoplasms↗
PubMed1987

Orbital metastasis from a carcinoid tumor. Computed tomography, magnetic resonance imaging, and electron microscopic findings.

An otherwise asymptomatic 63-year-old woman with a history of a carcinoid tumor of the ileum and a cutaneous melanoma of the shoulder developed unilateral proptosis. Orbital ultrasonography, computed tomography, and magnetic resonance imaging revealed a large, well-circumscribed orbital mass involving the superior rectus muscle. The surgically excised tumor was studied by light microscopy, histochemistry, and transmission electron microscopy. These studies confirmed the diagnosis of carcinoid tumor. The clinical and pathologic features of this rare type of orbital metastasis are discussed.

Carcinoid Tumor↗
PubMed1987

Malignant transformation of presumed pleomorphic adenoma of lacrimal gland after 60 years.

A woman was diagnosed as having a benign lacrimal gland mass at age 23 years and no treatment was advised. About 60 years later, the previously stationary proptosis began to increase, and biopsy specimens demonstrated a malignant mixed tumor (pleomorphic adenocarcinoma) of the lacrimal gland. The patient was subsequently treated with orbital exenteration. From the clinical history and histopathologic findings, it appears that the patient harbored a long-standing pleomorphic adenoma (benign mixed tumor) that gave rise to a pleomorphic adenocarcinoma after remaining stationary for 60 years.

Adenoma↗
PubMed1987

Prevalence and mechanisms of secondary intraocular pressure elevation in eyes with intraocular tumors.

A survey of 2704 eyes with intraocular tumors in patients who were evaluated on the Oncology Service at Wills Eye Hospital showed that 126 of the tumor-containing eyes (5%) had tumor-induced elevated intraocular pressure (IOP) at the time of diagnosis of the tumor. Of the 2111 eyes with uveal melanomas, secondary IOP elevation was present in 55 (3%). Secondary IOP elevation was present in 7% of eyes with iris melanoma, 17% with ciliary body melanoma, and 2% with choroidal melanoma. The most common mechanism of elevated IOP was tumor invasion of the angle in the case of iris melanomas, pigment dispersion and tumor invasion of the angle in the case of ciliary body melanomas, and iris neovascularization in the case of choroidal melanomas. Of the 256 eyes with uveal metastases, secondary IOP elevation was found in 12 eyes (5%). Secondary IOP elevation was present in 64% of eyes with iris metastases, 67% with ciliary body metastases, and 1% with choroidal metastases. The most common mechanism of elevated IOP was tumor invasion of the angle in the case of iris and ciliary body metastases, and angle closure in the case of choroidal metastases. There were 303 eyes with retinoblastoma, 17% of which had elevated IOP which was secondary to iris neovascularization in 70% of cases and to an angle closure without neovascularization in 27%. Several other intraocular tumors including lymphoma, leukemia, medulloepithelioma, melanocytoma, and adenoma of the iris pigment epithelium were occasionally associated with secondary elevated IOP.

Biomechanical Phenomena↗
PubMed1987

Solitary metastasis of choroidal melanoma to the contralateral eyelid.

A 60-year-old man developed a subcutaneous mass in the right lower eyelid 2 1/2 years after enucleation of the left eye for a mixed-cell-type choroidal melanoma. Excision of the subcutaneous eyelid mass revealed the tumor to be a malignant melanoma composed of spindle B cells similar to those in the intraocular tumor. The patient's systemic evaluation, including liver enzymes, has remained normal, with no signs of further metastasis and no evidence of another primary melanoma for 14 months of postexcision follow-up. The significance of the rare occurrence of isolated metastatic melanoma from the choroid of one eye to the eyelid of the other is discussed.

Choroid Neoplasms↗
PubMed1987

Occult prostatic carcinoma metastatic to the medial canthal area. Diagnosis by immunohistochemistry.

A 91-year-old man developed a mass in the right medial canthal and lacrimal sac region, which was found histopathologically to be a poorly differentiated neoplasm. The results of a complete systemic evaluation, including urologic consultation, rectal examination, bone scan, and determination of serum acid phosphatase level, were normal. In spite of the negative evaluation for prostatic carcinoma, immunohistochemical studies using immunoperoxidase stains for prostatic-specific antigen demonstrated that the lacrimal sac tumor was metastatic carcinoma from an occult primary neoplasm in the prostate gland. The presence of tumor in the prostate gland was then confirmed by a needle biopsy. Modern immunohistochemical techniques are particularly valuable in the diagnosis of selected ophthalmic tumors in which the diagnosis cannot be determined by routine diagnostic techniques.

Aged↗
PubMed1987

Intracranial extension of choroidal melanoma via the optic nerve.

A 62-year-old woman was treated with cyclocryotherapy for neovascular glaucoma of uncertain origin. Fifteen months later she was diagnosed as having a choroidal melanoma, which extended extrasclerally to fill the orbit and invaded the optic nerve intracranially to the chiasm. She was treated by orbital exenteration and neurosurgical resection of the intracranial portion of the optic nerve. The patient is alive and clinically free of metastasis five years after the onset of neovascular glaucoma and almost four years after surgical resection. The significance of this highly unusual growth pattern of uveal melanoma is discussed.

Choroid Neoplasms↗
PubMed1986

Types and frequency of lesions of the caruncle.

We reviewed 57 consecutive biopsies of lesions of the caruncle seen in the Wills Eye Hospital Pathology Department from 1977 through 1985. The types and relative frequency of excised caruncular lesions were recorded and correlation of pathologic diagnosis with preoperative clinical diagnosis, age, and sex was made. Squamous papillomas accounted for 18 (32%) and nevi for 14 (24%) of all caruncular masses. Pyogenic granulomas accounted for five (9%), epithelial inclusion cysts for four (7%), chronic inflammation for four (7%), and oncocytomas for two (4%) of all caruncular masses. Of the 57 cases only three (5%) were malignant tumors.

Adenoma↗
PubMed1986

Conjunctival involvement in Churg-Strauss syndrome.

A 64-year-old man had slowly progressive thickening of the bulbar and palpebral conjunctiva of the right eye, followed by signs and symptoms of an upper respiratory infection. A biopsy specimen of the conjunctival lesions demonstrated granulomatous inflammation with eosinophils compatible with a diagnosis of Churg-Strauss syndrome (asthma, eosinophilia, vasculitis, and granulomatous inflammation with eosinophils). Subsequently, fever, shortness of breath, moderate renal failure, and anemia developed. Therapy with systemic corticosteroids and cyclophosphamide was instituted, with resolution of the systemic and ocular manifestations.

Conjunctival Diseases↗
PubMed1986

Oncocytoma of the caruncle.

The oncocytoma (oxyphil adenoma) is an uncommon tumor composed of transformed epithelial cells of the ducts of salivary glands and other organs. In two men, 66 and 75 years old, oncocytomas originated in the caruncle where they assumed rather characteristic features. The caruncular oncocytomas clinically appeared to be cystic. Light microscopy showed that the tumor cells (oncocytes) had eosinophilic granular cytoplasm; electron microscopy demonstrated that the cytoplasm contained densely packed abnormal mitochondria.

Adenoma↗