Jerry Shields - Academia.edu (original) (raw)
Papers by Jerry Shields
Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), Jan 2, 2015
Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness a... more Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published literature and personal experience. This malignancy can arise from the sebaceous units in the tarsus (meibomian glands), in association with the cilia (Zeis glands), in the brow, and in the caruncle. There is a tendency for diffuse intraepithelial growth (pagetoid spread) that can be clinically invisible. Detection before lymph node metastasis is critical. This malignancy often masquerades as a chronic unilateral conjunctivitis or blepharitis, typically in older patients. Management includes a 2-step approach with step 1 focused on eyelid and conjunctival map biopsies to determine the full extent of solid deep tumor as well as pagetoid spread. After complete review of all biopsies, step 2 is performed using local resection for all deep tumor, cryotherapy to pagetoid disease, and reconstruction. In most cases, the posterior ...
41-year-old asymptomatic woman was referred for enucleation of a 7.5-mm-thick intra- ocular tumor... more 41-year-old asymptomatic woman was referred for enucleation of a 7.5-mm-thick intra- ocular tumor suspected to be choroidal melanoma. The clinical findings combined with imaging studies suggested instead a diagnosis of giant nodular posterior scleritis. A scleral biopsy was performed to confirm the diagnosis. After 12 years of observation, the lesion has remained stable and visual acuity has been preserved. Nodular
American Journal of Ophthalmology, 2001
PURPOSE: To report a case of an extramedullary plasmacytoma confined to the choroid.METHODS: Inte... more PURPOSE: To report a case of an extramedullary plasmacytoma confined to the choroid.METHODS: Interventional case report with cytopathologic correlation.RESULTS: A 76-year-old asymptomatic woman presented with 2 globular orange and amelanotic choroidal lesions in the right eye. Fine needle aspiration biopsy of one of the choroidal lesions followed by immunocytochemical studies revealed monoclonal plasma cells, diagnostic of plasmacytoma. Systemic evaluation was
Ophthalmology, 2002
BackgroundDiffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern... more BackgroundDiffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern and often presents as unilateral hyperchromic heterochromia and glaucoma. There have been no large clinical reports of diffuse iris melanoma.
Objectives: To analyze the results of intraocular sur- gery in patients treated for retinoblastom... more Objectives: To analyze the results of intraocular sur- gery in patients treated for retinoblastoma and to assess the ocular and systemic outcomes. Design: Retrospective noncomparative case series. Patients: Forty-five consecutive patients who under- went an introcular surgery after treatment for retino- blastoma. Main Outcome Measures: (1) Recurrence of retino- blastoma, (2) need for enucleation, and (3) systemic me- tastasis. Overall
American Journal of Ophthalmology, 2001
PURPOSE: Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that man... more PURPOSE: Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that manifests as circumferential, flat tumor growth predominantly confined to the trabecular meshwork and other anterior chamber angle structures. We report the clinical and histopathological features, management, and prognosis of ring melanoma of anterior chamber angle.METHODS: A retrospective review of clinical features, management, histopathologic features,
Retina-the Journal of Retinal and Vitreous Diseases, 2002
ABSTRACT
Ophthalmology, 2001
PurposeTo review the clinical presentation, histopathologic analysis, management, and ocular and ... more PurposeTo review the clinical presentation, histopathologic analysis, management, and ocular and systemic outcome of rhabdomyosarcoma affecting the ocular region.
ebaceous gland carcinoma usually arises from meibomian or Zeis glands deep within the eyelid, but... more ebaceous gland carcinoma usually arises from meibomian or Zeis glands deep within the eyelid, but it can rarely arise within the conjunctival epithelium without a deep com- ponent. We describe a woman with a history of chronic blepharoconjunctivitis unre- sponsive to topical medications. Examination disclosed confluent papillary hypertro- phy of the upper palpebral conjunctiva and deposits of white flaky material.
Ophthalmology, 2000
ObjectiveTo analyze patient management and prognosis after vitrectomy in eyes with unsuspected re... more ObjectiveTo analyze patient management and prognosis after vitrectomy in eyes with unsuspected retinoblastoma.
sion during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurr... more sion during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurrence per eye was found in 37% of eyes at 1 year, 51% at 3 years, and no fur- ther increase at 5 years. By multivariate analysis, the only factor predictive of retinal tumor recurrence was the pres- ence of tumor-associated subretinal seeds at the initial ex-
Ophthalmology, 2001
PurposeTo review the clinical features and management of circumscribed choroidal hemangioma and d... more PurposeTo review the clinical features and management of circumscribed choroidal hemangioma and determine factors predictive of poor visual outcome.
Retina-the Journal of Retinal and Vitreous Diseases, 2006
To describe a case of two uveal melanomas in a child with mild ocular melanocytosis. A 6-year-old... more To describe a case of two uveal melanomas in a child with mild ocular melanocytosis. A 6-year-old girl was followed for 5 years with an ill-defined, slowly enlarging presumed choroidal nevus in the postequatorial fundus. Ocular oncology evaluation revealed mild sectorial scleral and uveal melanocytosis and an episcleral sentinel vessel superotemporally. Two discrete uveal melanomas were present. In the circumpapillary and macular region, tumor 1 was diffuse at 9.0 mm in base and 4.1 mm in thickness and with overlying subretinal fluid. In the ciliary body, tumor 2 was discovered by transillumination and was 6.0 mm in base and 2.2 mm in thickness. Enucleation was performed. Histopathologic analysis disclosed two discrete uveal melanomas in a bed of diffuse mild uveal melanocytosis. Tumor 1 was a mixed, predominantly epithelioid cell melanoma with active mitotic figures, and tumor 2 was a mixed, predominantly spindle cell melanoma. The choroid between the melanomas showed only benign, dendritic melanocytes consistent with melanocytosis. There was no extrascleral extension. Ocular melanocytosis can predispose to one or multiple uveal melanomas. Lifetime ophthalmic monitoring of affected patients is warranted.
Survey of Ophthalmology, 2005
Sebaceous carcinoma of the ocular region is a malignant neoplasm that is being recognized more fr... more Sebaceous carcinoma of the ocular region is a malignant neoplasm that is being recognized more frequently and managed by innovative techniques of local resection, cryotherapy, topical chemotherapy, and radiotherapy, resulting in improved visual and systemic prognosis.
Retinal Cases & Brief Reports, 2010
To report a case of retinoblastoma in a child with oculocutaneous albinism (OCA). A 24-month-old ... more To report a case of retinoblastoma in a child with oculocutaneous albinism (OCA). A 24-month-old girl with classic features of OCA developed leukocoria in the left eye. The patient was found to have an endophytic retinoblastoma and an exophytic retinoblastoma, with a total retinal detachment and neovascularization of the iris. Enucle-ation was performed, and histopathology confirmed massive retinoblastoma with optic nerve involvement to the posterior margin of the lamina cribrosa but no choroidal invasion. Although rare, retinoblastoma can occur in children with OCA.
Ophthalmology, 2008
To evaluate the clinical features and management of diffuse infiltrating retinoblastoma.Retrospec... more To evaluate the clinical features and management of diffuse infiltrating retinoblastoma.Retrospective case series.Thirty-four eyes in 32 patients.The patients' records were reviewed for patient and tumor features, ocular management, histopathologic findings, and patient survival.Clinical features, tumor management, and patient survival.Of 1507 patients with retinoblastoma, only 32 (2%) were classified with diffuse infiltrating retinoblastoma. The mean age at diagnosis was 4 years (range 1.5–16 years). The referring diagnoses included retinoblastoma (26 eyes, 76%), uveitis (3, 9%), Coats disease (1, 3%), trauma (1, 3%), and unspecified retinal problem (3, 9%). The anterior segment displayed tumor seeds on the corneal endothelium (8, 24%), cornea stromal edema (3, 9%), pseudohypopyon (11, 32%), hyphema (3, 9%), iris neovascularization (17, 50%), and iris tumor nodules (6, 18%). The posterior segment revealed extensive ill-defined retinoblastoma infiltrating the retina for a mean basal diameter of 20 mm and overall flat growth, sometimes with undulating retinal thickening. Overlying extensive vitreous tumor seeds (31, 91%) and vitreous hemorrhage (8, 24%) were noted. Calcification was present on ultrasonography (27/34, 79%) and computed tomography (8/9, 89%). Enucleation was performed for all 34 eyes, and there were no cases of metastases at 47 months follow-up.Diffuse infiltrating retinoblastoma can masquerade as uveitis or unexplained hyphema or keratic precipitates. Suspicion for retinoblastoma is important.The authors have no proprietary or commercial interest in any materials discussed in this article.
Transactions of the American Ophthalmological Society, 2007
To evaluate clinical features and risks for transformation of conjunctival primary acquired melan... more To evaluate clinical features and risks for transformation of conjunctival primary acquired melanosis (PAM) into melanoma. Retrospective chart review and Kaplan-Meier estimates of times to PAM enlargement, recurrence, and transformation into melanoma. PAM enlargement, recurrence, and transformation into melanoma. The mean patient age at diagnosis of PAM was 56 years; 62% were female and 96% Caucasian. The conjunctival quadrant(s) affected by PAM and its extent in clock hours were recorded. Initial management included observation in 62%, biopsy combined with cryotherapy in 34%, and other methods in 4%. Of PAM that was observed, Kaplan-Meier estimates at 10 years revealed PAM enlargement in 35% and transformation into melanoma in 12%. Of those that underwent incisional or excisional biopsy, 10-year estimates of PAM recurrence and transformation into melanoma were 58% and 11%, respectively. Progression to melanoma occurred in 0% of PAM without atypia, 0% of PAM with mild atypia, and 13...
Ophthalmology, 2004
To describe a patient with conjunctival metastasis as the initial manifestation of metastasis fro... more To describe a patient with conjunctival metastasis as the initial manifestation of metastasis from a cutaneous melanoma. Single interventional case report. A 48-year-old woman with a history of cutaneous axillary melanoma developed a rapidly growing conjunctival mass. Subsequent systemic evaluation disclosed asymptomatic liver metastasis. The conjunctival lesion was resected. Histopathologic evaluation of the conjunctival tumor disclosed an epithelioid cell melanoma located in the conjunctival stroma, without appreciable junctional activity, compatible with metastatic melanoma. Conjunctival metastasis from cutaneous melanoma can rarely be the initial manifestation of disseminated melanoma.
Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), Jan 2, 2015
Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness a... more Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published literature and personal experience. This malignancy can arise from the sebaceous units in the tarsus (meibomian glands), in association with the cilia (Zeis glands), in the brow, and in the caruncle. There is a tendency for diffuse intraepithelial growth (pagetoid spread) that can be clinically invisible. Detection before lymph node metastasis is critical. This malignancy often masquerades as a chronic unilateral conjunctivitis or blepharitis, typically in older patients. Management includes a 2-step approach with step 1 focused on eyelid and conjunctival map biopsies to determine the full extent of solid deep tumor as well as pagetoid spread. After complete review of all biopsies, step 2 is performed using local resection for all deep tumor, cryotherapy to pagetoid disease, and reconstruction. In most cases, the posterior ...
41-year-old asymptomatic woman was referred for enucleation of a 7.5-mm-thick intra- ocular tumor... more 41-year-old asymptomatic woman was referred for enucleation of a 7.5-mm-thick intra- ocular tumor suspected to be choroidal melanoma. The clinical findings combined with imaging studies suggested instead a diagnosis of giant nodular posterior scleritis. A scleral biopsy was performed to confirm the diagnosis. After 12 years of observation, the lesion has remained stable and visual acuity has been preserved. Nodular
American Journal of Ophthalmology, 2001
PURPOSE: To report a case of an extramedullary plasmacytoma confined to the choroid.METHODS: Inte... more PURPOSE: To report a case of an extramedullary plasmacytoma confined to the choroid.METHODS: Interventional case report with cytopathologic correlation.RESULTS: A 76-year-old asymptomatic woman presented with 2 globular orange and amelanotic choroidal lesions in the right eye. Fine needle aspiration biopsy of one of the choroidal lesions followed by immunocytochemical studies revealed monoclonal plasma cells, diagnostic of plasmacytoma. Systemic evaluation was
Ophthalmology, 2002
BackgroundDiffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern... more BackgroundDiffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern and often presents as unilateral hyperchromic heterochromia and glaucoma. There have been no large clinical reports of diffuse iris melanoma.
Objectives: To analyze the results of intraocular sur- gery in patients treated for retinoblastom... more Objectives: To analyze the results of intraocular sur- gery in patients treated for retinoblastoma and to assess the ocular and systemic outcomes. Design: Retrospective noncomparative case series. Patients: Forty-five consecutive patients who under- went an introcular surgery after treatment for retino- blastoma. Main Outcome Measures: (1) Recurrence of retino- blastoma, (2) need for enucleation, and (3) systemic me- tastasis. Overall
American Journal of Ophthalmology, 2001
PURPOSE: Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that man... more PURPOSE: Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that manifests as circumferential, flat tumor growth predominantly confined to the trabecular meshwork and other anterior chamber angle structures. We report the clinical and histopathological features, management, and prognosis of ring melanoma of anterior chamber angle.METHODS: A retrospective review of clinical features, management, histopathologic features,
Retina-the Journal of Retinal and Vitreous Diseases, 2002
ABSTRACT
Ophthalmology, 2001
PurposeTo review the clinical presentation, histopathologic analysis, management, and ocular and ... more PurposeTo review the clinical presentation, histopathologic analysis, management, and ocular and systemic outcome of rhabdomyosarcoma affecting the ocular region.
ebaceous gland carcinoma usually arises from meibomian or Zeis glands deep within the eyelid, but... more ebaceous gland carcinoma usually arises from meibomian or Zeis glands deep within the eyelid, but it can rarely arise within the conjunctival epithelium without a deep com- ponent. We describe a woman with a history of chronic blepharoconjunctivitis unre- sponsive to topical medications. Examination disclosed confluent papillary hypertro- phy of the upper palpebral conjunctiva and deposits of white flaky material.
Ophthalmology, 2000
ObjectiveTo analyze patient management and prognosis after vitrectomy in eyes with unsuspected re... more ObjectiveTo analyze patient management and prognosis after vitrectomy in eyes with unsuspected retinoblastoma.
sion during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurr... more sion during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurrence per eye was found in 37% of eyes at 1 year, 51% at 3 years, and no fur- ther increase at 5 years. By multivariate analysis, the only factor predictive of retinal tumor recurrence was the pres- ence of tumor-associated subretinal seeds at the initial ex-
Ophthalmology, 2001
PurposeTo review the clinical features and management of circumscribed choroidal hemangioma and d... more PurposeTo review the clinical features and management of circumscribed choroidal hemangioma and determine factors predictive of poor visual outcome.
Retina-the Journal of Retinal and Vitreous Diseases, 2006
To describe a case of two uveal melanomas in a child with mild ocular melanocytosis. A 6-year-old... more To describe a case of two uveal melanomas in a child with mild ocular melanocytosis. A 6-year-old girl was followed for 5 years with an ill-defined, slowly enlarging presumed choroidal nevus in the postequatorial fundus. Ocular oncology evaluation revealed mild sectorial scleral and uveal melanocytosis and an episcleral sentinel vessel superotemporally. Two discrete uveal melanomas were present. In the circumpapillary and macular region, tumor 1 was diffuse at 9.0 mm in base and 4.1 mm in thickness and with overlying subretinal fluid. In the ciliary body, tumor 2 was discovered by transillumination and was 6.0 mm in base and 2.2 mm in thickness. Enucleation was performed. Histopathologic analysis disclosed two discrete uveal melanomas in a bed of diffuse mild uveal melanocytosis. Tumor 1 was a mixed, predominantly epithelioid cell melanoma with active mitotic figures, and tumor 2 was a mixed, predominantly spindle cell melanoma. The choroid between the melanomas showed only benign, dendritic melanocytes consistent with melanocytosis. There was no extrascleral extension. Ocular melanocytosis can predispose to one or multiple uveal melanomas. Lifetime ophthalmic monitoring of affected patients is warranted.
Survey of Ophthalmology, 2005
Sebaceous carcinoma of the ocular region is a malignant neoplasm that is being recognized more fr... more Sebaceous carcinoma of the ocular region is a malignant neoplasm that is being recognized more frequently and managed by innovative techniques of local resection, cryotherapy, topical chemotherapy, and radiotherapy, resulting in improved visual and systemic prognosis.
Retinal Cases & Brief Reports, 2010
To report a case of retinoblastoma in a child with oculocutaneous albinism (OCA). A 24-month-old ... more To report a case of retinoblastoma in a child with oculocutaneous albinism (OCA). A 24-month-old girl with classic features of OCA developed leukocoria in the left eye. The patient was found to have an endophytic retinoblastoma and an exophytic retinoblastoma, with a total retinal detachment and neovascularization of the iris. Enucle-ation was performed, and histopathology confirmed massive retinoblastoma with optic nerve involvement to the posterior margin of the lamina cribrosa but no choroidal invasion. Although rare, retinoblastoma can occur in children with OCA.
Ophthalmology, 2008
To evaluate the clinical features and management of diffuse infiltrating retinoblastoma.Retrospec... more To evaluate the clinical features and management of diffuse infiltrating retinoblastoma.Retrospective case series.Thirty-four eyes in 32 patients.The patients' records were reviewed for patient and tumor features, ocular management, histopathologic findings, and patient survival.Clinical features, tumor management, and patient survival.Of 1507 patients with retinoblastoma, only 32 (2%) were classified with diffuse infiltrating retinoblastoma. The mean age at diagnosis was 4 years (range 1.5–16 years). The referring diagnoses included retinoblastoma (26 eyes, 76%), uveitis (3, 9%), Coats disease (1, 3%), trauma (1, 3%), and unspecified retinal problem (3, 9%). The anterior segment displayed tumor seeds on the corneal endothelium (8, 24%), cornea stromal edema (3, 9%), pseudohypopyon (11, 32%), hyphema (3, 9%), iris neovascularization (17, 50%), and iris tumor nodules (6, 18%). The posterior segment revealed extensive ill-defined retinoblastoma infiltrating the retina for a mean basal diameter of 20 mm and overall flat growth, sometimes with undulating retinal thickening. Overlying extensive vitreous tumor seeds (31, 91%) and vitreous hemorrhage (8, 24%) were noted. Calcification was present on ultrasonography (27/34, 79%) and computed tomography (8/9, 89%). Enucleation was performed for all 34 eyes, and there were no cases of metastases at 47 months follow-up.Diffuse infiltrating retinoblastoma can masquerade as uveitis or unexplained hyphema or keratic precipitates. Suspicion for retinoblastoma is important.The authors have no proprietary or commercial interest in any materials discussed in this article.
Transactions of the American Ophthalmological Society, 2007
To evaluate clinical features and risks for transformation of conjunctival primary acquired melan... more To evaluate clinical features and risks for transformation of conjunctival primary acquired melanosis (PAM) into melanoma. Retrospective chart review and Kaplan-Meier estimates of times to PAM enlargement, recurrence, and transformation into melanoma. PAM enlargement, recurrence, and transformation into melanoma. The mean patient age at diagnosis of PAM was 56 years; 62% were female and 96% Caucasian. The conjunctival quadrant(s) affected by PAM and its extent in clock hours were recorded. Initial management included observation in 62%, biopsy combined with cryotherapy in 34%, and other methods in 4%. Of PAM that was observed, Kaplan-Meier estimates at 10 years revealed PAM enlargement in 35% and transformation into melanoma in 12%. Of those that underwent incisional or excisional biopsy, 10-year estimates of PAM recurrence and transformation into melanoma were 58% and 11%, respectively. Progression to melanoma occurred in 0% of PAM without atypia, 0% of PAM with mild atypia, and 13...
Ophthalmology, 2004
To describe a patient with conjunctival metastasis as the initial manifestation of metastasis fro... more To describe a patient with conjunctival metastasis as the initial manifestation of metastasis from a cutaneous melanoma. Single interventional case report. A 48-year-old woman with a history of cutaneous axillary melanoma developed a rapidly growing conjunctival mass. Subsequent systemic evaluation disclosed asymptomatic liver metastasis. The conjunctival lesion was resected. Histopathologic evaluation of the conjunctival tumor disclosed an epithelioid cell melanoma located in the conjunctival stroma, without appreciable junctional activity, compatible with metastatic melanoma. Conjunctival metastasis from cutaneous melanoma can rarely be the initial manifestation of disseminated melanoma.