Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.Methods: Case report with orbital imaging.Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.
Atypical lipomatous tumor/well-differentiated liposarcoma is a common neoplasm of the superficial and deep soft tissues of the extremities, trunk, and retroperitoneum. Atypical lipomatous tumor/well-differentiated liposarcoma is very rare in the orbit, with only 19 previously reported cases. The authors describe a 22-year-old woman who presented with an 8-month history of diplopia and was found to have an orbital mass on MRI. The excised tumor initially was interpreted as spindle cell/pleomorphic lipoma based on its morphologic and immunohistochemical features. Nine years later, the patient returned with a recurrence that required surgical debulking. Histopathologic and molecular cytogenetic evaluation of both primary and recurrent lesions disclosed Atypical lipomatous tumor/well-differentiated liposarcoma. This case highlights the diagnostic challenges and the importance of molecular genetic studies in evaluation of fatty orbital tumors.
Primary conjunctival rhabdomyosarcoma (RMS) is a rare entity that can present with or without papillomatous features. A 5-year-old Asian boy was referred for a rapidly growing conjunctival tumor in the superior fornix of the left eye. Surgical excision yielded a 28 mm multilobulated papillomatous specimen that exhibited histopathologic and immunohistochemical features consistent with embryonal (botryoid) RMS. Molecular analysis revealed the absence of the PAX3/FOXO1 fusion gene, indicating favorable prognosis. After surgery, he was promptly treated with systemic chemotherapy and proton beam radiotherapy.
To report a case of choroidal sarcoid granuloma simulating choroidal metastasis in a patient with prostate carcinoma.Case report.A 66-year-old man was found to have an asymptomatic choroidal mass in his left eye. He had known history of pulmonary sarcoidosis without systemic involvement and prostate carcinoma without metastasis. On examination, visual acuity was 20/20 in each eye. Anterior segment was normal, without inflammatory sign in either eye. The right fundus was healthy. The left fundus revealed a yellow choroidal mass of 2 mm diameter, temporal to the foveola and without subretinal fluid, retinitis, or vitritis. Optical coherence tomography demonstrated a homogenous hyporeflective choroidal mass with intact retinal pigment epithelium and compression of choroidal vascular structures. Given the medical history and rarity of prostate metastasis to the uvea, choroidal sarcoid granuloma was considered and oral prednisone with a slow taper was given. After 2 months of therapy, tumor resolution with reduction in size was confirmed on optical coherence tomography.Choroidal sarcoid granuloma is a rare condition that can simulate choroidal metastasis. Treatment with prednisone can assist in establishing the diagnosis.
