Myofibroma is a rare benign mesenchymal tumor of uncertain histogenesis. A six-year-old boy presented with a unilateral lower eyelid mass of six weeks’ duration. MRI revealed a circumscribed mass in the inferolateral orbit with bony erosion. A systemic examination was unremarkable. Excision with histopathology revealed a partially infiltrative spindle cell tumor with bland nuclear morphology expressing smooth muscle actin and muscle-specific actin, compatible with myofibroma. Solitary myofibroma is a rare childhood orbital tumor and may clinico-radiologically closely mimic a malignancy. Histopathology and immunohistochemistry can help reach a definitive diagnosis. Systemic evaluation and close follow up are crucial in such cases.
Purpose:
The aim of the study was to investigate the clinical resolution versus radiologic regression of orbital lymphatic malformations (LMs) following treatment with intralesional bleomycin sulfate sclerotherapy.
Methods:
A retrospective interventional study of 24 eyes with orbital LMs treated with nonimage-guided bleomycin sclerotherapy. The clinical and radiologic outcomes were classified as excellent, good, fair, and poor. Regression was assessed clinically and by radiologic volumetrics.
Results:
Mean age at presentation was 17 ± 18 years (median 11, range 5 months to 70 years). Lesion morphology was microcystic in 11 (46%), macrocystic in 8 (34%), and mixed in 5 (21%) eyes. Mean units of bleomycin injected per session were 4 ± 2 IU (median 5 IU, range 1–6 IU). Mean number of treatment sessions required was 2 ± 1 (median 2, range 1–6). Cumulative units of bleomycin injected were 11 ± 9 (median 9, range 1–38 IU). The clinical response was excellent in 19 (79%), good in 4 (17%), and fair in 1 (4%). The mean preoperative and postoperative lesion volumes were 7 ± 4 cm3 and 0.8 ± 1.2 cm3, respectively (p < 0.0001, 95% CI, −7.89 to −4.51). Radiologic resolution of LM was excellent in 6 (25%), good in 8 (33%), fair in 7 (29%), and poor in 3 (13%) eyes. Spearman’s rank correlation coefficient for correlation between clinical and radiologic grading was 0.51 (p = 0.01, 95% CI, 0.13–0.75%). There was a sustained tumor resolution without recurrence over a mean follow-up duration was 2 years (median 18 months; range 12–60 months).
Conclusions:
Bleomycin sclerotherapy for orbital LMs gives an excellent to good clinical response in 93%. However, a parallel radiologic regression is seen only in 58%. The endpoint to assess response should be clinical. Treatment till complete radiologic resolution may not be necessary.
Wrinkles or rhytids are a part of the natural ageing process of the human body. Long pulsed Nd: YAG laser (LPND) promotes dermal collagen remodelling without damaging the superficial layers and hence reduce periorbital wrinkles. Patients seeking treatment for periorbital wrinkles, and willing to participate in the study were included. Wrinkles were graded on the basis of wrinkle severity score (WSS) at baseline and one month after 4 monthly sessions of treatment. The 1064nm LPND was employed with settings of: spot size - 10mm, on time - 40 to 50 ms, fluence - 30 to 50 J/cm and frequency - 1 Hz. Three overlapping passes were done on both sides of the face. Outcome was measured by subjects, investigator and a blinded dermatologist. Appropriate statistical analysis was done. Twenty eight sites were treated in 14 subjects. Male to female ratio was 3:4. Their mean age was 45.86 ± 8.75. Mean WSS by investigator at baseline was 3.18 ± 1.188 and at the end of treatment was 1.89 ± 1.031 (p = 0.001). Mean WSS by the blinded dermatologist was 3.18 ± 1.188 at baseline and 2.43 ± 1.034 at end of the treatment (p =0.001). The subject’s degree of satisfaction was found to be 2.96 ± 1.036. There were no significant adverse events. LPND for periorbital wrinkles is both patient and physician friendly, offering maximum results with minimal discomfort and downtime. This modality needs further exploration in the treatment of periorbital wrinkles in the Indian population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.