A 39-year-old black man with sickle cell trait presented with a rapidly progressive, painful proptosis of the left eye. A computed tomographic scan was interpreted as revealing a cavernous hemangioma. Medial orbitotomy revealed a hard, gray mass supranasal to the optic nerve and invading the medial rectus muscle. Intraoperative frozen section specimens were read initially by the pathologist as metastatic adenocarcinoma. On gross examination, the conspicuous hemorrhage, necrosis, and bright yellow color characteristic of renal cell carcinoma were not present. Final pathologic analysis of the orbital lesion revealed metastatic renal medullary cell carcinoma. The primary lesion was located in the right kidney. Renal medullary carcinoma is a rare tumor, often affecting young individuals with sickle cell trait or disease. We report the first confirmed case of renal medullary carcinoma metastatic to the orbit with orbital symptoms preceding the diagnosis of the primary tumor.
The oculo-facial surgeon's quest for non-invasive procedures is a response to increasing patient demands for enhanced results without any downtime. Technology has obliged us with multiple injectable and light therapeutic modalities that tighten skin, relax and fill in wrinkles, and improve skin dyspigmentation and texture. When these techniques are combined, the results are superior to the use of individual therapies alone. The foundation for combination therapies are: botulinum toxin, filling agents, chemical peels, intense pulsed light, non-ablative and ablative lasers.
The evolution of safe, effective filling agents has become a critical step in non-invasive facial rejuvenation. Their combination with other minimally invasive therapies for the skin, such as chemical peels, radiofrequencybased and light-based treatments, has increased the degree of esthetic results and the level of satisfaction for patients and physicians. There have been many discussions theorizing the attributes of the perfect filling agent. We want a product that can be administered safely, conveniently, rapidly, and painlessly and without leaving any traces that it has been applied. We want a product that does not result in any complications and that lasts a long time. The ideal substance should be biocompatible, nonimmunogenic, nonresorbable, nonpyogenic, noncarcinogenic, inexpensive, and nonmigratory, with the ability to be stored, shaped, removed, and sterilized easily. 1 We have not yet achieved this level of perfection, but the non-animal-derived, stabilized hyaluronic acid products are the current state of the art, fulfilling much of our desired criteria. This article describes our clinical experience in the use of the currently available hyaluronic acid products for oculofacial rejuvenation.
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