Year : 1953 | Volume
: 1 | Issue : 1 | Page : 29--31
Case of neurogenic sarcoma, successfully operated without recurrence
Neuro-surgical unit,K.E.M.Hospital, Bombay, India
R G Ginde
Neuro-surgical unit,K.E.M.Hospital, Bombay
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Ginde R G. Case of neurogenic sarcoma, successfully operated without recurrence.Indian J Ophthalmol 1953;1:29-31
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Ginde R G. Case of neurogenic sarcoma, successfully operated without recurrence. Indian J Ophthalmol [serial online] 1953 [cited 2023 Feb 3 ];1:29-31
Available from: https://www.ijo.in/text.asp?1953/1/1/29/40806
Mr. C.J. aged 25, cine director referred by Dr. Y.G. Bhojraj was admitted in the neuro-surgical department of the King Edward Memorial Hospital, Bombay on 21st May 1951 for (1) progressive diminution of vision in the left eye resulting in almost total blindness in that eye, and (2) increasing proptosis of left eye.
History : About three years previous to his admission, he noticed a positive central scotoma in front of his left eye, which gradually increased. Later lie began to get diplopia from time to time. Simultaneously there was progressive impairment of his vision and he has been almost completely blind for the past two years. His left eye began to bulge simultaneously so that the whole eyeball appeared to have come out of the orbit. [Figure 1]
Past and Family History : Non contributory.
On examination, there was marked proptosis of his left eye which was also deviated outward and displaced downwards. On asking him to turn the eyeball inwards, a first yellowish mass probably the anterior edge of the tumour could be felt. Vision in left eye barely light perception. Right eye vision was 6/6. Left fundus showed primary optic atrophy. Right fundus was normal. There were no other local abnormal findings. General examination was negative: B.P 120/60 mm. Hg. Urine analysis normal. No septic foci. Blood group: A. Blood cholesterol 380 mg%, (normal 150-230 mg%" ) Blood count, but for a slight eosinophilia ( 8% ) was normal.
X-Ray examination showed an opacity of the left orbit which is suggestive of new bone formation in it.[Figure 3].
On 24-5-1951 an exploration of the left orbit was made by tits self and Dr. S. N. Cooper. ophthalmologist, using a modified Kronlein incision under intratracheal gas and oxygen. The upper part of the incision was taken in the left eyebrow to avoid a conspicuous scar and temporary paresis of left orbicularis oculi anti frontalis. After reflecting the flap. the external wall of the orbit was removed by using fine osteotomes and kept aside. On incising the periorbita a nodular, tense, pale bluish gray, well encapsulated cystic mass about 2.5 cms in diameter became visible. It was in relation with the optic nerve. The external means was cut and the bulk of the tumour was removed in one piece. Small portions of it were adherent behind to the periorbita and had to be removed in hits. It was feared that all of the tumour was not removed and a very small portion was in all probability left behind. After securing hemostasis, the external rectus was sutured, the periorbita closed and covered with gelfoam pad. the piece of outer orbit Which was removed and kept aside was wired back in position and the wound was closed. His condition at closure was very satisfactory.
The operated specimen shows the appearance of a neurinoma undergoing a malignant change neurogenic sarcoma. [Figure 4].
Postoperatively he was covered under Penicillin umbrella of 200.000 units B.D. for 6 days and daily dressings were done. He developed edema in the maxillary and mandibular region which subsided in 8 days. There was chemosis of lower conjunctiva which had practically cleared at the time of his discharge on 5-6-1951. Sutures were removed on the 5th day and the wound healed well. He movements were encouraged daily.
Follow -up : Following his discharge he was observed for a while as an outpatient. At that time, he developed a painful gland in the left preauricular region which gave some anxiety because of the histological nature of the tumour.This however subsided, therefore. no postoperative radiation was given. He began to get some external movements of his left eye. After about 3 months, he definitely could see light ( P.L. ). On 3rd May 1952, he wrote to us as follows:-
" I haze stated seeing colour of skin somewhat of the likeness of the person seen. To-day my eyes started moving to the left side. Is it not wonderful ? I see some more details in the evening and night and much more in the moonlight."
He was seen by us last on December 2. 1952. He cart recognize objects fairly well. But the vision in that eye is M.B. He sees objects as seen through ground glass. He still has primary type of optic atrophy in his left eye. Abduction movement has been restored to a large extent. [Figure 2].
A case of neurogenic sarcoma treated successfully by all operation without any sign of recurrence (1 year and 7 months since the operation ) in spite of an incomplete removal is reported.