Differential Diagnosis Of Orbital Tumors Research Articles

A Case of Orbital Eccrine Hidrocystoma

Purpose: To report the first domestic case of orbital eccrine hidrocystoma.Case summary: A 40-year-old man visited our clinic after an orbital mass was discovered in the left eye. Orbital magnetic resonance imaging showed a well-defined 1 cm mass on the superomedial side of the orbit, slightly posterior to the globe. The mass was excised completely without rupture through an incision to the upper eyelid skin. The mass appeared more like a cyst than a hemangioma. The diagnosis of eccrine hidrocystoma was confirmed histopathologically. The patient recovered and there was no recurrence at the 6-month follow-up.Conclusions: Although orbital eccrine hidrocystoma is very rare, it should be included in the differential diagnosis of orbital tumors.

An aggressive orbital mass in a young patient

<br>Undifferentiated pleomorphic sarcoma (UPS), earlier known as malignant fibrous histiocytoma, is a rare entity in the orbit. Here, we report a case of UPS in a 34-year male, who presented as rapidly progressive unilateral proptosis with no history of any other systemic diseases. The tumor was removed surgically, followed by adjuvant chemotherapy and radiotherapy. After one year follow-up, the patient had not shown any orbital recurrence but had lung and gastrointestinal metastasis. UPS is rare, but because of its aggressive behavior, it should be included in the differential diagnosis of orbital tumors.<br>

Новообразование орбиты у пациента с хроническим вирусным гепатитом С с системными проявлениями (клиническое наблюдение)

Aim. To present the case report of orbital tumor in patient with chronic hepatitis C with systemic manifestations, diagnostic and treatment approaches in such patients. Material and methods. We describe a clinical case of 48 y.o. female patient complaining of right-sided upper eyelid swelling and ptosis. According to MRI an orbital tumor was previously visualized in the location of right lacrimal gland. It was known, that the patient suffers from HCV infection since 1992. She was prescribed local and systemic immunosuppressive treatment with a positive effect, however due to hemorrhagic vasculitis development and eyelid swelling recurrence 2 weeks later she was admitted to the hospital. In diagnostic purpose the orbital tumor was surgically excised followed by morphological and immunohistochemical investigation. Results. A differential diagnosis between chronic dacryoadenitis, lymphoid tissue hyperplasia (due to longstanding antigene stimulation (MALT – tissue) and marginal lymphoma (MALT – lymphoma) was performed. Immunohistochemical staining and PET – CT failed to confirm the lymphoproliferative disease. However, in 1 year due to tumor recurrence, repeated biopsy followed by previously described analyses confirmed extranodal marginal zone B-cell lymphoma (MALT – lymphoma). Repeated PET-CT showed metabolic activity in the right orbit and in the location of paraesophageal lymph node. The patient received polychemotherapy inducting lymphoma remission. Conclusion. Current clinical case shows that differential diagnosis of orbital tumors in patients with chronic hepatitis C should include lymphoproliferative diseases. Key words: orbit neoplasm, dacryoadenitis, lymphoma, chronic viral hepatitis C.

NI-03 USEFULNESS OF IMP-SPECT IN PREOPERATIVE GRADE EVALUATION OF INTRAORBITAL TUMOR

INTRODUCTIONThe frequency of intraorbital tumors is small as 0.9% of all brain tumors, but its pathological type is diverse. Among them, the diagnosis of whether particularly malignant tumor scan clinically, is extremely important. Nuclear medical testing is essential for non-invasive differential diagnosis in brain tumors. SPECT, good malignancy differentiation, evaluation of malignancy, usefulness such as differentiation of non-tumorous lesions have been reported many. However, there are few reports that SPECT was useful in preoperative differential diagnosis of orbital tumors. Since 123IMP-SPECT was useful in preoperative differential diagnosis of intraorbital tumors, we report some literature considerations.METHODAmong the 27 cases of intraorbital tumors that were operated on in our clinic between August 2005 and August 2016, 14 cases of SPECT prior to surgery were examined for the usefulness of preoperative differential diagnosis. Breakdown of cases, as the malignant tumor, two cases of malignant lymphoma, MALT lymphoma 2 cases, adenoid cystic carcinoma 1 case, in one case plasma cytoma, as a benign tumor, false tumors 4 cases, three hemangioma cases, neurocytoma 1 case it was.RESULTSIn IMP early image, accumulation of clear IMP was observed in all six cases of malignant tumors. In benign tumors, there is no accumulation in hemangioma and neurosheath, there is a strong accumulation in one of the four cases in false tumors, it was observed mild accumulation in the remaining two cases. Tumor to normal ratio of IMP early image was an average of 2.39 in six malignant tumors and 1.52 in 8 benign tumors.CONCLUSIONThis time, we examined the usefulness of 123IMP-SPECT in preoperative differential diagnosis of intraorbital tumors. The T/N ratio of intraorbital malignant tumors is higher than benign tumors, and it was thought to help to evaluate preoperative malignancy of intraorbital tumors.

Differentiation between orbital malignant and benign tumors using intravoxel incoherent motion diffusion-weighted imaging: Correlation with dynamic contrast-enhanced magnetic resonance imaging.

To evaluate the performance of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for differentiating orbital malignant from benign tumors, and to assess the correlation between IVIM-DWI parameters and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters.Twenty-seven patients (17 benign and 10 malignant) with orbital tumors underwent 3.0T MRI examination for pre-treatment evaluation, including IVIM-DWI and DCE-MRI. IVIM-DWI parameters (tissue diffusivity, D; pseudo-diffusion coefficient, D∗; and perfusion fraction, f) were quantified using bi-exponential fitting model. DCE-MRI parameters (Ktrans, the volume transfer constant between the plasma and the extracellular extravascular space [EES]; Ve, the volume fraction of the EES, and Kep, the rate constant from EES to blood plasma) were quantified using modified Tofts model. Independent-sample t test, receiver operating characteristic curve analyses and Spearman correlation test were used for statistical analyses.Malignant orbital tumors showed lower D (P <.001) and higher D∗ (P = .002) than benign tumors. Setting a D value of 0.966 × 10−3 mm2/s as the cut-off value, a diagnostic performance (AUC, 0.888; sensitivity, 100%; specificity, 82.35%) could be obtained for diagnosing malignant tumors. While setting a D∗ value of 42.371 × 10−3 mm2/s as cut-off value, a diagnostic performance could be achieved (AUC, 0.847; sensitivity, 90.00%; specificity, 70.59%). Poor or moderated correlations were found between IVIM-DWI and DCE-MRI parameters (D∗ and Kep, r = 0.427, P = .027; D and Ve, r = 0.626, P <.001).IVIM-DWI is potentially useful for differentiating orbital malignant from benign tumors. Poor or moderate correlations exist between IVIM-DWI and DCE-MRI parameters. IVIM-DWI may be a useful adjunctive perfusion technique for the differential diagnosis of orbital tumors.

Differential Diagnosis of Orbital Tumors in Children

Orbital tumors in children are very rare and radiologic image as magnetic resonance is extremely important for correct diagnosis We report six cases of different diagnosis of orbital tumors comparing their images and clinical aspects Radiologic images are essential for determine specific diagnosis in most cases of pediatric orbital pathology

Value of contrast-enhanced ultrasound in differential diagnosis of orbital tumors using Logistic regression analysis

Objective To evaluate the value of conventional ultrasound and contrast-enhanced ultrasound(CEUS) in differential diagnosis of orbital tumors using the binary Logistic regression model to explore the diagnostic values of benign and malignant orbital neoplasms in different enhanced levels. Methods Sixty-one cases of orbital tumors which were confirmed by pathological results and undergone CEUS before suregery, and the results were analyzed by Logistic regression. Logistic model was made upon the ultrasonic parameters with high relativity to orbital tumors. The ROC curve was constructed to assesss the performance of the Logistic model. The differential diagonosis value of contrast-enhanced ultrasound in orbtial tumors was evaluated. Results Three characteristic variables, including semi-descending slope, cloor Doppler degree, enhancement type, were took into the Logistic regression model by binary Logistic regression analysis, which were the sensitive indicators for differential diagnosis. The accuracy, sensitivity and specificity of this model were 75.4%, 82.6%, 78.9%, respectively. Area under ROC was 0.852. Conclusions Multipe paramets of conventional ultrasound and CEUS have important value in differential diagnosis of orbital tumors using the binary Logistic regression model. Key words: Contrast-enhanced ultrasound; Logistic models; Orbital neoplasms; ROC curve

Epithelioid Hemangioma of the Orbit or Angiolymphoid Hyperplasia With Eosinophilia

A patient was referred to the department for an incidentally discovered right orbital mass on MRI. After surgical excision, histopathologic examination led to the diagnosis of epithelioid hemangioma, a tumor rarely located in the orbit, whose main histopathologic feature is an exuberant proliferation of small vascular channels lined by enlarged endothelial cells. The clinical characteristics and histopathology of epithelioid hemangioma allow differentiation with Kimura disease, angiosarcoma, intravascular papillary endothelial hyperplasia, and other vascular tumors that share the common feature of an abnormal proliferation of endothelial cells. Although epithelioid hemangioma is extremely rare, it should be considered in the differential diagnosis of orbital tumors.

Leiomyolipoma of the Orbit

Orbital leiomyolipoma is a rare benign tumor characterized by a mixture of mature smooth muscle cells and adipocytes. The authors present a case which, to the best of their knowledge, is the second case of leiomyolipoma of the orbit reported in the ophthalmic literature. A 65-year-old patient presented with a painful and swollen left eye, the symptoms having been present for 1 week. Imaging (CT, MRI follow up) confirmed the presence of a nearly 2-cm lesion medial to the lacrimal gland. A biopsy was planned, and 3 specimens were taken for histologic examination. Histology showed diffusely intermingling smooth muscle cells and mature adipocytes; immunohistochemistry demonstrated positive staining for smooth muscle actin and negativity for HMB45, MART-1, and Cytokeratin AE1/3. Although it is very rare, ophthalmologists should consider leiomyolipoma in the differential diagnosis of orbital tumors. The long-term prognosis for patients affected by this benign tumor is good.

Orbital Nerve Sheath Myxoma: A Case Report

A 72-year-old man was referred to the Service of Ophthalmology due to a 2-year history of ptosis and a painless mass in the lateral orbital margin of the right eye. Orbital MRI revealed a well-demarcated lesion in the superotemporal quadrant of the orbit. After surgical excision, histopathological examination led to the diagnosis of nerve sheath myxoma, a tumor composed of myxoid nodules separated by fibrous septa with spindle-shaped and stellate cells. Many of these cells were immunostained with antibodies to S-100 protein. This is the first case reported in the literature of such a tumor located in the orbit, and, though extremely rare, it should be considered in the differential diagnosis of orbital tumors.

Magnetic resonance imaging in the analysis of pediatric orbital tumors: Utility of diffusion-weighted imaging

To identify common radiographic features of pediatric orbital tumors by the use of magnetic resonance imaging (MRI) techniques, diffusion-weighted imaging (DWI), fat saturated T2, and pre- and postgadolinium T1. DWI is hypothesized to help identify and predict the malignancy of specific brain tumors. To our knowledge, a similar analysis in which the authors have used this combination of MRI techniques has not been performed with orbital tumors. We performed a retrospective chart review of all patients younger than 18 years of age, each diagnosed with an orbital mass lesion, imaged by MRI from 2005 to 2008. The MR images were analyzed by use of the aforementioned techniques. Mass lesions identified in the chart review included rhabdomyosarcoma (n = 4), myofibroma (n = 2), hemangioma (n = 4), lymphangioma (n = 2), neurofibroma (n = 4), Langerhans histiocytosis (n = 2), and one of each of the following: giant cell tumor, meningioma, lymphoid hyperplasia of the lacrimal gland (chronic sclerosing sialadenitis), optic nerve glioma, lipodermoid, and dermoid. DWI was used to differentiate tumors into those with increased diffusion, restricted diffusion, and a mixed diffusion pattern. Capillary hemangiomas and rhabdomyosarcomas 2 tumors with potentially overlapping appearances with traditional MRI techniques had contrasting appearances with DNI. DWI can help to distinguish among certain pediatric orbital tumors when combined with traditional MRI techniques. This technique may thus be considered an additional tool to help, refine the differential diagnosis of orbital tumors in children.

Orbital Cavernous Hemangiomas: Ultrasound and Magnetic Resonance Imaging Evaluation

Cavernous hemangioma is the most common intraorbital lesion in adults. The aim of our study was to evaluate the magnetic resonance imaging (MRI) and ultrasound (US) characteristics of cavernous hemangioma and their role in the differential diagnosis of orbital tumors. Eight patients with orbital cavernous hemangiomas, five women and three men with a mean age of 48 years were examined in a period of six years. All patients underwent MRI examination and four patients were also evaluated by US. In all cases MRI depicted a well-defined intraconal tumor. The lesions were homogeneous, isointense to muscle on T1-weighted sequence and hyperintense to muscle on T2-weighted sequence in six patients. In one patient the mass was isointense on T1WI with heterogeneous signal intensity on T2WI and in one patient the lesion had heterogeneous signal intensity on both T1- and T2-weighted sequences. After intravenous contrast medium administration, the tumors showed initial inhomogeneous enhancement with progressive accumulation of contrast material on delayed images in seven patients and initial homogeneous enhancement in one patient. On ultrasonography, the orbital masses appeared slightly hyperechoic, heterogeneous with small areas of slow blood flow. The analysis of imaging characteristics of a well-defined intraconal lesion in an adult patient with painless progressive proptosis can be highly suggestive of the diagnosis of cavernous hemangioma.

Orbital Solitary Fibrous Tumor : A Case Report and Diagnostic Clues

Orbital solitary fibrous tumor (SFT) is a rare tumor originating from the mesenchyme. We describe the clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT. The patient was a 46-year-old female who presented with progressive proptosis advanced for 20 months. On ophthalmological examination, no visual impairment was detected, but left eye was found to be obviously protruded on exophthalmometry. Orbital magnetic resonance imaging showed a 2.5 x 2 x 2 cm, intensely enhanced mass in the left orbit, which compressed the eyeball forward and the optic nerve downward. The patient underwent frontal craniotomy with superior orbitotomy and gross total resection was performed for the tumor. The histopathological diagnosis including immunohistochemistry was a SFT. After the surgery, proptosis was markedly relieved without visual impairment. Although orbital SFT is extremely rare, it should be considered in the differential diagnosis of orbital tumors. Clinical presentations such as painless proptosis and CD34 immunoreactivity play a significant role in differentiating orbital SFT from other spindle-cell neoplasms of the orbit.

Orbital Dermoid Cyst With Intratumoral Inflammatory Hemorrhage -Case Report-

An 85-year-old female presented with a 3-month history of worsening hyperlacrimation and blurred vision following blunt head injury. Her past medical history was unremarkable. Her blood examination identified no abnormal findings. Neuroophthalmological inspection revealed extraocular movement disorder and mild exophthalmos on the affected side. Her visual acuity was not disturbed. Neuroimaging showed a cystic mass located extraconally in the superolateral compartment of the anterior orbit, without enhancement by contrast medium. Surgical exploration resulted in escape of chocolate-colored, liquefied hematoma during dissection. No vascular lesion was found. A grayish-white cyst wall was found adhering strongly to the lateral and superior rectus muscles. The lacrimal gland was not identified. The mass was totally resected. Histological examination indicated dermoid cyst with inflammatory interstitial hemorrhage. No component of vascular malformation or atypia was found. Hyperlacrimation and extraocular movement improved postoperatively. We thought that the previous blunt head injury might have induced intratumoral hemorrhage in the preexisting dermoid cyst and that the escaped contents caused inflammatory irritation, resulting in the hyperlacrimation. Dermoid cyst may show atypical presentation with intratumoral hemorrhage and should always be included in the differential diagnosis of orbital tumor.

Orbitale MALT-Lymphome: Klinisch-pathologische Korrelation

Extranodal MALT lymphomas are slow growing tumors of B-cell origin which may be found in the orbit. They are associated with mucosa and epithelial structures. We present eight patients with biopsy confirmed orbital MALT Lymphomas. The diagnostic imaging techniques are described. Histopathological and immunohistological analysis showed typical findings of MALT lymphomas. After staging six patients had radiation therapy. Two patients refused treatment due to lack of discomfort. MALT lymphomas should be considered in the differential diagnosis of orbital tumors. While ultrasonography and MRI are needed to determine the extension of these tumors, their identification requires excision or biopsy with histological/immunohistochemical analysis, especially in view of new treatment options.

A Case of Alveolar Rhabdomyosarcoma of the Ethmoid Sinus Invading the Orbit in an Adult

PurposeA case study and literature review of alveolar rhabdomyosarcoma (RMS) in an adult.MethodsA 48-year-old male patient presented at our clinic complaining of proptosis that had persisted for 2 weeks in his left eye. A computed tomography (CT) scan revealed a destructive soft-tissue mass in the left ethmoid sinus with invasion of the left orbit and compression of the medial rectus muscle. Endoscopic intranasal biopsy revealed alveolar RMS. Conservative debulking and orbital wall decompression were performed.ResultsImmunohistochemical testing was positive for desmin, S-100, and smooth muscle actin (SMA), supporting the diagnosis of RMS. Since ipsilateral cervical and spinal metastasis was detected, systemic treatment was administered simultaneously.ConclusionsAlthough rarely found in adults, RMS should be considered in the differential diagnosis of orbital tumors. Immunohistochemical analysis plays an important role in the definitive diagnosis of RMS.

Afectación orbitaria como primera manifestación de la enfermedad de Hand-Schuller-Christian: Caso clínico

PURPOSE/MATERIAL AND METHOD: To describe the clinical case of a 20-month-old boy with Hand-Schuller-Christian disease. Exophthalmos was the only systemic manifestation evident over a period of at least 6 weeks, but later the triad of exophthalmos with multiple lytic lesions of the skull and diabetes insipidus were present. Histiocytosis X should be considered in the differential diagnosis of orbital tumors in children.

Solitary fibrous tumor of the orbit: Is it rare? Report of a case series and review of the literature

Purpose The real incidence of solitary fibrous tumor (SFT) of the orbit is unknown, but it seems that since it was first described in 1994, orbital SFT has been increasingly recognized. We believe that the orbital SFT is a relatively common tumor and that it should be considered in the differential diagnosis of any orbital tumor. Design Interventional case series. Participants Four new cases of orbital SFT. Methods Four patients affected by solitary fibrous tumor of the orbit are described. One patient experienced a recurrent SFT shortly after initial surgical excision performed elsewhere. Thirty-eight cases have been reported in the literature in 7 years. Results The number of orbital SFTs reported has been increasing, reaching an average of more than five tumors reported per year. Since the first orbital SFT was described in 1994, 37 cases have been reported in the literature. We add four new cases in our series, including a recurrent tumor. A total of 42 cases have now been described, eight with recurrences. Malignant transformation occurred in one case. Conclusions We believe that before 1994, the diagnosis orbital SFT was confused with other benign orbital tumors, such as fibrous histiocytoma and hemangiopericytoma because of a lack of use of immunohistochemical techniques. This entity should now be considered relatively common and should be included in the differential diagnosis of orbital tumors in any age group. Local recurrences of SFT are possible and usually follow an incomplete initial excision. Recurrent tumors in the orbit have shown the tendency to infiltrate the surrounding tissues and the bone, rendering complete secondary excision more difficult. Recurrent orbital SFT also has the potential for malignant transformation. The treatment of choice of orbital SFT is complete surgical excision and careful follow-up. Considering the more aggressive course followed by recurrent tumor, correct diagnosis and management is essential.

Orbital xanthoma in a 9-month-old infant

PURPOSE: To report a case of orbital xanthoma in a 9-month-old female. METHODS: A 9-month-old female presented with a mass in the superior temporal left orbit since birth. Clinically, a dermoid cyst was suspected. RESULTS: The orbital tumor was removed through an incision in the upper eyelid crease. Pathologic diagnosis was orbital xanthoma. CONCLUSION: Orbital xanthoma should be added to the differential diagnosis of orbital tumors in children.

Unifocal eosinophilic granuloma (Langerhans cell histiocytosis) of the supratemporal orbital bone in an adult

Langerhans cell histiocytosis is rare and can be categorized into three forms on the basis and extent of organ involvement: eosinophilic granuloma, Hand-Schüller-Christian disease, and Letterer Siewe disease. We present a 30-year-old patient with an isolated eosinophilic granuloma arising from the supratemporal orbital bone and manifesting as a space-occupying orbital lesion. Langerhans cell histiocytosis should be considered in the differential diagnosis of orbital tumors in both children and adults.