To present three patients with a syringomatous carcinoma (SC). SC is a rare cutaneous neoplasm, most frequently situated on the face and scalp and histologically characterised by an infiltrative pattern of basaloid or squamous cells, a desmoplastic stromal reaction, keratin filled cysts, and granular structures.
METHODS
The clinical histories of the patients with a SC were investigated retrospectively.
RESULTS
Patient 1 had a benign appearing tumour of the lower eyelid. Five tumour excisions were necessary to remove the SC completely. Patient 2 had a tumour on the lateral part of the lower eyelid and in the medial canthal area. The histopathological findings revealed a squamous cell carcinoma, later revised as a SC. In spite of two excisions and one microscopically controlled excision, a recurrence occurred. An exenteration orbitae was recommended. Patient 3, known to have a history of multiple malignant skin tumours after kidney transplantation and use of cyclosporin, presented with a firm mass in the eyebrow region and in the nasal area of the orbit. The pathological diagnosis of this adnexal tumour was difficult. An exenteration was recommended.
CONCLUSIONS
SC is a benign appearing but extremely invasive, locally destructive, slowly growing adnexal tumour, derived from eccrine sweat glands. It is often mistaken, both clinically and microscopically, for other benign and malignant entities. The tumour recurrence is high due to extensive perineural invasion, but regional or distant metastases are rare. The local aggressive nature of the tumour and the high recurrence rate may necessitate mutilating procedures. Optimal treatment consists of a complete microscopically controlled surgical excision with clear surgical margins.
Purpose: The primary objective of the study was to determine the incidence of the various pathological conditions present at the base of the periocular cutaneous horns. The secondary objective was to study the presentation of these cutaneous horns with a view to finding any clinical indicators for premalignant, malignant and benign lesions at the base.Methods: Prospective multicentre study of patients presenting with cutaneous horns. Informed consent followed by excision biopsy of the base lesion was performed in all the cases included for the study. The biopsy specimens were examined histologically and results analysed.Results: Twenty-six patients presented with cutaneous horns in the periocular region over a period of 2 years, of these two patients presented with more than one cutaneous horn. 23 patients underwent excision biopsy. There were a total of 25 specimens. Of the base lesions 2/25 (8%) were malignant, 7/25 (28%) were pre-malignant and the remaining 16/25 (64%) were benign. Analysis of the findings on clinical presentation revealed no clinical indicators to correlate with the final histology.Conclusion: The incidence of malignant and pre-malignant lesions present at the base of periocular cutaneous horns was 36% with 8% of them being malignant. It is important to perform an excision biopsy with histological diagnosis of the base of the cutaneous horn as there are no definite clinical features that point towards a potential for malignancy.
Paraneoplastic non-caseating granulomatous inflammation of the eyelid EDITOR,-Periocular granulomatous inflam- mation is most commonly due to a chalazion or sarcoidosis, and more rarely to allergic granulomatosis (Churg-Strauss), Erdheim- Chester disease, Wegener's granulomatosis, and necrobiotic xanthogranuloma.When no cause for this inflammation can be found, it may be called idiopathic non-infectious granulomatous inflammation' or orbital sarcoid.2We report a case in which this idiopathic inflammation appeared to be associated with squamous cell carcinoma of the lung.
To investigate whether the rate of infiltration of local anaesthetic influences the pain or efficacy of local anaesthesia in oculoplastic surgery.A prospective observational study on consecutive patients undergoing a variety of oculoplastic procedures under local anaesthesia. An observer recorded the rate of injection of local anaesthetic during each procedure. The same mixture of local anaesthetic and the same needle gauge was used in all cases. Patients were asked to rate the pain of both the injection and the surgery using a visual analog scale (VAS).77 consecutive patients were observed, 39/77 (50.6%) patients were female and the average age was 63.5 years (range 31-94). A statistically significant correlation was found between the rate of injection and the VAS score from the injection (p<0.0001, r=0.42). There was no significant correlation between the injection rate and the VAS score from the procedure itself (p=0.25, r=0.13). Additionally, a significant correlation was found between the injection VAS score and the procedure VAS score (p=0.0002, r=0.42).The slower the rate of injection of local anaesthetic, the less pain was reported by the patient from the injection itself. Indeed the perception of pain from the surgery overall was significantly related to the pain felt during the injection, highlighting the importance of minimising pain during the injection of the local anaesthetic. We conclude that slowing the rate of injection is an effective way of alleviating pain from administration of the anaesthetic.
Orbital involvement is frequent in generalised amyloidosis. However, primary localised amyloid in the orbit is rare and requires systemic investigation. We present a case with amyloid deposits localised to one extraocular muscle in whom systemic investigation has been negative.
Background: Maximal CPET requires HRMax to be ≤15bpm predicted (220-age). In patients on ß-blockers, HRMax is unlikely to be ≤15bpm using (220-age). In some patients the Chronotropic Reserve Index (CRI) is useful as a CRI <0.6 is associated with adverse outcomes. Methods: A retrospective data analysis compared (220-age) to 3 equations that predict HRMax in patients on ß-blockers: HRMax=119+(0.5HRRest)–(0.5Age) HRMax=164–(0.70Age) HRMax=168–(0.76Age) Data from 50 patients having a maximal CPET treadmill test were reviewed. For each patient, predicted HRMax from each equation was compared to the recorded HRMax and the CRI calculated. Data are mean ± SD. Results: Age: 55±12yrs, HRRest: 70±5.5bpm, HRMax: 117±7.8bpm. The (220-Age) equation gave significantly lower (p<0.001) %Max values compared to the 3 equations. The CRI values for the (220-Age) equation were all <0.60, but >0.73 for the 3 equations and were significantly higher (p<0.001) than the (220-Age) equation. The slopes between the (220-Age) and the 3 equations for CRI were 1.74, 1.24 and 1.19 respectively with equation 1 being steeper (p<0.001). Conclusion: In patients undergoing CPET who are taking ß-blockers, using an HRMax prediction equation that reflects the use of this medication provides a more accurate assessment of HR response to exercise, and is essential where accurate determination of the CRI is important for clinical purposes.
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