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Malignant Transformation of Primary Acquired Melanosis into Conjunctival Melanoma in an Adolescent Male: A Clinico-Pathological Case Report and Management Review Fitrah; Ardizal Rahman; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1426

Background: Conjunctival malignant melanoma (CMM) is a rare but potentially lethal ocular surface malignancy, especially uncommon in adolescents. It often arises from a precursor lesion known as primary acquired melanosis (PAM) with atypia. We present a case of CMM developing from long-standing PAM in an 18-year-old male, highlighting the diagnostic and therapeutic challenges in this unusual demographic. Case presentation: An 18-year-old male presented with a pigmented conjunctival lesion in his right eye, which had been present for over a decade but had recently shown progressive enlargement and darkening. Slit-lamp biomicroscopy revealed a 5x2 mm, variegated, hyperpigmented lesion on the bulbar conjunctiva with a prominent feeding vessel. The patient underwent an excisional biopsy using a "no-touch" technique with 4 mm margins and adjunctive double freeze-thaw cryotherapy. Histopathological analysis confirmed an invasive malignant melanoma, Breslow thickness of 1.8 mm, arising from PAM with severe atypia. Surgical margins were clear of the tumor. Conclusion: This case underscores that malignant transformation of conjunctival melanocytic lesions can occur even in young patients. The presence of a changing pigmented lesion, regardless of patient age, necessitates a high index of suspicion and a low threshold for excisional biopsy. Meticulous surgical technique combined with adjuvant therapy and vigilant long-term surveillance is paramount for optimizing patient outcomes.

A Masquerading Giant: Unprecedented Sebaceous Gland Carcinoma with Massive Orbito-facial Invasion and the Diagnostic and Therapeutic Challenges of an Extreme Presentation Rizki Dwayana Putra; Mardijas Efendi; Ardizal Rahman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1434

Background: Sebaceous gland carcinoma (SGC) is a rare, aggressive adnexal malignancy of the eyelid, notorious for masquerading as benign inflammatory conditions. Presentations involving massive, destructive orbito-facial invasion are exceptionally rare and pose profound diagnostic and therapeutic challenges, often reflecting a confluence of biological aggression and systemic delays in care. Case presentation: A 68-year-old male presented with a one-year history of a progressively enlarging mass on his left upper eyelid, which had evolved into a giant, 15 x 15 x 7 cm fungating tumor, causing complete destruction of the orbital contents and extensive invasion into adjacent facial structures. An initial incisional biopsy was paradoxically interpreted as benign sebaceous hyperplasia. Due to the stark clinico-pathological discordance, a repeat, deeper biopsy was performed. The subsequent histopathological examination revealed a high-grade carcinoma, and the diagnosis was definitively confirmed by a panel of immunohistochemical stains, including strong positivity for Epithelial Membrane Antigen (EMA) and Cytokeratin 7 (CK7). The disease was staged as T4dN1M0 and deemed unresectable. Conclusion: This case documents a catastrophic outcome of SGC, resulting from a combination of delayed patient presentation and initial diagnostic error. It highlights that giant SGC, while rare, must be considered in the differential of destructive facial tumors and underscores that immunohistochemistry is mandatory for resolving clinico-pathological paradoxes in ocular adnexal pathology. This case serves as a call to action for improved public health awareness and enhanced diagnostic acumen to prevent such devastatingly advanced presentations.

A Diagnostic Rarity: Apocrine Hidrocystoma Presenting as a Medial Canthal Mass in Adolescence Atika Syafendra; Mardijas Efendi; Ardizal Rahman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1438

Background: Apocrine hidrocystomas are benign adnexal tumors of the glands of Moll, typically diagnosed in adults. Their presentation in adolescence is an exceptional clinical finding that challenges standard diagnostic paradigms for periocular masses in this age group, necessitating a broad and meticulous differential diagnosis. Case presentation: A 15-year-old female presented with a two-month history of a stable, asymptomatic, 7×5×1 mm cystic mass at the inferomedial canthus of the left eye. The patient's primary concern was cosmetic. A comprehensive ophthalmologic examination was unremarkable. Orbital computed tomography confirmed a simple, preseptal subcutaneous cyst. A complete excisional biopsy was performed, and histopathological analysis revealed a unilocular cyst lined by a double layer of epithelium with inner columnar cells demonstrating pathognomonic decapitation secretion, confirming an apocrine hidrocystoma. Conclusion: This case highlights the necessity of including apocrine hidrocystoma in the differential diagnosis of periocular masses in adolescents. The primary lesson is that a patient's age should broaden, not narrow, the diagnostic possibilities. Definitive diagnosis relies on histopathology, not demographic probability, and complete surgical excision remains the gold standard for both diagnosis and curative therapy, yielding an excellent prognosis.

Beyond the Floor: Traumatic Medial Rectus Entrapment in a Medial Orbital Wall Fracture Presenting with Diplopia and Retinal Hemorrhage Pratistha Satyanegara; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1450

Background: Medial orbital wall fractures with extraocular muscle entrapment represent a significant but less common variant of orbital trauma compared to floor fractures. These injuries pose a diagnostic and management challenge, with the potential for severe, long-term functional deficits and life-threatening systemic complications if not addressed promptly. This report details a case of medial rectus muscle entrapment complicated by a concurrent posterior segment injury. Case presentation: A 21-year-old male presented to the emergency department following a motorcycle accident, sustaining blunt trauma to his left eye. He reported an acute onset of blurred vision and binocular diplopia. Ophthalmic examination revealed a visual acuity of 20/80 in the left eye. There was a manifest esotropia and a profound abduction deficit, with marked restriction of movement on attempted lateral, superolateral, and inferolateral gaze. The forced duction test was positive, confirming mechanical restriction. Funduscopy identified significant retinal hemorrhages. A maxillofacial computed tomography scan confirmed a comminuted fracture of the left medial orbital wall (lamina papyracea) with clear evidence of medial rectus muscle entrapment within the fracture fragments. The patient underwent urgent surgical intervention involving exploration of the medial orbit, careful release of the incarcerated medial rectus muscle, and anatomical reconstruction of the wall with a titanium mini-plate. Intraoperative forced duction testing confirmed complete resolution of the mechanical restriction. Postoperatively, the patient showed free passive ocular motility, although active movement was recovering, and the retinal injuries required continued observation. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for medial rectus entrapment in patients presenting with post-traumatic diplopia and an abduction deficit. A thorough clinical examination, particularly the forced duction test, is paramount and often more definitive than imaging alone. Urgent surgical decompression and reconstruction are imperative to prevent permanent strabismus from muscle ischemia and to mitigate the risk of the oculocardiac reflex. Furthermore, the presence of concomitant intraocular injuries, such as traumatic retinopathy, must be diligently assessed as they significantly impact the final visual prognosis.

Vitamin D Supplementation is Associated with Attenuated Ocular Surface Oxidative Stress in Mild Thyroid Eye Disease: A Preliminary Interventional Study Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen; Rani Apriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1451

Background: Thyroid eye disease (TED) is an autoimmune orbitopathy where inflammation drives significant oxidative stress, contributing to patient morbidity. Malondialdehyde (MDA), a lipid peroxidation product, is a key biomarker of this oxidative damage. While vitamin D has known systemic immunomodulatory effects, its capacity to mitigate local oxidative stress on the ocular surface in TED is poorly understood. This study aimed to investigate the association between oral vitamin D supplementation and tear film MDA levels in patients with mild TED. Methods: A prospective, single-center, quasi-experimental pre-post study without a control group was conducted on 15 patients diagnosed with mild, active TED (Clinical Activity Score ≤3). Participants received 1000 IU of oral cholecalciferol (Vitamin D3) daily for 21 consecutive days. The primary outcome was the change in tear film MDA concentration, measured by ELISA. Secondary outcomes included serum 25-hydroxyvitamin D [25(OH)D] levels and clinical ocular surface parameters (Ocular Surface Disease Index [OSDI], Tear Break-Up Time [TBUT], Schirmer's I test). Results: A statistically significant reduction in mean tear film MDA levels was observed, decreasing from a baseline of 8.69 ± 4.15 ng/L to 5.70 ± 1.56 ng/L post-intervention (p<0.001). This was accompanied by a significant increase in mean serum 25(OH)D levels from 18.2 ± 5.9 ng/mL to 29.8 ± 6.4 ng/mL (p<0.001). Significant improvements were also noted in OSDI scores (p=0.002) and TBUT (p=0.005). The reduction in tear film MDA showed a significant negative correlation with the increase in serum 25(OH)D (r = -0.68, p=0.005). Conclusion: In this preliminary, uncontrolled study, short-term oral vitamin D supplementation was associated with a significant attenuation of ocular surface oxidative stress in patients with mild TED. These findings provide initial biochemical evidence for the potential localized benefits of vitamin D and support the need for larger, placebo-controlled randomized trials to validate its role as a safe adjunctive therapy for managing the ocular surface component of this disease.

Clinicopathological Spectrum and Management of Lacrimal Gland Tumors: A Five-Year Retrospective Analysis from an Indonesian Tertiary Center Agustin Virajati Negoro; Mardijas Efendi; Ardizal Rahman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1456

Background: Lacrimal gland tumors are a rare and heterogeneous group of neoplasms, representing a significant diagnostic and therapeutic challenge. Regional data, particularly from Southeast Asia, is sparse. This study aims to define the clinicopathological spectrum, radiological features, and management strategies for lacrimal gland tumors at a major tertiary referral center in Indonesia. Methods: A retrospective, cross-sectional analysis was conducted on all patients with histopathologically confirmed lacrimal gland tumors treated between January 2019 and June 2024. Data extracted from medical records included demographics, detailed clinical presentations (visual acuity, proptosis, pain scores), radiological findings from computed tomography (CT) and magnetic resonance imaging (MRI), definitive histopathological diagnoses with immunohistochemical profiles, and treatment modalities with short-term outcomes. Descriptive statistics and comparative analyses were performed. Results: A total of 35 patients (19 male, 16 female; mean age 48.2 ± 16.5 years) were included. Non-epithelial lesions (88.6%) were more common than epithelial tumors (11.4%). The most prevalent diagnosis was idiopathic orbital inflammation (IOI) (n=12, 34.3%), followed by lymphoproliferative disorders (n=11, 31.4%). Adenoid cystic carcinoma (ACC) was the most frequent malignant epithelial tumor (n=3, 8.6%). Superior eyelid edema was the hallmark of non-epithelial lesions (83.9%), whereas proptosis (mean 6.2mm) and severe pain (mean VAS 7.3/10) were characteristic of ACC. Radiological findings were highly correlative, with IOI showing diffuse gland enhancement and ACC demonstrating bone erosion and perineural invasion. Management was tailored to histology, with corticosteroids for IOI, radiotherapy for lymphomas, and radical surgery for ACC. Conclusion: In this Indonesian cohort, lacrimal gland tumors are predominantly non-epithelial, with inflammatory and lymphoproliferative conditions being most common. A high index of suspicion for malignancy, particularly ACC, is warranted in patients presenting with pain and proptosis. Integrating clinical, radiological, and pathological data is paramount for accurate diagnosis and effective management.

A Diagnostic Rarity: Apocrine Hidrocystoma Presenting as a Medial Canthal Mass in Adolescence Atika Syafendra; Mardijas Efendi; Ardizal Rahman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1438

Background: Apocrine hidrocystomas are benign adnexal tumors of the glands of Moll, typically diagnosed in adults. Their presentation in adolescence is an exceptional clinical finding that challenges standard diagnostic paradigms for periocular masses in this age group, necessitating a broad and meticulous differential diagnosis. Case presentation: A 15-year-old female presented with a two-month history of a stable, asymptomatic, 7×5×1 mm cystic mass at the inferomedial canthus of the left eye. The patient's primary concern was cosmetic. A comprehensive ophthalmologic examination was unremarkable. Orbital computed tomography confirmed a simple, preseptal subcutaneous cyst. A complete excisional biopsy was performed, and histopathological analysis revealed a unilocular cyst lined by a double layer of epithelium with inner columnar cells demonstrating pathognomonic decapitation secretion, confirming an apocrine hidrocystoma. Conclusion: This case highlights the necessity of including apocrine hidrocystoma in the differential diagnosis of periocular masses in adolescents. The primary lesson is that a patient's age should broaden, not narrow, the diagnostic possibilities. Definitive diagnosis relies on histopathology, not demographic probability, and complete surgical excision remains the gold standard for both diagnosis and curative therapy, yielding an excellent prognosis.

Beyond the Floor: Traumatic Medial Rectus Entrapment in a Medial Orbital Wall Fracture Presenting with Diplopia and Retinal Hemorrhage Pratistha Satyanegara; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1450

Background: Medial orbital wall fractures with extraocular muscle entrapment represent a significant but less common variant of orbital trauma compared to floor fractures. These injuries pose a diagnostic and management challenge, with the potential for severe, long-term functional deficits and life-threatening systemic complications if not addressed promptly. This report details a case of medial rectus muscle entrapment complicated by a concurrent posterior segment injury. Case presentation: A 21-year-old male presented to the emergency department following a motorcycle accident, sustaining blunt trauma to his left eye. He reported an acute onset of blurred vision and binocular diplopia. Ophthalmic examination revealed a visual acuity of 20/80 in the left eye. There was a manifest esotropia and a profound abduction deficit, with marked restriction of movement on attempted lateral, superolateral, and inferolateral gaze. The forced duction test was positive, confirming mechanical restriction. Funduscopy identified significant retinal hemorrhages. A maxillofacial computed tomography scan confirmed a comminuted fracture of the left medial orbital wall (lamina papyracea) with clear evidence of medial rectus muscle entrapment within the fracture fragments. The patient underwent urgent surgical intervention involving exploration of the medial orbit, careful release of the incarcerated medial rectus muscle, and anatomical reconstruction of the wall with a titanium mini-plate. Intraoperative forced duction testing confirmed complete resolution of the mechanical restriction. Postoperatively, the patient showed free passive ocular motility, although active movement was recovering, and the retinal injuries required continued observation. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for medial rectus entrapment in patients presenting with post-traumatic diplopia and an abduction deficit. A thorough clinical examination, particularly the forced duction test, is paramount and often more definitive than imaging alone. Urgent surgical decompression and reconstruction are imperative to prevent permanent strabismus from muscle ischemia and to mitigate the risk of the oculocardiac reflex. Furthermore, the presence of concomitant intraocular injuries, such as traumatic retinopathy, must be diligently assessed as they significantly impact the final visual prognosis.

Vitamin D Supplementation is Associated with Attenuated Ocular Surface Oxidative Stress in Mild Thyroid Eye Disease: A Preliminary Interventional Study Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen; Rani Apriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1451

Background: Thyroid eye disease (TED) is an autoimmune orbitopathy where inflammation drives significant oxidative stress, contributing to patient morbidity. Malondialdehyde (MDA), a lipid peroxidation product, is a key biomarker of this oxidative damage. While vitamin D has known systemic immunomodulatory effects, its capacity to mitigate local oxidative stress on the ocular surface in TED is poorly understood. This study aimed to investigate the association between oral vitamin D supplementation and tear film MDA levels in patients with mild TED. Methods: A prospective, single-center, quasi-experimental pre-post study without a control group was conducted on 15 patients diagnosed with mild, active TED (Clinical Activity Score ≤3). Participants received 1000 IU of oral cholecalciferol (Vitamin D3) daily for 21 consecutive days. The primary outcome was the change in tear film MDA concentration, measured by ELISA. Secondary outcomes included serum 25-hydroxyvitamin D [25(OH)D] levels and clinical ocular surface parameters (Ocular Surface Disease Index [OSDI], Tear Break-Up Time [TBUT], Schirmer's I test). Results: A statistically significant reduction in mean tear film MDA levels was observed, decreasing from a baseline of 8.69 ± 4.15 ng/L to 5.70 ± 1.56 ng/L post-intervention (p<0.001). This was accompanied by a significant increase in mean serum 25(OH)D levels from 18.2 ± 5.9 ng/mL to 29.8 ± 6.4 ng/mL (p<0.001). Significant improvements were also noted in OSDI scores (p=0.002) and TBUT (p=0.005). The reduction in tear film MDA showed a significant negative correlation with the increase in serum 25(OH)D (r = -0.68, p=0.005). Conclusion: In this preliminary, uncontrolled study, short-term oral vitamin D supplementation was associated with a significant attenuation of ocular surface oxidative stress in patients with mild TED. These findings provide initial biochemical evidence for the potential localized benefits of vitamin D and support the need for larger, placebo-controlled randomized trials to validate its role as a safe adjunctive therapy for managing the ocular surface component of this disease.

Clinicopathological Spectrum and Management of Lacrimal Gland Tumors: A Five-Year Retrospective Analysis from an Indonesian Tertiary Center Agustin Virajati Negoro; Mardijas Efendi; Ardizal Rahman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1456

Background: Lacrimal gland tumors are a rare and heterogeneous group of neoplasms, representing a significant diagnostic and therapeutic challenge. Regional data, particularly from Southeast Asia, is sparse. This study aims to define the clinicopathological spectrum, radiological features, and management strategies for lacrimal gland tumors at a major tertiary referral center in Indonesia. Methods: A retrospective, cross-sectional analysis was conducted on all patients with histopathologically confirmed lacrimal gland tumors treated between January 2019 and June 2024. Data extracted from medical records included demographics, detailed clinical presentations (visual acuity, proptosis, pain scores), radiological findings from computed tomography (CT) and magnetic resonance imaging (MRI), definitive histopathological diagnoses with immunohistochemical profiles, and treatment modalities with short-term outcomes. Descriptive statistics and comparative analyses were performed. Results: A total of 35 patients (19 male, 16 female; mean age 48.2 ± 16.5 years) were included. Non-epithelial lesions (88.6%) were more common than epithelial tumors (11.4%). The most prevalent diagnosis was idiopathic orbital inflammation (IOI) (n=12, 34.3%), followed by lymphoproliferative disorders (n=11, 31.4%). Adenoid cystic carcinoma (ACC) was the most frequent malignant epithelial tumor (n=3, 8.6%). Superior eyelid edema was the hallmark of non-epithelial lesions (83.9%), whereas proptosis (mean 6.2mm) and severe pain (mean VAS 7.3/10) were characteristic of ACC. Radiological findings were highly correlative, with IOI showing diffuse gland enhancement and ACC demonstrating bone erosion and perineural invasion. Management was tailored to histology, with corticosteroids for IOI, radiotherapy for lymphomas, and radical surgery for ACC. Conclusion: In this Indonesian cohort, lacrimal gland tumors are predominantly non-epithelial, with inflammatory and lymphoproliferative conditions being most common. A high index of suspicion for malignancy, particularly ACC, is warranted in patients presenting with pain and proptosis. Integrating clinical, radiological, and pathological data is paramount for accurate diagnosis and effective management.

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