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Bita Esmaeli - One of the best experts on this subject based on the ideXlab platform.
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treatment and outcomes for metastatic Sebaceous Cell carcinoma of the eyelid
International Journal of Dermatology, 2008Co-Authors: Amina Husain, George R Blumenschein, Bita EsmaeliAbstract:OBJECTIVE: To report the management and outcomes in patients with metastatic eyelid Sebaceous Cell carcinoma. METHODS: The clinical records of four patients with metastatic eyelid Sebaceous Cell carcinoma treated between January 1999 and August 2006 were reviewed. RESULTS: The study included four women with a mean age of 66 years. Metastatic sites included the lung in three patients, regional lymph nodes in two, liver in two, and bone in one. Time from diagnosis of eyelid carcinoma to metastasis ranged from 0 to 62 months. Treatment of regional nodal metastasis consisted of complete neck dissection followed by radiation therapy. One patient developed lung metastasis 5 years after the diagnosis of eyelid tumor; she was treated with systemic chemotherapy followed by subtotal lung resection. Systemic chemotherapy was considered for two additional patients: in one, chemotherapy was deferred due to poor performance status and ongoing medical problems; and another patient died before chemotherapy could be started. The patient with bony metastasis was treated with radiation therapy to the spine. Two patients died during the study period. The follow-up time from diagnosis of metastasis to last contact or death ranged from 1 month to 3 years (median of 21 months). CONCLUSION: Eyelid Sebaceous Cell carcinoma can result in systemic metastasis and death. Metastasis can be discovered as late as 5 years after treatment of the eyelid carcinoma, warranting continued surveillance. Treatment of metastatic disease may include a combination of chemotherapy, radiation, and surgical neck dissection.
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sentinel lymph node biopsy for Sebaceous Cell carcinoma and melanoma of the ocular adnexa
Archives of Otolaryngology-head & Neck Surgery, 2007Co-Authors: Viet Ho, Merrick I Ross, Victor G. Prieto, Aisha Khaleeq, Bita EsmaeliAbstract:Objective To provide clinical details and long-term outcome data for a series of patients with eyelid or conjunctival melanoma or eyelid Sebaceous Cell carcinoma who underwent sentinel lymph node (SLN) biopsy. Design Retrospective interventional case series with review of clinical records and pathologic specimens. Setting Tertiary comprehensive cancer center. Patients Twenty-five consecutive patients treated at 1 institution for eyelid or conjunctival melanoma or eyelid Sebaceous Cell carcinoma from December 2000 to October 2004. Interventions Surgical removal of the eyelid or conjunctival tumor and SLN biopsy. Main Outcome Measures Local treatment modalities; lymphatic basins in which SLNs were identified; status of SLNs; false-negative rate; and long-term patterns of local recurrence, regional and distant metastasis, and survival. Results Seven patients had conjunctival melanoma, 8 had eyelid-margin melanoma with a considerable palpebral conjunctival component, and 10 had eyelid Sebaceous Cell carcinoma. The SLNs were identified in all but 1 patient by using technetium Tc 99m sulfur colloid as a tracer. Intraoperatively, in 16 patients in whom blue dye was used in addition to technetium Tc 99m sulfur colloid during mapping, no SLN was blue. One patient with conjunctival melanoma and 1 patient with eyelid melanoma had a histologically positive SLN. Two patients with eyelid melanoma and 2 patients with eyelid Sebaceous Cell carcinoma had negative findings from SLN biopsy but developed recurrence in their regional lymph nodes during the follow-up period. Overall, during follow-up, 2 of 10 patients with Sebaceous Cell carcinoma (20%) and 5 of 15 patients with eyelid or conjunctival melanoma (33%) had regional lymph node metastasis. Four patients with melanoma who had regional metastasis also developed distant organ metastasis. Two patients with Sebaceous Cell carcinoma—1 with regional metastasis and 1 without—developed distant organ metastasis. Conclusions The detection of histologically positive SLNs in this series of patients may justify further study of SLN biopsy for high-risk patients with ocular adnexal melanoma or eyelid Sebaceous Cell carcinoma. The false-negative rate is higher than that reported for SLN biopsy at most other anatomic sites. Patients with negative findings from SLN biopsy still require careful long-term follow-up because they may develop regional or distant metastasis.
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Expression of retinoid receptors in Sebaceous Cell carcinoma.
Journal of cutaneous pathology, 2006Co-Authors: Nitin Chakravarti, H.g. Saadati, Adel K. El-naggar, Reuben Lotan, Roxanna E. Diba, Abdul H. Diwan, Victor G. Prieto, James Anderson, Bita EsmaeliAbstract:PURPOSE: The aim of this study is to investigate whether there are any abnormalities in the in vivo expression of retinoid acid receptors (RAR-alpha, RAR-beta and RAR-gamma) and retinoid X receptors (RXR-alpha, RXR-beta and RXR-gamma) in Sebaceous Cell carcinoma. METHODS: Expression of retinoid receptors in paired specimens of cancerous tissues (n = 10) and adjacent normal tissues (n = 10) from 10 patients with Sebaceous Cell carcinoma was studied immunohistochemically by using anti-retinoid receptor antibodies. RESULTS: In eight of the 10 normal tissue samples, all six receptors were expressed. In the other two samples, all receptors were expressed except RAR-gamma (one sample) or RXR-gamma (two samples). Five tumours (50%) lacked RAR-alpha; RAR-alpha expression was lower in tumours than in normal tissues in eight of 10 cases. RAR-beta was expressed in the cytoplasm of nine of 10 tumours; RAR-beta expression was at least as high in tumours as in normal tissue in eight of 10 cases. Two tumours lacked RAR-gamma; three tumours had lower RAR-gamma expression than paired normal epithelium; four had the same RAR-gamma expression, and one had higher RAR-gamma expression. RXR-alpha expression was strong in all normal tissues and tumour samples. Ten tumours lacked RXR-beta and all 10 tumours lacked RXR-gamma expression. CONCLUSIONS: Diminished RXR-beta and RXR-gamma expression might be related to the development of Sebaceous Cell carcinoma. Additional studies are required to establish whether the defects in RAR expression in Sebaceous Cell carcinoma might affect the potential response of this tumour to treatment with retinoids.
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sentinel lymph node biopsy for conjunctival and eyelid malignancies
2006Co-Authors: Dominick Golio, Bita EsmaeliAbstract:Sentinel lymph node (SLN) biopsy is a minimally invasive technique that aims to diagnose microscopic metastasis in the regional lymph nodes The value of SLN biopsy has been widely studied for cutaneous melanoma, breast carcinoma, as well as other solid cancers. We have modified SLN biopsy techniques for conjunctival and eyelid tumors, because many of the cancers of the ocular adnexa such as conjunctival melanoma and Sebaceous Cell carcinoma have the predilection for regional lymph nodes as the site of first metastasis An SLN biopsy technique using both isosulfan blue dye (0.2 cc volume) and technetium (0.3 mCi in 0.2 cc volume) was initially used by our group. A smaller volume of these tracers is used than in other anatomic sites, in order to prevent excessive ballooning up of the conjunctiva and the spread of the tracer to non-specific quadrants of the conjunctiva. We have abandoned the use of the isosulfan blue dye in the latter part of our trial as none of the SLNs was found to be blue. We believe this is due to the much smaller volume of the isosulfan dye used for ocular adnexal lesions and the rapid transit of the dye through the lymphatics in the head and neck region The regional lymph nodes at the greatest risk for metastasis from conjunctival and eyelid cancers are the parotid, preauricular, and submandibular lymph nodes Our experience suggests that SLN biopsy can be safely performed for conjunctival and eyelid cancers and is associated with very few side effects.Only three out of 27 patients enrolled in our trial have had a temporary weakness of the marginal mandibular branch of the facial nerve as a result of sentinel lymph node biopsy in the parotid region. Each has had spontaneous resolution of the facial nerve paresis within a few weeks. Blue discoloration of the ocular surface or periocular skin has not been observed in any of the patients enrolled in our trial so far. No patient in our trial has experienced an anaphylactic shock from the blue dye, although this has been reported in other studies of SLN biopsy Two out of 27 patients enrolled in our trial — both with a diagnosis of conjunctival melanoma — have had a histologically positive sentinel lymph node which was clinically (on physical examination) and radiographically negative. This validates the concept that SLN biopsy can identify patients who may harbor microscopic nodal metastasis, thus offering the opportunity for additional treatments earlier in their course Two out of 27 patients who had a “negative” SLN later developed clinically detectable metastasis within the regional lymph nodes, suggesting a false negative rate of about 8% Careful evaluation of regional lymph nodes is indicated in all patients with conjunctival melanoma, eyelid melanoma, eyelid Sebaceous Cell carcinoma,Merkel Cell carcinoma, or other ocular adnexal cancers with a tendency to metastasize to the regional lymph nodes. Ultrasonography and computed tomography should be utilized at baseline and throughout the course of the disease. If these radiographic modalities fail to find a positive node at baseline, consideration should be given to sentinel lymph node biopsy at the time of initial diagnosis of these ocular adnexal cancers
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Retinoid Receptor Subtypes in Sebaceous Cell Carcinoma of the Eyelid
Ophthalmic plastic and reconstructive surgery, 2005Co-Authors: Nitin Chakravarti, H.g. Saadati, Adel K. El-naggar, Reuben Lotan, Roxanna E. Diba, Bita EsmaeliAbstract:PURPOSE To study retinoid receptor expression in Sebaceous Cell carcinoma of the eyelid. METHODS Expression of retinoid receptors (RAR alpha, beta, and gamma and RXR alpha, beta, and gamma) in tumor specimens from 10 patients with Sebaceous Cell carcinoma of the eyelid and in 3 normal incidental tarsus specimens from healthy adults without cancer was studied immunohistochemically by using antiretinoid receptor antibodies. RESULTS In all 3 specimens of normal tarsus, all 6 retinoid receptors were expressed. RARalpha expression was absent in 3 tumors and was decreased in 3 tumors compared with expression in the control tissues. RARbeta expression in carcinomas was primarily perinuclear; 6 tumors showed increased RARbeta expression compared with controls. RARgamma expression was absent in 4 tumors and was decreased in 2 tumors compared with controls. RXRalpha nuclear expression was decreased compared with controls in 5 tumors. RXRbeta expression was low in 7 tumors. RXRgamma expression was absent in 6 tumors. CONCLUSIONS Aberrant expression of retinoid receptors in Sebaceous Cell carcinoma of the eyelid might play a role in the pathogenesis and progression of this carcinoma.
Timothy J Sullivan - One of the best experts on this subject based on the ideXlab platform.
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the significance of dna mismatch repair genes in the diagnosis and management of periocular Sebaceous Cell carcinoma and muir torre syndrome
British Journal of Ophthalmology, 2011Co-Authors: Brent Gaskin, Bertie Fernando, Charlotte Anne Sullivan, Kevin Whitehead, Timothy J SullivanAbstract:Objective The aims of this study were to determine the significance of expression of DNA mismatch repair proteins in detecting systemic malignancies in a series of patients with periocular Sebaceous Cell carcinoma and to determine the clinical characteristics and frequency of Muir–Torre syndrome in this cohort. Design The study was a retrospective non-comparative interventional case series. Participants 31 patients with histologically proven Sebaceous Cell carcinoma of the eyelid participated in the study. Methods The authors made use of retrospective chart review and immunohistochemical staining of specimens. Main outcome measures The main outcome measures are as follows: location, tumour size, sites of origin, growth patterns, management, histopathological and immunohistochemical findings, metastasis, other visceral malignancies and mortality. Results The median age of presentation of the 31 patients in this study was 71 years (range 35–92 years). There was a near-equal gender distribution (M:F—14:17). The average follow-up was 72 months. Seventeen patients had tumours arising from the upper lid, 13 from the lower lid and 1 from the caruncle. Nine patients had clinical Muir–Torre syndrome. Four patients were positive for microsatellite instability complexes and four were negative. Histologically, 14 patients had a high-grade tumour, 13 were intermediate grade and 4 were low grade. Based on the in situ pattern, six patients had a bowenoid pattern, five had both bowenoid and pagetoid patterns and two had a pagetoid pattern. Eighteen patients had no in situ disease detected. Twenty-one patients were alive without disease, and two were alive with disease. Six patients had died, five from other causes and one from the disease. Conclusions Visceral malignancies are common in patients with periocular Sebaceous Cell carcinoma. Approximately one in eight demonstrated a heritable risk for further visceral malignancy through failure to express DNA mismatch repair proteins. Diagnosis of periocular Sebaceous Cell carcinoma should prompt physicians to search for other associated malignancies. Immunohistochemical characterisation of these Sebaceous lesions is useful in identifying increased risk in affected patients and family members.
Brent Gaskin - One of the best experts on this subject based on the ideXlab platform.
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the significance of dna mismatch repair genes in the diagnosis and management of periocular Sebaceous Cell carcinoma and muir torre syndrome
British Journal of Ophthalmology, 2011Co-Authors: Brent Gaskin, Bertie Fernando, Charlotte Anne Sullivan, Kevin Whitehead, Timothy J SullivanAbstract:Objective The aims of this study were to determine the significance of expression of DNA mismatch repair proteins in detecting systemic malignancies in a series of patients with periocular Sebaceous Cell carcinoma and to determine the clinical characteristics and frequency of Muir–Torre syndrome in this cohort. Design The study was a retrospective non-comparative interventional case series. Participants 31 patients with histologically proven Sebaceous Cell carcinoma of the eyelid participated in the study. Methods The authors made use of retrospective chart review and immunohistochemical staining of specimens. Main outcome measures The main outcome measures are as follows: location, tumour size, sites of origin, growth patterns, management, histopathological and immunohistochemical findings, metastasis, other visceral malignancies and mortality. Results The median age of presentation of the 31 patients in this study was 71 years (range 35–92 years). There was a near-equal gender distribution (M:F—14:17). The average follow-up was 72 months. Seventeen patients had tumours arising from the upper lid, 13 from the lower lid and 1 from the caruncle. Nine patients had clinical Muir–Torre syndrome. Four patients were positive for microsatellite instability complexes and four were negative. Histologically, 14 patients had a high-grade tumour, 13 were intermediate grade and 4 were low grade. Based on the in situ pattern, six patients had a bowenoid pattern, five had both bowenoid and pagetoid patterns and two had a pagetoid pattern. Eighteen patients had no in situ disease detected. Twenty-one patients were alive without disease, and two were alive with disease. Six patients had died, five from other causes and one from the disease. Conclusions Visceral malignancies are common in patients with periocular Sebaceous Cell carcinoma. Approximately one in eight demonstrated a heritable risk for further visceral malignancy through failure to express DNA mismatch repair proteins. Diagnosis of periocular Sebaceous Cell carcinoma should prompt physicians to search for other associated malignancies. Immunohistochemical characterisation of these Sebaceous lesions is useful in identifying increased risk in affected patients and family members.
Kevin Whitehead - One of the best experts on this subject based on the ideXlab platform.
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the significance of dna mismatch repair genes in the diagnosis and management of periocular Sebaceous Cell carcinoma and muir torre syndrome
British Journal of Ophthalmology, 2011Co-Authors: Brent Gaskin, Bertie Fernando, Charlotte Anne Sullivan, Kevin Whitehead, Timothy J SullivanAbstract:Objective The aims of this study were to determine the significance of expression of DNA mismatch repair proteins in detecting systemic malignancies in a series of patients with periocular Sebaceous Cell carcinoma and to determine the clinical characteristics and frequency of Muir–Torre syndrome in this cohort. Design The study was a retrospective non-comparative interventional case series. Participants 31 patients with histologically proven Sebaceous Cell carcinoma of the eyelid participated in the study. Methods The authors made use of retrospective chart review and immunohistochemical staining of specimens. Main outcome measures The main outcome measures are as follows: location, tumour size, sites of origin, growth patterns, management, histopathological and immunohistochemical findings, metastasis, other visceral malignancies and mortality. Results The median age of presentation of the 31 patients in this study was 71 years (range 35–92 years). There was a near-equal gender distribution (M:F—14:17). The average follow-up was 72 months. Seventeen patients had tumours arising from the upper lid, 13 from the lower lid and 1 from the caruncle. Nine patients had clinical Muir–Torre syndrome. Four patients were positive for microsatellite instability complexes and four were negative. Histologically, 14 patients had a high-grade tumour, 13 were intermediate grade and 4 were low grade. Based on the in situ pattern, six patients had a bowenoid pattern, five had both bowenoid and pagetoid patterns and two had a pagetoid pattern. Eighteen patients had no in situ disease detected. Twenty-one patients were alive without disease, and two were alive with disease. Six patients had died, five from other causes and one from the disease. Conclusions Visceral malignancies are common in patients with periocular Sebaceous Cell carcinoma. Approximately one in eight demonstrated a heritable risk for further visceral malignancy through failure to express DNA mismatch repair proteins. Diagnosis of periocular Sebaceous Cell carcinoma should prompt physicians to search for other associated malignancies. Immunohistochemical characterisation of these Sebaceous lesions is useful in identifying increased risk in affected patients and family members.
Charlotte Anne Sullivan - One of the best experts on this subject based on the ideXlab platform.
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the significance of dna mismatch repair genes in the diagnosis and management of periocular Sebaceous Cell carcinoma and muir torre syndrome
British Journal of Ophthalmology, 2011Co-Authors: Brent Gaskin, Bertie Fernando, Charlotte Anne Sullivan, Kevin Whitehead, Timothy J SullivanAbstract:Objective The aims of this study were to determine the significance of expression of DNA mismatch repair proteins in detecting systemic malignancies in a series of patients with periocular Sebaceous Cell carcinoma and to determine the clinical characteristics and frequency of Muir–Torre syndrome in this cohort. Design The study was a retrospective non-comparative interventional case series. Participants 31 patients with histologically proven Sebaceous Cell carcinoma of the eyelid participated in the study. Methods The authors made use of retrospective chart review and immunohistochemical staining of specimens. Main outcome measures The main outcome measures are as follows: location, tumour size, sites of origin, growth patterns, management, histopathological and immunohistochemical findings, metastasis, other visceral malignancies and mortality. Results The median age of presentation of the 31 patients in this study was 71 years (range 35–92 years). There was a near-equal gender distribution (M:F—14:17). The average follow-up was 72 months. Seventeen patients had tumours arising from the upper lid, 13 from the lower lid and 1 from the caruncle. Nine patients had clinical Muir–Torre syndrome. Four patients were positive for microsatellite instability complexes and four were negative. Histologically, 14 patients had a high-grade tumour, 13 were intermediate grade and 4 were low grade. Based on the in situ pattern, six patients had a bowenoid pattern, five had both bowenoid and pagetoid patterns and two had a pagetoid pattern. Eighteen patients had no in situ disease detected. Twenty-one patients were alive without disease, and two were alive with disease. Six patients had died, five from other causes and one from the disease. Conclusions Visceral malignancies are common in patients with periocular Sebaceous Cell carcinoma. Approximately one in eight demonstrated a heritable risk for further visceral malignancy through failure to express DNA mismatch repair proteins. Diagnosis of periocular Sebaceous Cell carcinoma should prompt physicians to search for other associated malignancies. Immunohistochemical characterisation of these Sebaceous lesions is useful in identifying increased risk in affected patients and family members.