fluorouracil, and tegafur. The predominant side effects of these drugs include myelosuppression, nausea, vomiting, and mucositis.

Vincristine is a Vinca alkaloid and has associated neurological side effects, such as paresthesias, neuritic pain, muscle weakness, ptosis, and diplopia. Etoposide is an epipodophyllotoxin. Its most common side effects are myelosuppression, alopecia, and gastrointestinal disturbances. Secondary acute myelogenous leukemia has been reported following chemotherapy with etoposide. Dactinomycin, doxorubicin, bleomycin, and mitomycin C are antibiotics. In toxicity profile, they are similar to the alkylating agents already discussed. Doxorubicin may cause a cardiomyopathy. Ventricular ejection may be monitored during treatment to detect early cardiotoxicity. A reversible alopecia also occurs with doxorubicin. Bleomycin has been reported to cause pulmonary toxicity. Mitomycin C induces a severe myelosuppression and thus has limited utility for systemic administration. Topical mitomycin C is well tolerated when delivered onto an intact conjunctival and corneal epithelium. Reported side effects have been transient and resolved upon discontinuation of the drug. These include conjunctival injection, chemosis, epiphora, and punctate keratitis.90–92,109,110 This is in contrast to earlier studies in which topical mitomycin C was applied to bare sclera, with a resultant scleral necrosis.16,117 The taxoids docetaxel and paclitaxel are derivatives of the yew tree. Their principal toxicity is myelosuppression and a severe allergic reaction. The first dose of should be administered under close observation. Interferon-alfa, interleukin 2, and granulocyte colony-stimulating factor cause flulike symptoms that may be accompanied by a rash or metabolic abnormalities.

The platinum-coordinated complexes include cisplatin and carboplatin. Their most significant side effect is myelosuppression. Cisplatin, unlike carboplatin, is more likely to be associated with nephrotoxicity and ototocixity. Cyclosporine and azathioprine are immunosuppressive agents. Cyclosporine can cause nephrotocixity, neurotoxicity, and hepatoxicity, while azathioprine’s most significant side effects are leukopenia and gastrointestinal distress.

Numerous side effects have been associated with prolonged use of corticosteroids. Most notably these include avascular necrosis of the hip, cataracts, cushingoid features, diabetes, glaucoma, hypertension, increased appetite, mood disturbances, osteoporosis, and gastric ulcers. Corticosteroid use should be limited to a few months. Agents that protect against osteoporosis and gastric irritation should be considered.

The monoclonal antibodies represent a new approach to chemotherapy, targeting specific cell surface markers in an attempt to maximize therapeutics and minimize toxicity. Infliximab, an inhibitor of tumor necrosis factor- , has been associated with severe

septicemia and reactivation of latent tuberculosis.32,33,118,119 Rare cases of optic neuritis and exacerbation of demyelinating diseases have been reported in patients receiving infliximab.120,121 Rituximab, an anti-CD20 monoclonal antibody, has been associated with hypersensitivity reactions resulting in interstitial pneumonitis and Stevens–Johnson syndrome.122,123 Rapid cell death following administration may result in tumor lysis syndrome and acute renal failure.124 Phase I to III trials with cetuximab, an antiepidermal growth factor receptor antibody, have reported fever, asthenia, transaminase elevation, nausea, and skin toxicities as the most adverse reactions.87–89

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radiation treatment of, 399 radiologic features of, 331–332 sign(s) of, 329–330

proptosis, bilateral as, 330 tests of, orbital change, 331 unilateral, lymphoma and, 332

H

Hemangioma, 219, 417 capillary, 142, 144–148

clinical features of, 145 management and prognosis of,

146–148

morphologic features of, 144, 146 radiologic features of, 145, 146

cavernous, 141–144, 142 clinical features of, 141–142 management and prognosis of,

144

morphologic features of, 143–144 ophthalmoscopic findings in, 143 radiologic features of, 143

Hemangiopericytoma, 142, 152–154 clinical features of, 152–153 management and prognosis of, 154 morphologic features of, 153–154 radiologic features of, 153

Hematic cyst, 339–342 Histiocytoses, 166–172

Langerhans cell, 166–168 non-Langerhans cell, 166–172 xanthogranuloma, 166, 167, 168,

169–170

Histone acetylation, 9–11 acetylase and

deacetylase, 10–11 histone, 10–11

gene expression and, 12 TSG and, 10

Hypothalamus dysfunction, 405

I

Idiopathic orbital inflammation (IOI), 312–321

myositis, orbital as, 318–321 biopsy of, 320–321 diagnosis of, 318 treatment of, 320

Immune system. See also Immunosuppression

antigen discrimination of, self/nonself, 15

cancer and response of, 14–17 APCs and, 15–16

major histocompatibility complex and, 15

orbital tumors and response of, 24 Immunosuppression

cancer and, 27–29 skin, 28–29

infection and, 29–30 invasive aspergillosis, 29

I N D E X

mucormycosis, 29–30 orbital tumors and, 29

viruses and, 27–28 orbital tumors and, 28t

IOI. See Idiopathic orbital inflammation

K

Kimura disease, 159–160 clinical features of, 159

management and prognosis of, 160 morphologic features of, 159–160 radiologic features of, 159

L

Lacrimal drainage system tumors, 221–229. See also Lacrimal gland tumors

biopsy and, 223 dacryocystectomy, 227, 228 investigation of, 222–226 lacrimal sac fossa region,

differential diagnosis of masses in, 221

lacrimal sac tumor presentation in, 221–222

suspected, 221–222 unsuspected, 221

management of, 226–227 papillomas of, 223–225 pathology of, 223

SCC as, 237–239, 245–247 squamous carcinomas as, 225–226 suspected sac tumor of, 221–222,

226–227 management of, 226

unsuspected sac tumor of, 221, 226 management of, 226

Lacrimal gland tumors, 204–219 acinic cell carcinoma as, 217 adenocarcinoma as, 216, 217

management and prognosis of, 216

adenoid cystic carcinoma as, 212–216

clinical features of, 212–213, 214, 215

management and prognosis of, 214–216

pathology of, 213–214 radiologic features of, 213, 214,

215

dacryops as, 205–206, 208 epithelial, 204, 205t hemangioma as, 219 malignant mixed tumors as,

211–212

clinical features of, 211, 212 management and prognosis of,

211–212 pathology of, 211

radiologic features of, 211

4 3 5

malignant rhabdoid tumor as, 219 mucoepidermoid carcinoma as, 216 management and prognosis of,

216 nonepithelial, 204 oncocytoma as, 219 orbital, 81–82

carcinoma as, 82 dacryoadenitis as, 82 lymphoid tumors of, 81 pleomorphic adenoma as, 81

pleomorphic adenoma as, 206–211 clinical features of, 206, 208, 209 management and prognosis of,

208, 209, 211 pathology of, 209–211

radiologic features of, 207–209 radiation treatment of, 401

SCC as, 219

solitary fibrous tumor as, 218, 219 spindle cell myoepithelioma as,

219

staging of, 355–356 Warthin tumor as, 219

Leiomyoma, 142, 159 clinical features of, 159

management and prognosis of, 159 morphologic features of, 159 radiologic features of, 159

Loss of heterozygosity (LOH), tumor cells and, 5, 6

Lymphangioma, 99, 100, 142, 148–152

clinical features of, 148–149 hemorrhage, spontaneous of, 146,

148

location of, 148, 149, 150 management and prognosis of,

150–151

morphologic features of, 150 proptosis of, 148

radiologic features of, 150 Lymphoma, 31

unilateral, 332 Lymphoproliferative disease, 77–78,

422–423

M

Maffucci syndrome, 178, 179 Magnetic resonance imaging (MRI),

89

advantages and disadvantages of, 88 artifacts of, 90, 91

computer image guidance with, 391–392

image interpretation with, 84 imaging with, fibrohistiocytic

tumor, 164–165 indications for, 87 nanoparticle, 110–111

optic nerve lesions detected by, 87–89