The case of a 72-year-old woman with diffuse large B-cell lymphoma of the lacrimal sac is reported. The patient was evaluated for the first time in our department for tearing of the right eye. One month later, a slightly aching mass appeared over the right lacrimal sac. An acute infectious etiology was suspected and antibiotic therapy was given. When she finally presented with a rapidly growing lesion, she underwent echography and computed tomography followed by incisional biopsy. Results of histopathologic and immunohistochemical evaluation showed a primary, diffuse, large B-cell non-Hodgkin lymphoma of the lacrimal sac. This case demonstrates how difficult the clinical diagnosis of tumors of the lacrimal sac may be in the early stages. The clinical signs, usually aspecific, may be misleading and the diagnosis delayed.
No abstract
Over an 18 year period 42 patients with ocular metastases, age 30-75 years, 27 female and 15 male, were evaluated echographically. The right eye was affected in 18, the left in 17, and both eyes in 7. The most frequent primary tumours were carcinomas from breast (n = 25), lung (n = 6), and urinary bladder (n = 2). The choroidal metastases appeared mainly flat-infiltrating or domeshaped, on B-scan. A-scan generally revealed high or medium reflectivity, however with important exceptions. Atypical cases are discussed. Usually eyes with metastases should not be enucleated. Accordingly, ultrasonic evaluation and follow-up is of obvious importance.The real incidence of uveal metastases is debatable since metastases can be underestimated if there are no eye symptoms. Usually patients with malignancies do not undergo ophthalmic screening and when post-mortem examination is performed, the ocular region is not taken into consideration. Many authors maintain that these ocular tumours are quite frequent (Rossi 1981; Shields 1983; Spencer 1986). The aim of our report is to present our experience based on the retrospective evaluation of medical and echographic data from af series of patients affected by ocular metastases. Material and methodFrom 1973 to 1990, at the University Eye Clinic of Ferrara, 42 patients with ocular metastases were seen. Among them, 7 patients were affected by ocular metastases in both eyes. Therefore, in total, 49 eyes were observed. The patients' medical records and the results of their echographic examination were analysed, in order to evaluate both medical and echographic data. The following medical parameters were taken into account; sex, age, eye, primary tumour.The echographic parameters were: reflectivity on A-scan, and shape and region on B-scan since 1980. The following equipments were used: Kretztechnik 7200 MA, Ophthalmoscan 200, Sonometrics Inc., Tecknar Ophthasonic, Sonomed 3000, Nidek, Ophtascan S Biophysique. ResultsAmong the 42 patients affected by ocular metastases 27 were female and 15 were male; they were between 30 and 75 years of age.The ocular metastases were located: in 18 cases in the right eye, in 17 cases in the left eye and in 7 cases in both eyes.The most frequent primary tumour was breast carcinoma: it occured in 25 cases. In 6 cases it was a bronchopulmonary tumour, in 2 cases the primary tumour was a bladder carcinoma; in l case it was a parotid carcinoma, a brain lymphoma, a lymphoblastic thymoma, a uterine carcinoma and a skin melanoma. In 4 cases the location of the primary tumour was unknown (Fig. 1).We observed that in the majority of our cases the A-scan echographic parameters did not differ from the characteristics established by medical literature (high or medium-high reflectivity; internal Vshaped pattern for thicker metastases, Ossoinig & Harrie 1983; Mazzeo 1987). The most frequent shape shown on B-scan was a flat-infiltrating shape (12 cases), followed by a dome shape (7 cases) and an irregular shape: flat with some very low domes (5 cases). DiscussionIn accor...
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