- The retinal astrocytic hamartoma is a hallmark ophthalmic feature of tuberous sclerosis complex (TSC).1 The typical course of such tumours is a relatively slow-growing nonaggressive lesion in the retina that can be managed expectantly.2 Nonetheless, there have been several reports in the literature of aggressive astrocytic hamartomas that do not demonstrate this benign course.3 We present here a rare case of an aggressive tumour in a patient with TSC that has cell types more typical of the subependymal giant cell astrocytoma (SEGA) that is seen in the brains of such patients.
- A 53-year-old previously healthy Caucasian male presented to an emergency department with fever, well-circumscribed tender erythematous nodules of the shins, bilateral plantar pain, and bilateral ankle swelling and pain of 1-week duration. He was discharged without a diagnosis and his symptoms began to spontaneously resolve over the next 3 days. A month later, he developed new diplopia, left lower eyelid swelling, and a palpable orbital lump.
- Amyloid fibril protein is a protein that is deposited as insoluble fibrils, mainly in extracellular spaces of organs and tissues as a resrult of a sequence of changes in protein folding.1 By definition, amyloid must exhibit both affinity for Congo red and green birefringence when samples that are stained with Congo red are viewed under polarized light.1 It can accumulate in all body tissues, including the brain, skin, respiratory tract, genitourinary tract, gastrointestinal tract, heart, spleen, soft tissues, and ocular and orbital tissues.
- A 34-year-old previously healthy male construction worker presented to an Urgent Care Centre with rapidly progressing left upper eyelid swelling and severe pain associated with increasing edema of the orbit and face. He had been discharged from the same Urgent Care Centre 4 hours prior with a suspected acute hordeolum. On arrival, his vital signs were: temperature 36.7°C, blood pressure 148/86 mm Hg, heart rate 97 beats/min, and oxygen saturation of 98% on room air. His condition deteriorated over the next 30 minutes with rapid progression of orbit and facial edema.
- A previously healthy 4-month-old child presented with a right-sided medial canthal subcutaneous mass that was present for 2 weeks (Fig. 1). Parents stated it had been growing in size since it appeared, and there was tearing from this eye. Clinically, location and discolouration gave the appearance of a dacryocystocele; however, the lesion was firm and appeared adherent to the bone. The ocular examination was otherwise normal. Probing of the nasolacrimal duct showed free flow into the nose and did not decompress the lesion.
- Sebaceous cell carcinoma is a rare tumour that accounts for 1% to 5% of malignant eyelid tumours in white populations.1 However, in East and South Asian populations in which basal cell carcinoma is less frequent, sebaceous cell carcinoma is more frequent. A recent review of malignant eyelid tumours in Western Kowloon, Hong Kong, reported that 11.1% of their tumours were sebaceous cell carcinoma.2 It originates in meibomian glands and glands of Zeis.3 Most commonly found on the upper and lower eyelids, it can masquerade as chronic unilateral blepharitis, recurrent chalazia, basal cell carcinoma, or sebaceous cell carcinoma.
- Lacrimal sac rhinosporidiosis is an uncommon infection and to our knowledge has not been reported in Canada. Rhinosporidium seeberi is a fungus-like parasite with an evolutionary origin near the animal-fungal divergence that causes chronic infection of the mucous membranes of the upper respiratory tract.1 It is endemic in India and Southeast Asia, but rarely a cause of disease outside of this region.2