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A Monte Carlo approach for small electron beam dosimetry.

BACKGROUND AND PURPOSE: In treatments where it is necessary to conform the field shape yielding a very small effective beam area, dosimetry and conventional treatment planning may be inaccurate. The Monte Carlo (MC) method can be an alternative to verify dose calculations. A conjunctival mucosa-associated lymphoid tissues lymphoma is presented, to show the importance of an independent assessment in critical situations. MATERIALS AND METHODS: In this work, the MC technique has been employed using the program BEAM (based on EGS4 code). Electron beam simulation has been performed and the results have been compared with those obtained with films. The patient dose distribution has been obtained by two methods: the full Monte Carlo (FMC) simulation and a conventional planning system (PLATO). RESULTS: Concerning dosimetry, some differences have been observed in the comparison of profiles obtained with film and those obtained with the MC method. Moreover, significant differences were found in the patient isodose distribution between both calculation methods. CONCLUSIONS: The results highlight that, in treatments where small beams are needed, conventional dosimetry and planning systems have some limitations. Therefore, an independent and more accurate assessment, such as MC, would be desirable.

Computer Simulation↗

Radiotherapy in the management of epidemic Kaposi's sarcoma: a retrospective study of 643 cases.

PURPOSE: To report to the literature the largest published series of epidemic Kaposi's sarcoma (EKS), treated with radiation therapy, to summarize and discuss our 10 years experience in the treatment of this malignancy. METHODS AND MATERIALS: From June 1986 to December 1996, 643 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with radiation therapy (RT) at the Cancerology Department of Henri Mondor University Hospital. The patients, 640 men and 3 women had an average age of 38.5 years (range 20-68 years). Three hundred eighty-seven patients (60.1 %) had received previous treatment for their Kaposi's sarcoma (KS). In total, 6777 fields were irradiated, as follows: face 1342 (19.8%), eyelid and conjunctiva 362 (5.3%), trunk 1903 (28.1%), upper and lower limbs 2866 (42.3%), genitals 189 (2.8%). and oral cavity 115 fields (1.7%). Radiation therapy consisted of 4 MV or 45-70 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. RESULTS: Objective response (CR and PR) was observed in 92% (5947/6464) of all cases, treated for cutaneous form of EKS. All patients with irradiated oral lesions had an objective response. The overall tolerance was acceptable for the cutaneous lesions. By contrast, in oral lesions, mucosal reactions were often observed after relatively low doses of radiotherapy. CONCLUSIONS: Doses of 15 Gy for oral lesions, 20 Gy for lesions involving eyelids, conjunctiva, and genitals, have been shown to be sufficient to produce shrinkage of the tumor and good palliation of the symptoms. For the cutaneous EKS, we propose 30 Gy given in a local field, using a fractionated scheme with small size applicators. Radiotherapy has its own place in the management of EKS, as an efficient treatment.

Acquired Immunodeficiency Syndrome↗

A conformal technique for a ring shaped conjunctive lymphoma treatment.

Radiotherapy is commonly utilised as standard treatment in the so called mucosa-associated lymphoid tissues (MALT), due to the low probability of distant relapse. The particularities of the lesion, make necessary both energy degradation and beam conformation. To keep homogeneity within acceptable limits, a lengthener attached to the electron applicator has been devised to closely fit the anatomy of the patient. Considering the small area of the outcoming field, film dosimetry is preferred, since the dimensions of an ionisation chamber and even of a semiconductor probe might be comparable to the field size.

Adult↗

[Conjunctival tumors in children. A histopathologic study of 42 cases].

PURPOSE: The aim of this study was to describe the clinicopathological characteristics of 42 conjunctival tumors surgically removed in children. PATIENTS AND METHODS: Records of all conjunctival tumors surgically removed in children during the 11-year period 1990-2001 were collected from the records of the Department of Ophthalmology, Edouard Herriot Hospital, Lyon. In all cases, the tumor was resected with no additional treatment. Sections of all cases were reviewed by the same pathologist. RESULTS: A total of 42 cases (40 patients) were included in the study. The mean age of the subjects at the time of surgical excision was 10 years, with a range of 1-17 years; 45% were male. The most frequent indication for tumor removal was suspected growth. The clinical diagnosis was accurate in 91% of cases. The tumor was localized at the limbus in 57% of cases. Most tumors were pigmented nevi, accounting for 83% of the lesions. The histopathological diagnoses in decreasing order of frequency were: nevi (35), angioma (2), dermolipoma (2), dermoid (1), papilloma (1), and squamous cell carcinoma (1). In one case, the histological study revealed squamous cell carcinoma in a child suffering from xeroderma pigmentosum. CONCLUSIONS: This retrospective study suggests that malignancy of pigmented conjunctival lesions is extremely rare in children. Although squamous cell carcinoma is rare in children, surgical excision and histological study are necessary when a conjunctival lesion is associated with xeroderma pigmentosum or immunodeficiency.

Adolescent↗

[Nodular melanoma on primary acquired conjunctival melanosis].

A 74-year-old woman consulted for bloody tears. The etiology was a large conjunctival nodular melanoma hidden in the left superior fornix that had developed quietly on an unknown primary acquired melanosis. In this report the clinical and histological features as well as the treatment are presented. A decisional tree summarizes the treatment for conjunctival melanosis.

Age Factors↗

Ocular and cutaneous squamous cell carcinoma in an African American man with epidermodysplasia verruciformis resulting in blindness and death.

Epidermodysplasia verruciformis (EV) is a hereditary disease that has served as a model for viral-induced carcinogenesis. Patients with EV have an increased susceptibility to infection with human papillomavirus, which results in the development of benign lesions in childhood. The lesions may resemble tinea versicolor in appearance and distribution, and usually remain benign. However, later in life cutaneous squamous cell carcinoma may develop on sun-exposed areas, such as the forehead. Radiation therapy may not only result in the malignant conversion of EV lesions, but may also increase the risk of metastases. To our knowledge, this is the first report of a patient with EV in whom squamous cell carcinoma of the conjunctiva developed. His clinical course was complicated by ocular invasion causing blindness, metastasis, and eventually death.

Blindness↗

Erythroplasia (Queyrat) of conjunctiva.

Erythroplasia of Queyrat (EQ) is an epidermoid carcinoma in situ which is histologically identical with Bowen's disease of the skin but involves mucosal surfaces. The lesion is known to occur on the glans penis, the vulva, and the oral mucosa. Two cases of EQ of the conjunctiva that developed several years after radiotherapy for basal cell carcinoma of the eyelids are here reported. The signs and symptoms closely mimicked those of chronic conjunctivitis. The lesions were excised by the microscopically controlled excision of Mohs. It is recommended that biopsy material be obtained in patients who develop a nonresolving chronic conjunctivitis, especially when there is history of radiotherapy of the eyelids.

Carcinoma in Situ↗

Kaposi's sarcoma of the conjunctiva.

Three cases of Kaposi's sarcoma involving the conjunctiva are reported. The first patient had been affected by a single lesion on the glans penis. In the second patient the conjunctival lesion adopted a peculiar globular shape. The third patient had been treated with corticosteroids for pemphigus when the Kaposi's sarcoma lesion appeared. Although these conjunctival lesions are extremely rare, dermatologists should not rule out the possibility of Kaposi's sarcoma with ocular involvement, bearing in mind its higher incidence because of the epidemic of acquired immunodeficiency syndrome and the increasing number of patients with immunosuppression.

Aged↗

Pigmented lesions of the conjunctiva.

A careful examination of the conjunctiva and ocular adnexa should be performed as part of a complete dermatologic examination. This article reviews the clinical presentation and classification of pigmented lesions of the conjunctiva. The histologic features of these conjunctival lesions are compared with those of pigmented lesions of the skin.

Conjunctiva↗

Ocular melanomas and melanocytic lesions of the eye.

This article describes several melanocytic lesions of the eye. Benign and malignant lesions will be discussed as well as a review of the dysplastic nevus syndrome and its proposed association with ocular melanoma. Ocular melanomas arise from the same embryologically derived melanocytes as their cutaneous counterparts. However, ocular and cutaneous melanomas differ in many respects. The diagnosis and management of these ocular tumors rely heavily on the ophthalmologist. However, knowledge of melanocytic lesions will aid the dermatologist in detection and in proper referral of these patients.

Conjunctival Neoplasms↗

Surgery of the adnexa.

Review of the functional anatomy of ocular adnexal tissues is followed by presentation of surgical procedures aimed at correcting conditions of the eyelids, conjunctiva, and third eyelids of small animals. Procedures used effectively by the primary author are described in detail including instances where combination procedures may be indicated. Some newer, recently described techniques are also briefly discussed. Illustrations of applied anatomy and multiple surgical techniques are provided by illustrator and coauthor Dr. Gheorghe Constantinescu. References are given to encourage readers to further explore alternative techniques focusing on the surgical correction of adnexal diseases of dogs and cats.

Animals↗

[Eye involvement in AIDS-related Kaposi sarcoma].

BACKGROUND: The study evaluates the incidence of ocular compromise in the Kaposi's sarcoma associated with AIDS. METHODS: We revised the clinical histories of HIV seropositives patients seen in the ophthalmology department from January, 1994 to December, 1998. All patients were examined by direct visually and dilated fundus examination with the use of either a direct or an indirect ophthalmoscope. RESULTS: In 6,552 patients, ocular Kaposi's sarcoma was diagnosed in 17 (0.25%), predominantly in male sex (88.23%). The lesions predominated in eyelids, and the inferior has been the most affected. In only one female, the ocular compromise was the first neoplastic manifestation. CONCLUSIONS: The ocular compromise in the Kaposi's sarcoma is an alternative to be considered in AIDS patients with previous or simultaneous cutaneous or visceral involvement. Due to the few clinical signs of these lesions, a thorough ocular study is recommended in these patients.

Acquired Immunodeficiency Syndrome↗

Report of a primary lymphoma of the conjunctiva. A lymphoma of MALT origin?

A case of primary conjunctival lymphoma is reported herein. A 47-year-old woman presented with an indolent salmon-coloured tumour of the lower epibulbar conjunctiva. Histologically, we found a lymphoid infiltrate in the epithelium and subepithelium consisting of two components. One component was characterized by centrocytic-like cells and the other by lymphocytic, plasmacytoid and plasma cells. An immunohistological study demonstrated a light chain restricted immunoglobulin expression of the tumour cells as well as some residual polytypic follicles exhibiting reticular dendritic cells. Tumour cell proliferation was associated with a T cell reactive population. A comprehensive investigation (in particular an orbital scan) did not demonstrate any other localization of this lymphoma. Such a lesion raised the question of a possible MALT origin, by analog with MALT-lymphomas of the gastrointestinal tract described by Isaacson and colleagues.

Antibodies, Monoclonal↗