Ординатура / Офтальмология / Английские материалы / Ocular Pathology_6th edition_Yanoff, Sassani_2009

2). The percentage of CDR+, CD7− cells is elevated in the peripheral blood of patients who have Sézary’s syndrome.

3). Although mycosis fungoides rarely involves the orbit, it does so more commonly than the other T-cell lymphomas.

Very rarely, mycosis fungoides can involve the vitreous.

4). Altered forms of the retrovirus HTLV-I and

HTLV-II have been incriminated in the causation of some cases of mycosis fungoides and Sézary’s syndrome.

E.Hodgkin’s disease‡

1.Hodgkin’s disease very rarely presents initially with orbital involvement, and orbital involvement is rare in any stage of the disease.

2.Hodgkin’s disease may be a direct consequence of a bcl-2 translocation through additional genomic events to be clarified in the future.

The bcl-2 oncogene acts mainly on the pathways of apoptosis (programmed death) and plays a crucial role in the control of cellular growth of lymphoid and nonlymphoid cells. Two other types of oncogenes are recognized: oncogenes such as myc, ras, and abl act as growth and proliferative regulatory genes; and oncogenes such as Rb and p53 inhibit growth and proliferation.

3.Di erentiation of Hodgkin’s disease from non-

Hodgkin’s lymphoma is based on finding Reed–

Sternberg cells in the former. Also helpful is the presence of markers for the Reed–Sternberg cells

[e.g., CD30 (Ki-1), and CD15], and the absence of

CD45.

In the absence of any Reed–Sternberg cells and the presence of CD30 positivity, the diagnosis of anaplastic Ki-1+

(CD30) large cell lymphoma should be considered. Four types of Ki-1+ large cell lymphoma may exist: common,

Hodgkin’s-related, giant cell-rich, and lymphohistiocytic. The tumor cells stain intensely positive with CD30. Approximately 70% of cases are of T-cell type, 15% are of B-cell type, 5% are mixed B- and T-cell types, and 10% are null type.

4.Epstein–Barr virus is found in a high percentage of cases of Hodgkin’s disease (see p. 63 in Chapter 3)

5.The origin of the neoplastic cells in Hodgkin’s disease remains an enigma in spite of the advances in immunology, cytogenetics, and molecular biology.

IX. Leukemia† (Fig. 14.47; see p. 353 in Chapter 9)

A.Orbital leukemic infiltrates most commonly occur late in the disease.

B.Occasionally, acute leukemia, usually granulocytic (myeloid or myelogenous) or stem cell, may present

initially with exophthalmos. Acute angle closure glaucoma has accompanied bilateral orbital infiltration with acute myeloid leukemia. Ultrasonography revealed uveoscleral thickening and anterior rotation of the ciliary body.

Rarely, the first sign of granulocytic leukemia relapse is ocular adnexal involvement. Occasionally, granulocytic sarcoma of the orbit has been reported as an isolated lesion.

1.The initial blood count may be normal or low with no circulating leukemic cells.

2.The bone marrow initially may be normal or hypocellular.

3.Exophthalmos is caused by an infiltrate of leukemic cells, called myeloid (granulocytic) sarcoma.

Because the pigment myeloperoxidase is sometimes present, the tumors appear greenish; hence the term chloroma.

The World Health Organization recommends the term myeloid sarcoma for a localized extramedullary tumor composed of immature myeloid cells; other terms are chloroma and granulocytic sarcoma.

4.Approximately two-thirds of patients who have myeloid leukemia present with some blurring of vision and accompanying fundus changes.

C.Histologically, leukemic cells infiltrate the orbit (see p. 353 in Chapter 9).

1.Auer rods (splinter-shaped, azurophilic, cytoplasmic crystalline inclusions) may be found in the blast cells of acute myeloid leukemia (see Fig.

14.47D).

2.The myeloid nature of the tumor is identified by chloroacetate esterase staining of the neoplastic cells.

The cells are CD43, CD45, Leder, and antilysozyme positive.

X.Monoclonal and polyclonal gammopathies‡

A.Monoclonal (single species of antibody) and polyclonal (multiple species of antibodies) macroglobulinemia may be seen in a variety of lymphoproliferative disorders such as nodular lymphoid hyperplasia, immunoblastic lymphadenopathy,nodular malignant lymphoma, and the plasma cell dyscrasias multiple myeloma, Waldenström’s macroglobulinemia, and the rare entities such as light-chain deposition disease and heavy-chain disease.

1.Monoclonal gammopathies are immunoglobulin products of single clones of plasma cells and B lymphocytes; polyclonal gammopathies are produced by more than one clone.

2.Most monoclonal gammopathies do not evolve into a malignant condition (all polyclonal gammopathies do not so evolve) and are termed monoclonal gammopathies of undetermined significance.

B.Multiple myeloma‡ (Fig. 14.48)

1.Multiple myeloma shows evidence of bone marrow plasmacytosis, monoclonal gammopathy in serum or urine (Bence Jones protein), and lytic bone lesions.

2.Direct orbital infiltration by myeloma cells, mimicking a primary orbital tumor, is uncommon.

a.The orbital involvement, however, may be the initial manifestation of the systemic disease.

b.Solitary orbital extramedullary plasmocytoma is a rare tumor; fewer than 15 cases have been described.

Some cases show necrobiotic xanthogranuloma of the eyelid. The eyelids may also show characteristic hemorrhagic lesions (see Fig. 7.13).

C.Waldenström’s macroglobulinemia‡

1.Waldenström’s macroglobulinemia is a small B-cell lymphocytic lymphoma that produces monoclonal

IgM, a pentameric immunoglobulin of high molecular weight.

2.Clinical symptoms are mainly related to anemia, bleeding, or symptoms of hyperviscosity.

A progressive macroglobulinemia-associated retinopathy may develop with associated antibodies against the connecting cilia of the photoreceptors.

D.In vitro immunologic and immunohistochemical techniques can aid in the diagnosis of plasma cell infiltrates.

E.Corneal, and even iris, crystals can be found in some patients who have monoclonal gammopathy.

F.Intranuclear and intracytoplasmic inclusions may be found in plasma cells and lymphocytes.

1.Intranuclear inclusions (Dutcher bodies; see Fig. 14.43D) are PAS-positive collections of monoclonal macroglobulins.

Actually, the inclusions are cytoplasmic invaginations into the nucleus. In some cases, the inclusions show no PAS positivity.

2.Intracytoplasmic inclusions (Russell bodies; see Fig. 1.13, and p. 12 in Chapter 1) are PAS-positive collections of monoclonal or polyclonal macroglobulins.

Secondary Orbital Tumors

I.Direct extension†

A.Intraocular neoplasms, especially malignant melanoma and retinoblastoma

B.Eyelid neoplasms, especially basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and sebaceous gland carcinoma

C.Conjunctival neoplasms, especially squamous cell carcinoma and malignant melanoma

D.Paranasal sinus cysts (mucoceles; Fig. 14.49) and neoplasms, especially squamous cell carcinoma, adenoid cystic carcinoma (malignant cylindroma), and mucoepidermoid carcinoma

E.Intracranial, especially meningioma II. Metastatic†

A.Neuroblastoma in children usually occurs as a late manifestation of the disease. Frequently, the orbital metastases are heralded by the onset of lower-lid ecchymosis (Fig. 14.50).

B.Lung carcinoma in adult men

C.Breast and lung carcinoma in adult women

In the past, breast carcinoma was much more common in women than lung carcinoma. With increased smoking by women, however, lung carcinoma has become much more common. Lung carcinoma tends to metastasize early, whereas breast metastases tend to be a late manifestation.

D.All other sites of primary neoplasms are rare.

BIBLIOGRAPHY

Normal Anatomy

Bu am FV: Lacrimal disease. In Podos SM, Yano M, eds: Textbook of Ophthalmology, vol. 4. New York, Gower Medical Publishing, 1993:7.1–7.6

Dutton JJ: Clinical anatomy of the orbit. In Ynao M, Duker JS, eds. Ophthalmology, 2nd edn. St. Louis, Mosby, 2004:641–648

Levine MR, Larson DW: Orbital tumors. In Podos SM, Yano M, eds: Textbook of Ophthalmology, vol. 4. New York, Gower Medical Publishing, 1993:10.4–10.13

Obata H, Yamamoto S, Horiuchi H et al.: Histopathologic study of human lacrimal gland: Statistical analysis with special reference to aging. Ophthalmology 102:678, 1995

Wojno TH: Orbital trauma and fractures. In Podos SM, Yano M, eds: Textbook of Ophthalmology, vol. 4. New York, Gower Medical Publishing, 1993:9.1–9.4

Exophthalmos

Char DH, Sobel D, Kelly WM et al.: Magnetic resonance scanning in orbital tumor diagnosis. Ophthalmology 92:1305, 1985

Hyman RA, Edwards JH: MR imaging versus CT in the evaluation of orbital lesions. Geriatr Ophthalmol 1:15, 1985

Kodsi SR, Shetlar DJ, Campbell RJ et al.: A review of 340 orbital tumors in children during a 60-year period. Am J Ophthalmol 117:177, 1994

Shields JA, Bakewell B, Augsburger JJ et al.: Classification and incidence of space-occupying lesions of the orbit: A survey of 645 biopsies.

Arch Ophthalmol 102:1606, 1984

Zimmerman RA, Bilaniuk LT, Yano M et al.: Orbital magnetic resonance imaging. Am J Ophthalmol 100:312, 1985

Developmental Abnormalities

Hoepner J, Yano M: Craniosynostosis and syndactylism (Apert’s syndrome) associated with a trisomy 21 mosaic. J Pediatr Ophthalmol 8:107, 1971

Kivelä T, Tarkkanen A: Orbital germ cell tumors revisited: A clinicopathological approach to classification. Surv Ophthalmol 38:541, 1994

Pasquale LR, Romayananda N, Kubacki J et al.: Congenital cystic eye with multiple ocular and intracranial anomalies. Arch Ophthalmol 109:985, 1991

Pokorny KS, Hyman BM, Jakobiec FA et al.: Epibulbar choristomas containing lacrimal tissue: Clinical distinction from dermoids and histologic evidence of an origin from the palpebral lobe. Ophthalmology 94:1249, 1987

Shields JA, Shields CL: Orbital cysts of childhood—classification, clinical features, and management. Surv Ophthalmol 49:281, 2004

Wilkins RB, Ho mann RJ, Byrd WA et al.: Heterotopic brain tissue in the orbit. Arch Ophthalmol 105:390, 1987

Yano M, Rorke LB, Niederer BS: Ocular and cerebral abnormalities in 18 chromosome deletion defect. Am J Ophthalmol 70:391, 1970

Orbital Inflammation

Duker JS, Brown GC, Brooks L: Retinal vasculitis in Crohn’s disease.

Am J Ophthalmol 103:664, 1987

Fairley C, Sullivan TJ, Bartley P et al.: Survival after rhino-orbital- cerebral mucormycosis in an immunocompetent patient. Ophthalmology 107:555, 2000

Font RL, Yano M, Zimmerman LE: Benign lymphoepithelial lesion of the lacrimal gland and its relationship to Sjögren’s syndrome. Am J Clin Pathol 48:365, 1967

Gravanis MB, Giansanti DMD: Malignant histopathologic counterpart of the benign lymphoepithelial lesion. Cancer 26:1332, 1970

Haneji N, Nakamura T, Takio K et al.: Identification of α-fodrin as a candidate antigen in primary Sjögren’s syndrome. Science 276:604, 1997

Hunt WE: Tolosa–Hunt syndrome: One cause of painful ophthalmoplegia. J Neurosurg 44:544, 1976

Jones DT, Monroy D, Ji Z et al.: Sjögren’s syndrome: Cytokine and Epstein–Barr viral gene expression within the conjunctival epithelium.

Invest Ophthalmol Vis Sci 35:3493, 1994

Kattah JC, Zimmerman LE, Kolsky MP et al.: Bilateral orbital involvement in fatal giant cell polymyositis. Ophthalmology 978:520, 1990

Klapper SR, Patrinely JR, Kaplan SL et al.: Atypical mycobacterial infection of the orbit. Ophthalmology 102:1536, 1995

McNab AA, Wright JE: Orbitofrontal cholesterol granuloma. Ophthalmology 97:28, 1990

Meyer D, Yano M, Hanno H: Di erential diagnosis in Mikulicz’s syndrome, Mikulicz’s disease and similar disease entities. Am J Ophthalmol 71:516, 1971

Parken B, Chew JB, White VA et al.: Lymphocytic infiltrationand enlargement of the lacrimal glands: a new subtype of primary Sjögren’s syndrome? Ophthalmology 112:2040, 2005

Streeten BW, Rabuzzi DD, Jones DB: Sporotrichosis of the orbital margin. Am J Ophthalmol 77:750, 1974

Tsubota K, Fujita H, Tsuzaka K et al.: Mikulicz’s disease and Sjögren’s syndrome. Invest Ophthalmol Vis Sci 41:1666, 2000

Tsubota K, Saito I, Miyasaka N: Granzyme A and perforin expressed in the lacrimal glands of patients with Sjögren’s syndrome. Am J Ophthalmol 117:120, 1994

Injuries

See Chapter 5 for bibliography.

Vascular Disease

See bibliography under appropriate sections.

Foroozan R, Shields CL, Shields JA et al.: Congenital orbital varices causing extreme neonatal proptosis. Am J Ophthalmol 129:693, 2000

Lacey B, Rootman J, Vangveeravong S et al.: Distensible venous malformations of the orbit. Ophthalmology 106:1197, 1999

Wright JF, Sullivan TJ, Garner A et al.: Orbital venous abnormalities.

Ophthalmology 104:905, 1997

Ocular Muscle Involvement in Systemic Disease

Bahn RS, Dutton CM, Heufelder AE et al.: A genomic point mutation in the extracellular domain of the thyrotropin receptor in patients with Graves’ ophthalmopathy. J Clin Endocrinol Metab 78:256, 1994

Bartalena L, Marcocci C, Bogazzi F et al.: Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 338:73, 1998

Bartley GB, Gorman CA: Diagnostic criteria for Graves’ disease. Am J Ophthalmol 119:792, 1995

Bartley GB, Fatourechi V, Kadrmas EF et al.: Clinical features of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol 121:284, 1996

Bartley GB, Fatourechi V, Kadrmas EF et al.: The chronology of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol 121:426, 1996

Bartley GB, Fatourechi V, Kadrmas EF et al.: Long-term follow-up of Graves’ ophthalmopathy in an incidence cohort. Ophthalmology 103:958, 1996

Carta A, D’Adda T, Carrara F et al.: Ultrastructural analysis of external muscle in chronic progressive external ophthalmoplegia. Arch Ophthalmol 118:1441, 2000

Chang TS, Johns DR, Walker D et al.: Ocular clinicopathologic study of the mitochondrial encephalomyopathy overlap syndromes. Arch Ophthalmol 111:1254, 1993

Crisp M, Starkey KJ, Lane C et al.: Adipogenesis in thyroid eye disease.

Invest Ophthalmol Vis Sci 41:3249, 2000

De Carli M, D’Elios MM, Mariotti S et al.: Cytolytic T cells with Th1-like cytokine profile predominate in retroorbital lymphocytic infiltrates of Grave’s ophthalmology. J Clin Endocrinol Metab 77:1120, 1993

Drachman DB: Myasthenia gravis. N Engl J Med 330:1797, 1994

Eshaghian J, March WF, Goossens W et al.: Ultrastructure of cataract in myotonic dystrophy. Invest Ophthalmol Vis Sci 17:289, 1978

Folberg R, Rummelt V, Ionasescu V: MELAS syndrome. Presented at the meeting of the Verhoe Society, 1993

Herzberg NH, van Schooneveld MJ, Bleeker-Wagemakers EM et al.:

Kearns–Sayre syndrome with a phenocopy of choroideremia instead of pigmentary retinopathy. Neurology 43:218, 1993

Jaume JC, Portolano S, Prummel MF et al.: Molecular cloning and characterization of genes for antibodies generated by orbital tissueinfiltrating B-cells in Graves’ ophthalmopathy. J Clin Endocrinol Metab 78:348, 1994

Leib ML, Odel JG, Cooney MJ: Orbital polymyositis and giant cell myocarditis. Ophthalmology 101:950, 1994

Nunery WR, Martin RT, Heinz GW et al.: The association of cigarette smoking with clinical subtypes of ophthalmic Graves’ disease. Ophthalmic Plast Reconstr Surg 9:77, 1993

Ohtsuka K, Hashimoto M: 1H-magnetic resonance spectroscopy of retrobulbar tissue in Graves ophthalmopathy. Am J Ophthalmol 128:715, 1999

Philips AV, Timchenko LT, Cooper TA: Disruption of splicing regulated by a CUG-binding protein in myotonic dystrophy. Science 280:737, 1998

Rosen CE, Parisi F, Raikow RB et al.: Immunohistochemical evidence for C3bi involvement in Graves’ ophthalmopathy. Ophthalmology 99:1325, 1992

Rosen CE, Raikow RB, Burde RM et al.: Immunohistochemical evidence for IgA1 involvement in Graves’ ophthalmopathy. Ophthalmology 99:146, 1992

Rummelt V, Folberg R, Ionasescu V et al.: Ocular pathology of MELAS syndrome with mitochondrial DNA nucleotide 3243 point mutation.

Ophthalmology 100:1757, 1993

Small RG: Enlargement of levator palpebrae superioris muscle fibers in Graves’ ophthalmopathy. Ophthalmology 96:424, 1989

Sue CM, Mitchell P, Crimmins DS et al.: Pigmentary retinopathy associated with the mitochondrial DNA 3243 mutation.Neurology 49:1013, 1997

Van Dyk HJL: Orbital Graves’ disease: A modification of the “no specs” classification. Ophthalmology 88:479, 1981

Weinberg DA, Lesser RL, Vollmer TL: Myasthenia gravis: A protein disorder. . Surv Ophthalmol 39:169, 1994

Yano M: Pretibial myxedema: A case report. Med Ann DC 34:319, 1965

Tumors: Choristoma

Boynton JR, Searl SS, Ferry AP et al.: Primary nonkeratinized epithelial (“conjunctival”) orbital cysts. Arch Ophthalmol 110:1238, 1992

Eijpe AA, Koornneef L, Verbeeten B et al.: Intradiploic epidermoid cysts of the bony orbit. Ophthalmology 98:1737, 1991

Goldstein MH, Soparkar CNS, Kersten RC et al.: Conjunctival cysts of the orbit. Ophthalmology 105:2056, 1998

Holds JB, Anderson RL, Mamalis N et al.: Invasive squamous cell carcinoma arising from asymptomatic choristomatous cysts of the orbit.

Ophthalmology 100:1244, 1993

Howard GR, Nerad JLA, Bonavolonta G et al.: Orbital dermoid cysts located within the lateral rectus muscle. Ophthalmology 101:767, 1994

Meyer DR, Lessner AM, Yeatts P et al.: Primary temporal fossa dermoid cyst: Characterization and surgical management. Ophthalmology 106:342, 1999

Pokorny KS, Hyman BM, Jakobiec FA et al.: Epibulbar choristomas containing lacrimal tissue: Clinical distinction from dermoids and histologic evidence of an origin from the palpebral lobe. Ophthalmology 94:1249, 1987

Prause JU, Børgesen SE, Carstensen H et al.: Cranio-orbital teratoma.

Acta Ophthalmol Scand Suppl 219:53, 1996

Rush A, Leone CR Jr: Ectopic lacrimal gland cyst of the orbit. Am J Ophthalmol 92:198, 1981

Shields JA, Shields CL: Orbital cysts of childhood—classification, clinical features, and management. Surv Ophthalmol 49:281, 2004

Tumors: Hamartomas

Bowen JH, Christensen FH, Klintworth GK et al.: A clinicopathologic study of a cartilaginous hamartoma of the orbit: A rare cause of proptosis. Ophthalmology 88:1356, 1981

Burnstine MA, Frueh BR, Elner VM: Angiosarcoma metastatic to the orbit. Arch Ophthalmol 114:93, 1996

Canavan YM, Logan WC: Benign hemangioendothelioma of the lacrimal gland fossa. Arch Ophthalmol 97:1112, 1979

Chang EL, Rubin PAD: Bilateral multifocal hemangilas of the orbit in the blue rubber bleb nevus syndrome. Ophthalmology 109:258, 2002 Ferry AP, Kaltreider SA: Cavernous hemangioma of the lacrimal sac.

Am J Ophthalmol 110:316, 1990

Geyer O, Neudorfer M, Stolevitch C et al.: Giant cavernous hemangioma of the face. Arch Ophthalmol 112:123, 1994

Haik BG, Karcioglu ZA, Gordon RA et al.: Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol 38:399, 1994

Harris GJ, Sakol PJ, Bonavolonta G et al.: An analysis of thirty cases of orbital lymphangioma. Ophthalmology 97:1583, 1990

Henderson JW, Farrow GM, Garrity JA: Clinical course of an incompletely removed cavernous hemangioma of the orbit. Ophthalmology 97:625, 1990

Imayama S, Murakamai Y, Hashimoto H et al.: Spindle cell hemangioendothelioma exhibits the ultrastructural features of reactive vascular proliferation rather than of angiosarcoma. Am J Clin Pathol 97:279, 1992

Katz SE, Rootman J, Vangveeravong S et al.: Combined venous lymphatic malformations of the orbit (so-called lymphangiomas): Association with noncontiguous intracranial vascular anomalies. Arch Ophthalmol 105:176, 1998

Kazim M, Kennerdell JS, Rothfus W et al.: Orbital lymphangioma.

Ophthalmology 99:1588, 1993

Neufeld M, Pe’er J, Rosenman E et al.: Intraorbital glomus cell tumor.

Am J Ophthalmol 117:539, 1994

Relf SJ, Bartley GB, Unni KK: Primary orbital intraosseous hemangioma. Ophthalmology 98:541, 1991

Reeves SW, Miele DL, Woodward JA et al.: Retinal folds as initial manifestation of orbital lymphangioma. Arch Ophthalmol 123:1756, 2005

Scheuerle AF, Steiner HH, Kolling G et al.: Treatment and long-term outcome of patients with orbital cavernomas. Am J Ophthalmol 138:237, 2004

Tunç M, Sadri E, Char DH: Orbital lymphangioma: An analysis of 26 patients. Br J Ophthalmol 83:76, 1999

Tumors: Mesenchymal–Vascular

Alles JU, Bosslet K: Immunocytochemistry of angiosarcomas: A study of 19 cases with special emphasis on the applicability of endothelial cell specific markers to routinely prepared tissues. Am J Clin Pathol 89:463, 1988

Cheuk W, Wong KOY, Wong CSC et al.: Immunostaining for human herpesvirus 8 latent nuclear antigen—1 helps distinguish Kaposi sarcoma from its mimickers. Am J Clin Pathol 121:335, 2004

Chow LTC, Yuen RWS, Tsui WMS et al.: Cytologic features of Kimura’s disease in fine-needle aspirates: A study of eight cases. Am J Clin Pathol 102:316, 1994

Fajardo LF: The complexity of endothelial cells. Am J Clin Pathol 92:241, 1989

Fetsch JF, Weiss SW: Observations concerning the pathogenesis of epithelioid hemangioma (angiolymphoid hyperplasia). Mod Pathol 4:449,

1991

Finn WG, Goolsby CL, Rao MS: DNA flow cytometric analysis of hemangiopericytoma. Am J Clin Pathol 101:181, 1994

Ghabrial R, Quivey JM, Dunn JP et al.: Radiation therapy of acquired immunodeficiency syndrome-related Kaposi’s sarcoma of the eyelids and conjunctiva. Arch Ophthalmol 110:1423, 1992

Jin Y-T,Tsai S-T, Yan J-J et al.: Detection of Kaposi’s sarcoma-associated herpesvirus-like DNA sequence in vascular lesions: A reliable diagnostic marker for Kaposi’s sarcoma. Am J Clin Pathol 105:360, 1996

Karcioglu ZA, Nasr A, Haik BG: Orbital hemangiopericytoma: Clinical and morphologic features. Am J Ophthalmol 124:661, 1997

Kledal TN, Rosenkilde MM, Coulin F et al.: A broad spectrum chemokine antagonist encoded by Kaposi’s sarcoma-associated herpesvirus. Science 277:1656, 1997

Kurumety UR, Lustbader JM: Kaposi’s sarcoma of the bulbar conjunctiva as an initial clinical manifestation of acquired immunodeficiency syndrome. Arch Ophthalmol 113:978, 1995

Lee JT, Pettit TH, Glascow BJ: Epibulbar hemangiopericytoma. Am J Ophthalmol 124:546, 1997

McEachren TM, Brownstein S, Jordan DR et al.: Epithelioid hemangioma of the orbit. Ophthalmology 107:806, 2000

Rettig MB, Ma RJ, Vescio RA et al.: Kaposi’s sarcoma-associated herpesvirus infection of bone marrow dendritic cells from multiple myeloma patients. Science 276:1851, 1997

Saxe SJ, Grossniklaus HE, Wojno TH et al.: Glomus cell tumor of the eyelid. Ophthalmology 100:139, 1993

Sekundo W, Roggenkämper P,Tschubel K et al.: Hemangio pericytoma of the inner canthus. Am J Ophthalmol 121:445, 1996

Tumors: Mesenchymal–Fatty

Brown HH, Kersten RC, Kulwin DR: Lipomatous hamartoma of the orbit. Arch Ophthalmol 109:240, 1991

Daniel CS, Beaconsfield M, Rose GF et al.: Pleomorphic lipoma of the orbit: a case series and review of the literature. Ophthalmology 110:101, 2003

Feinfield RE, Hesse RJ, Scharfenberg JC: Orbital angiolipoma. Arch Ophthalmol 106:1093, 1988

Gibis Z, Miettinen M, Limon J et al.: Cytogenetic and immunohistochemical profile of myxoid liposarcoma. Am J Clin Pathol 103:20, 1995

Sabb PC, Syed NA, Sires BS et al.: Primary orbital myxoid liposarcoma presenting as orbital pain. Arch Ophthalmol 114:353, 1996

Small ML, Green WR, Johnson LC: Lipoma of the frontal bone. Arch Ophthalmol 97:129, 1979

Yoganathan P, Meyer DR, Farber MG: Bilateral lacrimal gland involvement with Kimura disease in an African American male. Arch Ophthalmol 122:917, 2004

Tumors: Mesenchymal–Fibrous–Histiocytic

Allaire GS, Corriveau C, Teboul N: Malignant fibrous histiocytoma of the conjunctiva. Arch Ophthalmol 117:685, 1999

deBacker CM, Bodker F, Putterman AM et al.: Solitary fibrous tumor of the orbit. Am J Ophthalmol 121:447, 1996

Barr FG, Chatten J, D’Cruz et al.: Molecular assays for chromosomal translocations in the diagnosis of pediatric soft tissue sarcomas. JAMA 273:553, 1995

Bernardini FP, de Concilius C, Schneider S et al.: Solitary fibrous tumor of the orbit: is it rare? Report of a case series and review of the literature. Ophthalmology 110:1442, 2003

Boynton JR, Markowitch W, Searl SS: Atypical fibroxanthoma of the eyelid. Ophthalmology 96:1480, 1989

Conway RM, Holbach LM, Naumann GOH et al.: Benign fibrous histiocytoma of the corneoscleral limbus: unique clinicopathologic features. Arch Ophthalmol 121:1776, 2003

Dei Tos AP, Seregard S, Calonje E et al.: Giant cell angiofibroma: A distinctive orbital tumor in adults. Am J Surg Pathol 19:1286, 1995 Dickey GE, Sotelo-Avila C: Fibrous hamartoma of infancy: current

review. Pediatr Dev Pathol 2:236, 1999

Dorfman DM, To K, Dickerson GR et al.: Solitary fibrous tumor of the orbit. Am J Surg Pathol 18:281, 1994

Ferry AP, Sherman SE: Nodular fasciitis of the conjunctiva apparently originating in the fascia bulbi (Tenon’s capsule). Am J Ophthalmol

78:514, 1974

Font RL, Hidayat AA: Fibrous histiocytoma of the orbit: A clinicopathologic study of 150 cases. Hum Pathol 13:199, 1982

Gold JS, Antonescu CR, Hajdu C et al.: Clinicopathologic correlates of solitary fibrous tumors. Cancer 94:1057, 2002

Hartstein ME, Grove AS Jr, Woog JJ et al.: The multidisciplinary management of psammomatoid ossifying fibroma of the orbit. Ophthalmology 105:591, 1998

Hasegawa T, Hirose T, Seki K et al.: Solitary fibrous tumor of the soft tissue. An immunohistochemical and ultrastructural study. Am J Clin Pathol 106:325, 1996

Hayashi N, Borodic G, Karesh JW et al.: Giant cell angiofibroma of the orbit and eyelid. Ophthalmology 106:1223, 1999

Heathcote JG: Solitary fibrous tumor of the orbit. Can J Ophthalmol 32:432, 1997

Ing EB, Kennerdell JS, Olsen PR et al.: Solitary fibrous tumor of the orbit. Ophthalmic Plast Reconstr Surg 14:57, 1997

Jakobiec FA: Solitary fibrous tumor. Presented at the meeting of the Verhoe Society, 1994

Jakobiec FA, Klapper D, Maher E et al.: Infantile subconjunctival and anterior orbital fibrous histiocytoma: Ultrastructural and immunohistochemical studies. Ophthalmology 95:516, 1988

Jakobiec FA, Sacks E, Lisman RL et al.: Epibulbar fibroma of the conjunctival substantia propria. Arch Ophthalmol 106:661, 1988

John T, Yano M, Scheie HG: Eyelid fibrous histiocytoma: Ophthalmology 88:1193, 1981

Jones WD III, Yano M, Katowitz JA: Recurrent facial fibrous histiocytoma. Br J Plast Surg 32:46, 1979

Krishnakumar S, Subramanian N, Mohan ER et al.: Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of the literature. Surv Ophthalmol 48:544, 2003

Lakshminarayanan R, Konia T, Welborn J: Fibrous hamartoma of infancy. Arch Pathol Lab Med 129:520, 2005

Linder JS, Harris GJ, Segura AD: Periorbital infantile myofibromatosis.

Arch Ophthalmol 114:219, 1996

Ma CK, Zarbo RJ, Gown AM: Immunohistochemical characterization of atypical fibroxanthoma and dermatofibrosarcoma protuberans. Am J Clin Pathol 97:478, 1992

Martin AJ, Summersgill BM, Fisher C et al.: Chromosomal imbalances in meningeal solitary fibrous tumors. Cancer Genet Cytogenet 135:160, 2002

Rice CD, Gross DJ, Dinehart SM et al.: Atypical fibroxanthoma of the eyelid and cheek. Arch Ophthalmol 109:922, 1991

Scott IU, Tanenbaum M, Rubin D et al.: Solitary fibrous tumor of the lacrimal gland fossa. Ophthalmology 103:1613, 1996

Song A, Syed N, Kirby PA et al.: Giant cell angiofibroma of the ocular adnexae. Arch Ophthalmol 123:1438, 2005

Weiner JM, Hidayat AA: Juvenile fibrosarcoma of the orbit and eyelid.

Arch Ophthalmol 101:253, 1983

Westfall AC, Mansoor A, Sullivan SS et al.: Orbital and periorbital myofibromas in childhood: two case reports. Ophthalmology 110:2000, 2003

Westra WH, Gerald WL, Rosai J: Solitary fibrous tumor of the orbit: consistent CD34 immunoreactivity and occurrence in the orbit. Am J Surg Pathol 18:992, 1994

White VA, Heathcote G, Hurwitz JJ et al.: Epithelioid sarcoma of the orbit. Ophthalmology 101:1689, 1994

Wiley EL, Stewart D, Brown M et al.: Fibrous histiocytoma of the parotid gland. Am J Clin Pathol 97:512, 1992

Yano M, Scheie HG: Fibrosarcoma of the orbit: Report of two cases. Cancer 19:1711, 1966

Tumors: Mesenchymal–Muscle

Azumi N, Ben-Ezra J, Battifora H: Immunophenotypic diagnosis of leiomyosarcomas and rhabdomyosarcomas with monoclonal antibodies to muscle-specific actin and desmin in formalin-fixed tissue. Mod Pathol 1:469, 1988

Barr FG, Chatten J, D’Cruz et al.: Molecular assays for chromosomal translocations in the diagnosis of pediatric soft tissue sarcomas. JAMA 273:553, 1995

Van den Broek PP, de Faber J-THN, Kli en M et al.: Anterior orbital leiomyoma. Possible pulley smooth muscle tissue tumor. Arch Ophthalmol 123:1614, 2005

Du y MT, Harris M, Hornblass A: Infantile myofibromatosis of orbital bone: A case report with computed tomography, magnetic resonance imaging, and histologic findings. Ophthalmology 104:1471, 1997

Frayer WC, Enterline HT: Embryonal rhabdomyosarcoma of the orbit in children and young adults. Arch Ophthalmol 62:203, 1959

Gündüz K, Shields JA, Eagle RC Jr et al.: Malignant rhabdoid tumor of the orbit. Arch Ophthalmol 116:243, 1998

Hill DA, O’Sullivan MJ, Zhu X et al.: Practical application of molecular genetic testing as an aid to the surgical patthologic diagnosis of sarcomas: a prospective study. Am J Surg Pathol 26:965, 2002

Hou LC, Murphy MA, Tung GA: Primary orbital leiomyosarcoma: a case report with MRI findings. Am J Ophthalmol 135:408, 2003

Karcioglu ZA, Hadjistilianou D, Rozans M et al.: Orbital rhabdomyosarcoma. Cancer Control 11:328, 2004

Miguel-Fraile PS, Carrillo-Gijón R, Rodriguez-Peralto JL et al.:

Prognostic significance of DNA ploidy and proliferative index (MIB-1 index) in childhood rhadomyosarcomas. Am J Clin Pathol 121:358,

2004

Parthaam DM, Weeks DA, Beckwith JB: The clinicopathologic spectrum of putative extrarenal rhabdoid tumors: An analysis of 42 cases studied with immunohistochemistry or electron microscopy. Am J Surg Pathol 18:1010, 1994

Porterfield JF, Zimmerman LE: Orbital rhabdomyosarcoma: A clinicopathologic study of 55 cases. Virchows Arch Pathol Anat 335:329, 1962

Shields CL, Shields JA: Rhabdomyosarcoma: review for the ophthalmologist. Surv Ophthalmol 48:39, 2003

Taylor SF, Yen KG, Patel BCK: Primary conjunctival rhabdomyosarcoma. Arch Ophthalmol 120:668, 2002

Xia SJ, Pressey JG, Barr FG: Molecular pathogenesis of rhabdomyosarcoma. Cancer Biol Ther 1:2:97, 2002

Tumors: Mesenchymal–Cartilage

Jacobs JL, Merriam JC, Chadburn A et al.: Mesenchymal chondrosarcoma of the orbit: Report of three new cases and review of the literature. Cancer 73:399, 1994

Pasternak S, O’Connell JX, Verchere C et al.: Enchondroma of the orbit. Am J Ophthalmol 122:444, 1996

Tuncer S, Kebudi R, Peksayar G et al.: Congenital mesenchymal chondrosarcoma of the orbit: case report and review of the literature. Ophthalmology 111:1016, 2004

Tumors: Mesenchymal–Bone

Dailey R, Gilliland G, McCoy GB: Orbital aneurysmal bone cyst in a patient with renal cell carcinoma. Am J Ophthalmol 117:643, 1994

Katz BJ, Nerad JA: Ophthalmic manifestations of fibrous dysplasia: A disease of children and adults. Ophthalmology 105:2207, 1998

Leone CR, Lawton AW, Leone RT: Benign osteoblastoma of the orbit.

Ophthalmology 95:1554, 1988

Mercado GV, Shields CL, Gunduz K et al.: Giant cell reparative granuloma of the orbit. Am J Ophthalmol 127:485, 1999

Mooy CM, Naus NC, de Klein A et al.: Orbital chondrosarcoma developing in a patient with Paget’s disease. Am J Ophthalmol 127:619, 1999

Parmar DN, Luthert PH, Cree IA et al.: Two unusual osteogenic orbital tumors: presumed parosteal osteosarcoma. Ophthalmology 108:1452, 2001

Parrish CM, O’Day DM: Brown tumor of the orbit: Case report and review of the literature. Arch Ophthalmol 104:1199, 1986

Sires BS, Benda PM, Stanley RB Jr et al.: Orbital osteoid osteoma. Arch Ophthalmol 117:414, 1999

Trevisani MG, Fry CL, Hesse RJ et al.: A rare case of orbital osteogenic sarcoma. Arch Ophthalmol 114:494, 1996

Weiss JS, Bressler SB, Jacobs EF et al.: Maxillary ameloblastoma with orbital invasion: A clinicopathologic study. Ophthalmology 92:710, 1985

Tumors: Neural

Allman MI, Frayer WC, Hedges TR Jr: Orbital neurilemoma. Ann Ophthalmol 9:1409, 1977

Andreoli CA, Hatton M, Semple JP et al.: Perilimbal conjunctival schwannoma. Arch Ophthalmol 122:388, 2004

Arora R, Sarkar C, Betharia SM: Primary orbital primitive neuroectodermal tumor with immunohistochemical and electron microscopic confirmation. Orbit 12:7, 1993

Brannan PA, Schneider S, Grosniklaus HE et al.: Malignant mesenchymoma of the orbit. Case report and review of the literature. Ophthalmology 110:314, 2003

Briscoe D, Mahmood S, O’Donovan DG et al.: Malignant peripheral nerve sheath tumor in the orbit of a child with acute proptosis. Arch Ophthalmol 120:653, 2002

Bullock JD, Goldberg SH, Rakes S et al.: Primary orbital neuroblastoma. Arch Ophthalmol 107:1031, 1989

Chan C-C, Pack S, Pak E et al.: Translocation of chromosome 11 and 22 in choroidal metastatic Ewing sarcoma detected by fluorescent in situ hybridization. Am J Ophthalmol 127:226, 1999

Charles NC, Fox DM, Avendaño JA et al.: Conjunctival neurilemoma.

Arch Ophthalmol 115:547, 1997

Choi RY, Lucarelli MJ, Imesch PD et al.: Primary orbital Ewing sarcoma in a middle-aged woman. Arch Ophthalmol 117:535, 1999 Cibis GW, Freeman WI, Pang V et al.: Bilateral choroidal neonatal

neuroblastoma. Am J Ophthalmol 109:445, 1990

Coira BM, Sachdev R, Moscovic E: Skeletal muscle markers in alveolar soft part sarcoma. Am J Clin Pathol 94:790, 1990

Furman J, Murphy WM, Jelsma PF et al.: Primary primitive neuroectodermal tumor of the kidney: Case report and review of the literature.

Am J Clin Pathol 106:339, 1996

Halling KC, Scheithauer BW, Halling AC et al.: p53 expression in neurofibroma and malignant peripheral nerve sheath tumors: An immunohistochemical study of sporadic and ND-1 associated tumors.

Am J Clin Pathol 106:282, 1996

Hill DA, Pfeifer JD, Marley EF et al.: WT1 staining reliably di erentiates desmoplastic small round cell tumor from Ewing sarcoma/primitive neuroectodermal tumor: an immunohistochemical and molecular diagnostic study. Am J Clin Pathol 114:345, 2000

Khwang SI, Lucarelli MJ, Lemke BN et al.: Ancient schwannoma of the orbit. Arch Ophthalmol 117:262, 1999

Kussie PH, Gorina S, Marechal V et al.: Structure of the MDM2 oncoprotein bound to the p53 tumor suppressor transactivation domain. Science 274:948, 1996

Le Marc’hadour F, Romanet JP, Péoc’h M et al.: Schwannoma of the bulbar conjunctiva. Arch Ophthalmol 114:1258, 1996

Li T, Goldberg RA, Becker B et al.: Primary orbital extraskeletal Ewing sarcoma. Arch Ophthalmol 121:1049, 2003

Lucas DR, Bentley G, Dan ME et al.: Ewing sarcoma vs. lymphoblastic lymphoma: A comparative immunohistochemical study. Am J Clin Pathol 115:11, 2001

Messmer EP, Camara J, Boniuk M et al.: Amputation neuroma of the orbit: Report of two cases and review of the literature. Ophthalmology 91:1420, 1984

Pineda R II, Urban RC, Bellows AR et al.: Ciliary body neurilemoma.

Ophthalmology 102:918, 1995

Renshaw AA, Perez-Atayde AR, Fletcher JA et al.: Cytology of typical and atypical Ewing’s sarcoma/PNET. Science 274:948, 1996

Shields JA, Font RL, Eagle RC et al.: Melanotic schwannoma of the choroid. Ophthalmology 101:843, 1994

Singh AD, Husson M, Shields CL et al.: Primitive neuroectodermal tumor of the orbit. Arch Ophthalmol 112:217, 1994

Warwar RE, Bullock JD, Shields JA et al.: Coexistence of 3 tumors of neural crest origin: Neurofibroma, meningioma, and uveal melanoma.

Arch Ophthalmol 116:1241, 1997

Weiss SW: p53 gene alterations in benign and malignant nerve sheath tumors. Am J Clin Pathol 106:271, 1996

Tumors: Miscellaneous

Archer KF, Hurwitz JJ, Balogh JM et al.: Orbital nonchroma n paraganglioma. Ophthalmology 96:1659, 1989

Candy EJ, Miller NR, Carson BS: Myxoma of bone involving the orbit.

Arch Ophthalmol 109:919, 1991

Charles NC, Fox DM, Glasberg SS et al.: Epibulbar granular cell tumor: Report of a case and review of the literature. Ophthalmology 104:1454, 1997

Hashimoto M, Ohtsuka K, Suzuki T et al.: Orbital granular cell tumor developing in the inferior oblique muscle. Am J Ophthalmol 124:405, 1997

Jordan DR, MacDonald H, Noel L et al.: Alveolar soft-part sarcoma of

Sabet SJ, Tarbet KJ, Lemke BN et al.: Granular cell tumor of the lacrimal sac and nasolacrimal duct. No invasive behavior with incomplete resection. Ophthalmology 107:1992, 2000

Vogel MH: Granular cell myoblastoma of the ciliary body. Presented at the combined Meeting of the Verhoe Society and the European Ophthalmic Pathology Society, Houston, TX, April, 1996

Tumors: Epithelial of Lacrimal Gland

Alyahya GA, Stenman G, Persson F et al.: Pleomorphic adenoma arising in an accessory lacrimal gland of Wolfring. Ophthalmology 113:879, 2006

Bonavolontà G, Tranfa F, Staibano S et al.: Warthin tumor of the lacrimal sac. Am J Ophthalmol 124:857, 1997

Bullock JD, Fleishman JA, Rosset JS: Lacrimal ductal cysts. Ophthalmology 93:1355, 1986

Conlon MR, Chapman WB, Burt WL et al.: Primary localized amyloidosis of the lacrimal glands. Ophthalmology 98:1556, 1991

Devoto MH, Croxatto O: Primary cystadenocarcinoma of the lacrimal gland. Ophthalmology 110:2006, 2003

Font RL, Patipa M, Rosenbaum PS et al.: Correlation of computed tomographic and histopathologic features in malignant transformation of benign mixed tumor of lacrimal gland. Surv Ophthalmol 34:449, 1990

Font RL, Smith SL, Bryan RG: Malignant epithelial tumors of the lacrimal gland: A clinicopathologic study of 21 cases. Arch Ophthalmol 116:589, 1998

Grossniklaus HE, Abbuhl MF, McLean IW: Immunohistologic properties of benign and malignant mixed tumor of the lacrimal gland. Am J Ophthalmol 110:540, 1990

Grossniklaus HE, Wojno TH, Wilson MW et al.: Myoepithelioma of the lacrimal gland. Arch Ophthalmol 115:1588, 1997

Harris NL: Lymphoid proliferations of the salivary glands. Am J Clin Pathol 111(Suppl. 1):S94, 1999

Heathcote JG, Hurwitz JJ, Dardick I: A spindle-cell myoepithelioma of the lacrimal gland. Arch Ophthalmol 108:1135, 1990

Khalil M, Arthurs B: Basal cell adenocarcinoma of the lacrimal gland.

Ophthalmology 107:164, 2000

Levin LA, Popham J, To K et al.: Mucoepidermoid carcinoma of the lacrimal gland. Ophthalmology 98:1551, 1991

Milman T, Shields JA, Husson M et al.: Primary ductal adenocarcinoma of the lacrimal gland. Ophthalmology 112:2052S, 2005

Ostrowski ML, Font RL, Halpern J et al.: Clear cell epithelial-myoepi- thelial carcinoma arising in pleomorphic adenoma of the lacrimal gland. Ophthalmology 101:925, 1994

Rao NA, Kaiser E, Quiros PA et al.: Lymphoepithelial carcinoma of the lacrimal gland. Arch Ophthalmol 120:1745S, 2002

Rodman RC, Frueh BR, Elner VM: Mucoepidermoid carcinoma of the caruncle. Am J Ophthalmol 123:564, 1997

Rosenberg PS, Mahadevia PS, Goodman LA et al.: Acinic cell carcinoma of the lacrimal gland. Arch Ophthalmol 113:781, 1995

Selva D, Davis GJ, Dodd T et al.: Polymorphous low-grade adenocarcinoma of the lacrimal gland. Arch Ophthalmol 122:915, 2004

Shields CL, Shields JA, Eagle RC et al.: Adenoid cystic carcinoma in the nasal orbit. Am J Ophthalmol 123:398, 1997

Shields CL, Shields JA, Eagle RC et al.: Adenoid cystic carcinoma of the lacrimal gland simulating a dermoid cyst in a 9-year-old boy. Arch Ophthalmol 116:1673, 1998

Tellado MV, McClean IW, Specht CS et al.: Adenoid cystic carcinomas of the lacrimal gland in childhood and adolescence. Ophthalmology 104:1622, 1997

Vangveeravong S, Katz SE, Rootman J et al.: Tumors arising in the palpebral lobe of the lacrimal gland. Ophthalmology 103:1606, 1996

Zimmerman LE, Stangl R, Riddle PJ: Primary carcinoid tumor of the orbit: A clinicopathologic study with histochemical and electron microscopic observations. Arch Ophthalmol 101:1395, 1983

Tumors: Reticuloendothelial System

Allaire GS, Hidayat AA, Zimmerman LE et al.: Reticulohistiocytoma of the limbus and cornea. Ophthalmology 97:1018, 1990

Ben-Ezra JM, Koo CH: Langerhans’ cell histiocytosis and malignancies of the M-Pire system. Am J Clin Pathol 99:464, 1993

Chikama T-I, Yoshino H, Nishida T et al.: Langerhans cell histiocytosis localized to the eyelid. Arch Ophthalmol 116:1375, 1998

Demirci H, Shields CL, Shields JA et al.: Bilateral sequential orbital involvement by eosinophilic granuloma. Arch Ophthalmol 120:978, 2002

DeStafeno JJ, Carlson A, Myer DR: Solitary spindle-cell xanthogranuloma of the eye lid. Ophthalmology 109:258, 2002

Font RL, Rosenbaum PS, Smith JL: Lymphomatoid granulomatosis of eyelid and brow with progression to lymphoma. J Am Acad Dermatol

23:334, 1990

Harbour JW, Char DH, Ljung BM et al.: Langerhans cell histiocytosis diagnosed by fine needle biopsy. Arch Ophthalmol 115:1212, 1997

Hogan MJ, Zimmerman LE, eds: Ophthalmic Pathology: An Atlas and Textbook. Philadelphia, WB Saunders, 1962:778

Ireland KC, Hutchinson AK, Grossniklaus HE: Sinus histiocytosis presenting as bilateral epibulbar masses. Am J Ophthalmol 127:360, 1999

Jordan DR, McDonald H, Noel L et al.: Eosinophilic granuloma. Arch Ophthalmol 111:134, 1993

Kramer TR, Noecker RJ, Miller JM et al.: Langerhans cell histiocytosis with ocular involvement. Am J Ophthalmol 124:814, 1997