Differential Diagnosis Of Orbital Lesions Research Articles

Brain Tumors Affecting the Orbit Globe and Orbit Tumors Affecting the Brain.

Brain tumors affecting the orbit and orbital tumors affecting the brain are a heterogeneous group of lesions, with histological features, behaviors, diagnostic criteria, and treatments varying from each other. Dermoid cyst and cavernous hemangiomas are considered the most frequent benign lesions, while non-Hodgkin lymphoma is the most common malignant tumor in this region. Sharing the same anatomical region, clinical manifestations of orbital lesions may be often common to different types of lesions. Imaging studies are useful in the differential diagnosis of orbital lesions and the planning of their management. Lesions can be classified into ocular or extra-ocular ones: the latter can be further differentiated into extraconal or intraconal, based on the relationship with the extraocular muscles. Surgical therapy is the treatment of choice for most orbital lesions; however, based on the degree of removal, their histology and extension, other treatments, such as chemotherapy and radiotherapy, are indicated for the management of orbital lesions. In selected cases, chemotherapy and radiotherapy are the primary treatments. This chapter aimed to discuss the orbital anatomy, the clinical manifestations, the clinical testing and the imaging studies for orbital lesions, and the principal pathological entities affecting the orbit together with the principles of orbital surgery.

The role of ultrasonography in differential diagnosis of orbital lesions

The aim of this study is to assess the value of ultrasound in the differential diagnosis of orbital lesions. One hundred and thirty-eight patients with clinical features of an orbital mass were examined by orbital ultrasound prior to undergoing surgery, from January 2000 to January 2017. All patients underwent excisional or incisional orbital biopsy. The results of orbital ultrasonography were compared with the final histological diagnosis. Orbital lesions were localized by ultrasonography in 133/138 cases (96.4%); the false-negative rate of orbital echography was 3.6% (5/138). The nature of the orbital lesions was correctly determined by ultrasonography in 54.3% of the cases (75/138) preoperatively (true positives). In 58/138 (42%) patients, there was no correspondence between the ultrasound diagnosis and the histological diagnosis (false positives). The sensitivity of orbital ultrasonography for the detection of an orbital mass was 93.75% (CI 87.87-99.63%), while the specificity yielded no meaningful result (CI 0.00-60.24%). Moreover, the specificity of orbital ultrasonography to identify a malignant tumor falls within a CI of 0-62.72%. Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive in displaying an orbital mass; however, the specificity in the differential diagnosis of orbital lesions is not meaningful, particularly if malignancy is suspected. The assessment of orbital diseases requires multiple diagnostic approaches to balance the strengths and weaknesses of each method.

Kimura's Disease: Uncommon Cause of Proptosis

Purpose: To describe a case of inferior orbital mass with generalized lymphadenopathy and histopathological examination proven Kimura’s disease. Methodology: Case report Findings: A 17 year-old Malay man with no previous illness. Presented with two months history of progressive proptosis of the right eye (RE). Upon presentation vision was 6/7.5 RE and left eye (LE) 6/6. Ocular examination revealed RE proptosis with restricted extraocular muscle movement and optic disc swelling. Systemic examination noted multiple lymphadenopathy over cubital fossa and inguinal region. Blood investigation showed peripheral eosinophilia. CT brain and orbit revealed RE inferior orbital mass compressing the optic nerve. Subsequently RE orbital mass incisional biopsy and inguinal node excisional biopsy was done. The later showed typical features of Kimura’s disease with diffuse eosinophils infiltration within the germinal centres of the lymphoid nodule. He was started on tapering dose of oral corticosteroids and responded well evidenced by reducing RE proptosis. Conclusion: This case demonstrates that proptosis with lymphadenopathy does not always imply lymphoma but may have a benign pathogenesis such as Orbital Kimura’s disease. Therefore it should be considered in the differential diagnosis of orbital lesions occurring in adults. Accurate diagnosis in biopsies is also crucial to avoid unnecessary radical surgery.

Orbital Metastasis of Breast Cancer Mimicking Invasive Fungal Rhinosinusitis.

Introduction. A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures. In the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis can affect the orbit, which may look like initially a rhinosinusitis or even mimic malignancy. Case Presentation. Female patient, 32 years old, with headache and ocular proptosis. She was using prednisone in immunosuppressive doses for a year and had breast cancer treated three years earlier. The initial CT scan showed opacification of the sphenoid and ethmoid sinuses, left intraorbital involvement and contrast impregnation in the cavernous sinus. The biopsy resulted positive for invasive ductal carcinoma of the breast. Discussion. The initial CT scan of our patient showed both signs of early changes of invasive fungal rhinosinusitis (IFR) and possible metastatic involvement. The intracranial extension and ocular involvement are usually the most common signs of IFR (first hypothesis). Among metastases at the orbit and the eye, breast and lung carcinomas are the most frequent. Conclusion. Although several studies on the differential diagnosis of orbital lesions exist, especially when it concerns the involvement of the nasal cavity, the diagnosis by imaging is still a challenge.

Ophthalmic Manifestations of Systemic Diseases—Part 1: Phakomatoses, Hematologic malignancies, Metastases, and Histiocytosis

The orbit can be secondarily involved in various systemic conditions. The ophthalmic involvement is often the first clue to the presence of an underlying systemic condition. The ophthalmic involvement in systemic diseases can be either ocular or extraocular. The extent of involvement can be well delineated by imaging modalities like computed tomography and magnetic resonance imaging. In the first part of the article, we provide an overview of systemic diseases affecting the orbit, briefly discuss the modalities for orbital imaging, and discuss the imaging appearances of ophthalmic involvement in (1) phakomatoses, (2) hematologic malignancies, (3) metastases, and (4) histiocytosis. At the end of the 2-part article, we discuss a pattern-based approach and differential diagnosis of orbital lesions in systemic diseases.

Orbital and adnexal tuberculosis: a case series from a South Indian population.

BackgroundOrbital tuberculosis (OTb) is rare and may be regarded as a manifestation of extrapulmonary tuberculosis. We report an interesting case series of six patients with varied presentations of orbital and adnexal tuberculosis in a South Indian patient population.ResultsA retrospective, interventional case series of six patients diagnosed with orbital and adnexal tuberculosis on the basis of clinical, radiological and histopathological evaluations between 2010 and 2013 was performed. Among the six patients with histopathologically proven OTb, five were women. The varied presentations included tubercular dacryoadenitis (two cases), classical periostitis (two cases), OTb with bone involvement (one case) and ocular adnexal tuberculosis (one case). Systemic involvement was seen in one case. All cases were treated with a regimen of antitubercular therapy (ATT).ConclusionsOTb, though rare, should form a part of the differential diagnosis of orbital lesions in a high tuberculosis (TB) endemic country like ours. Biopsy still remains the mainstay of diagnosis.

Angiolymphoid Hyperplasia with Eosinophilia of the Lacrimal Gland: A Case Report

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare clinicopathologic entity that has been the subject of considerable confusion and debate. ALHE shares both clinical and histopathologic features with Kimura disease (KD). Because of this overlap, ALHE and KD have been used synonymously in the Western medical literature, as they were thought to represent variations of the same disease. Some pathologic reports have called for distinguishing ALHE and KD as two separate nosological entities, based on their clinical, laboratory, and especially histopathologic findings. ALHE commonly affects women in the third and fourth decades, with head and neck involvement. ALHE has been described rarely in the orbit, eyelids, and lacrimal gland. We report a case of ALHE involving the left lacrimal gland in a 40-year-old Mexican woman. Because ALHE can cause proptosis, lid swelling, ocular dysmotility, or a palpable mass, it should be considered in the differential diagnosis of orbital lesions occurring in adults.

Congenital orbital varices causing extreme neonatal proptosis

PURPOSE: To report a 6-week-old male with extreme proptosis caused by thrombosed orbital varices. METHODS: A 6-week-old male presented with advanced proptosis of his left eye. Computed tomography and magnetic resonance imaging studies of the orbits revealed a heterogeneous cystic mass that filled the entire left orbit. Extreme proptosis and corneal exposure prompted urgent surgical excision of the mass. Histopathologic review of the lesion was consistent with orbital varices. CONCLUSIONS: Although orbital varices usually are found in adults, they should be considered in the differential diagnosis of orbital lesions in children. Observation is usually warranted, but surgical intervention may be necessary in advanced cases.

Differential diagnosis of lateral orbital masses

Computed tomography is ideal for demonstrating orbital masses. It provides information regarding lesion location and involvement of intraorbital structures. It therefore can be used in both staging and follow-up of orbital lesions. Mass location, attenuation characteristics, form, and presence or absence of contrast enhancement all may aid the radiologist in the differential diagnosis of orbital lesions by CT. However, this review of lateral orbital masses illustrates that the differential diagnosis can be quite varied. Careful correlation with history and clinical findings may lead one to the proper diagnosis; however, often the exact nature of a lateral orbital mass must await histologic confirmation.