Orbital Space-occupying Lesions Research Articles

A Survey on Orbital Space-Occupying Lesions during a Twelve-Year Period from a Referral Center in Iran.

In this study, we describe different orbital space-occupying lesions (SOLs) from a referral center in Iran. In this retrospective case series, all records of "orbital tumors" with a definite histopathologic diagnosis at a referral center in Iran were reviewed from April 2008 to May 2020. A total of 375 orbital SOLs were included. The study population consisted of 212 (56.5%) female and 163 (43.5%) male subjects with overall mean age of 31.09 21.80 years. The most common clinical presentation was proptosis and the superotemporal quadrant was the most frequent site of involvement. Extraconal lesions (276 cases, 73.6%) outnumbered intraconal lesions (99 cases 26.4%). The great majority of SOLs (344, 91.7%) were primary, while 24 (6.4%) were secondary and 7 (1.9%) were metastatic. Benign lesions (309, 82.4%) were much more common than malignant SOLs (66, 17.6%). Overall, dermoid cysts and malignant lymphoma were the most prevalent benign and malignant orbital SOLs, respectively. The malignant to benign lesion ratio was 0.46 in children (18 years), 0.81 in middle-aged subjects (19-59 years), and 5.9 in older (60 years) cases. The most common type of malignancy was rhabdomyosarcoma in children, lymphoma in middle-aged subjects, and invasive basal cell carcinoma in older age group. Over the 12-year study period, benign, primary, extraconal orbital SOLs were more frequent than malignant, secondary, and intraconal lesions. The ratio of malignant lesions increased with age in this cohort of patients.

A clinicopathological classification of space-occupying lesions of the orbit in 1 913 patients from 2000 to 2021

Objective: To investigate the histopathological classification of orbital space-occupying lesions. Methods: This is a retrospective case series study. The clinical and pathological data of 1 913 tissue specimens from 1 913 patients with space-occupying lesions of the orbit which were examined in the Second Affiliated Hospital, Zhejiang University School of Medicine from January 2000 to December 2021 were collected. The mass lesions were classified based on histogenesis, pathological nature and age. Results: There were 913 males (47.7%) and 1 000 females (52.3%). The lesions were benign in 1 489 patients (77.8%) and malignant in 424 patients (22.2%). Based on histogenesis, there were 521 vasculogenic lesions (27.2%), which rancked first, 407 cystoid lesions (21.3%), 277 lymphoproliferative lesions (14.5%), 182 lacrimal gland lesions (9.5%) and 121 inflammatory lesions (6.3%). By pathological nature, there were 1 489 benign lesions, including cavernous hemangioma (275, 14.4%), dermoid cyst (225, 11.8%), other hemangiomas (199, 10.4%), epidermoid cyst (136, 7.1%) and benign mixed tumor of the lacrimal gland (134, 7.0%), and 257 malignant lesions, including lymphoma (210, 11.0%) and sebaceous gland carcinoma (47, 2.5%). The age of all patients ranged from 0 to 90 years, while 247 lesions (12.9%) occurred in patients aged 0 to18 years, 1 270 lesions (66.4%) in patients aged 19 to 59 years, and 396 lesions (20.7%) in patients aged 60 to 90 years. Conclusions: In 22 years, almost 2/3 benign orbital lesions in the Second Affiliated Hospital, Zhejiang University School of Medicine occurred in young and middle-aged patients, and males were fewer than females. The most common benign orbital tumors was cavernous hemangioma, followed by dermoid cyst and epidermoid cyst. And the most common malignant orbital tumor was lymphoma, which occurred more frequently in older patients.

A Clinical Study on Orbital Tumours in a Tertiary Care Centre in South India

Introduction: Space-occupying lesions of the orbit, both benign and malignant, cause significant functional and anatomical problems. A systematic and comprehensive approach is needed for prompt diagnosis and appropriate management of orbital space-occupying lesions. Methods: A total of 50 patients with orbital tumours were enrolled in the study. And it is a cross-sectional study conducted in the Department of Ophthalmology in Tirunelveli Medical College Hospital, Tamilnadu, India, for a time frame of 36 months from January 2018 to January 2021 and a follow up period of 12 months. Results: A total of 50 patients were included in the study. The most common age group involved was 40-60 years, and the mean age was 38 ± 5 years. Females were 40% and males were 60%. In 96% there was unilateral involvement and 4% had bilateral involvement. In the age group under 60 years, 23 eyes had a benign tumour and 11 eyes had a malignant tumour. In the age group of more than 60 years, 14 eyes had a malignant tumour and 2 had a benign tumour. Eccentric proptosis was reported in 85%, and axial proptosis was reported in 15%. In the total study population, 51% of the patients had benign lesions and 49% had malignant lesions. The majority of the cases are treated by chemotherapy alone (39%). The average survival rate is 81% in one year. Discussion: A multimodal systematic approach aids proper diagnosis and also prevents the quandary before commencing treatment. The tumour board discussion in treating every case of a space-occupying lesion plays a vital role in channelizing the case approach. The percentage of malignant tumours increased with age, due to the higher incidence of metastasis in the elderly. Old age tumours should be more suspected of malignancy which can be lifesaving.

Kimura's disease successively affecting multiple body parts: a case-based literature review

BackgroundKimura’s disease is a rare, benign, chronic inflammatory disease that presents as painless, solid masses mainly affecting the deep subcutaneous areas of the head and neck, especially the salivary glands, parotid glands and nearby lymph nodes. It is characterized by elevated peripheral blood eosinophil and Immunoglobulin E (IgE) levels.Case presentationA 31-year-old Asian male presented with an orbital space-occupying lesion lasting for 1.5 years. Ten years prior, surgical excision of bilateral fossa cubitalis and groin masses was performed, and the pathological examination showed "lymphoproliferative disease". One year later, masses reappeared near the surgical sites; they grew slowly and shrank after glucocorticoid treatment. At this point, admission examinations showed in the peripheral blood an eosinophil proportion of 13.4%, a total IgE level of 26,900.00 IU/mL, prurigo present on the whole body, and multiple palpable masses near the bilateral fossa cubitalis and groin. The left eyeball was exophthalmic. The left elbow mass was excised, and the pathological examination confirmed Kimura’s disease. Oral glucocorticoid therapy is taken and tapering regularly. The eosinophil count returned to normal, the IgE level gradually decreased, the orbital space-occupying lesion and elbow and groin masses shrank significantly, and the whole-body skin prurigo disappeared. Currently, the patient has been in a stable condition for eighteen months.ConclusionOur case provides a novel insight that Kimura’s disease should be involved in the differential diagnosis of inflammatory lesion mass of orbit and also supports systemic regular glucocorticoid as a valuable therapy of such condition, but close follow-up and long-term observation are crucial.

Chinese expert consensus on the diagnosis and treatment of epithelial tumors of the lacrimal gland (2021)

Orbital tumors frequently occur in the regions where the lacrimal gland is located. Lacrimal gland tumors account for about 10% of orbital space-occupying lesions. Among them, 20% to 50% were epithelial tumors, with benign tumors accounting for 55% and malignant tumors accounting for 45%. Epithelial lacrimal gland tumors usually have a special location with relatively distinctive manifestations, and the treatment principle is different from other orbital space-occupying lesions. Improper treatment often leads to recurrence and even malignant transformation, which compromise the prognosis and life quality of patients. In view of this, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society has put forward the expert consensus on the diagnosis and treatment of epithelial lacrimal gland tumors after serious discussion, in order to improve the level of diagnosis and treatment of this disease in China. (Chin J Ophthalmol, 2021, 57: 658-662).

Diagnostics of benign and malignant tumors of the orbit

Orbital space-occupying lesions can have asignificant impact on the quality of life. Depending on the dignity and etiology of the mass, they can even represent a life-threatening process, which must be timely treated in an interdisciplinary cooperation. To achieve acomprehensive overview about the diagnostics and frequency of malignant and benign masses of the orbit. A literature search was carried out in PubMed and Google scholar. Clinically, orbital lesions can show symptoms, such as exophthalmos with an increase in the vertical lid fissure, visual impairment and motility dysfunction with diplopia. Depending on the extent, an exposure keratopathy can occur due to failure to close the eyelids. For the diagnostics several tests should be carried out. Following athorough anamnesis and clinical examination, these should include ablood sample to test for various parameters, an ultrasound examination with subsequent computed tomography (CT) in cases of bone involvement or thin slice magnetic resonance imaging (MRI) of the orbit for assessment of soft tissues. In adults an endocrine orbitopathy is the most frequent cause of an inflammatory orbital process, where lymphomas are the most frequent entity among malignant tumors and vascular space-occupying lesions are the most frequent benign tumors. In children the most frequent benign masses are dermoid cysts and rhabdomyosarcoma is the most frequent primary malignant orbital tumor. The multimodal interdisciplinary treatment can include surgical excision and adjuvant radiotherapy or chemotherapy, depending on the entity.

Computerized Tomography-Guided Core-Needle Biopsy of Orbital Space-Occupying Lesions: A Case Series

Purpose: To describe our experience in performing biopsy of post-septal orbital masses with core needle under computerized tomography guidance (CT-CNB). Methods: The medical records of all patients who underwent this procedure were reviewed. The procedure was performed under local anesthesia on a day case basis under a peribulbar block. A planning non-contrast computerized tomography (CT) scan of the orbits was performed to localise the mass. A 6-cm 18-G Temno Evolution® semi-automated biopsy needle was inserted through the skin into the orbit. Prior to further advancement of the needle, a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy. Results: Five patients who underwent CT-CNB were identified. The CNB was successful in 4 patients and revealed a metastatic prostate adenocarcinoma, diffuse large B-cell lymphoma, a metastatic neuroendocrine tumour, and orbital inflammatory disease. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localisation on CT. He was eventually diagnosed with fibrous meningioma of the greater wing of sphenoid on open biopsy. None of the patients had any complications other than peri-ocular bruising which was present in all of them. Conclusion: CT-CNB of mass lesions located in the lateral aspect of the orbit can be an alternative to open biopsy in selected cases. It avoids major surgery and allows the use of radiotherapy, if required, without any delay.

Adult Orbital Lesions in Saudi Arabia: A Multi-centered Demographic Study with Clinicopathological Correlation

The demographics, clinical features, and histopathological classification of orbital space-occupying lesions in adults have not been widely described in our part of the world except for the pediatric population. In this retrospective study, we collected 110 consecutive adult patients (18 years and older) with orbital lesions (excluding lacrimal gland lesions) that were diagnosed histopathologically in two tertiary eye centers in Riyadh, Saudi Arabia (January 2000 to July 2017). Patients with thyroid-related orbitopathy, infectious, and inflammatory/pseudo-inflammatory lesions were excluded. We had 60 males (54.5%) and 50 females (45.5%). The mean age at presentation was 51.4 years (range 19–99). Proptosis was the most common clinical presentation (mean duration 15.4 months). The orbital lesions in order of increasing prevalence were: lymphoproliferative lesions in 26.4%; vascular in 21.8%; secondary tumors in 14.6%; neurogenic in 13.6%; structural in 10.0%; soft tissue tumors 8.2%; then metastatic tumors (2.7%) and others (extramedullary leukemia, fibrous dysplasia, and histiocytic lesion: Rosai-Dorfman disease): one case each. Gender distribution was varied in lymphoproliferative disorders compared to vascular lesions. Cavernous hemangioma was the most common vascular lesion (83.3%) and schwannoma was the most common neurogenic tumor (60%). Secondary lesions extended to the orbit mostly from eyelids in nine out of 16 or conjunctiva in four out of 16 cases. A favorable outcome was observed in about 80% of patients who underwent excisional biopsy. The rest encountered local recurrence of the tumors, growing of residual lesions, and recurrence with further invasion to nearby structures. We concluded having a similar demographic pattern of orbital lesions in adults as has been universally reported. We have fewer secondary tumors. We have summarized the pathological profile of adult orbital lesions according to patients’ age, gender, symptoms, and location of the lesion as a baseline guide for proper diagnosis of any orbital mass prior to surgical management planning and for future prognostic studies.

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography.

To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography (PDT). Twenty patients with orbital space-occupying lesions and 25 age- and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging (DTI), using a 3.0T magnetic resonance scanner (Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The asymmetry index (AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test; compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into three subgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side (P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls (P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients (P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups (P<0.05). FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

The frequency of ophthalmologic manifestations of granulomatosis with polyangiitis (Wegener's) and their relationship to systemic diseases

To estimate the frequency of lesions in the organ of vision in granulomatosis with polyangiitis (GPA) (Wegener's) and to determine their relationship to systemic diseases. The retrospective study enrolled 218 patients followed up at the E.M. Tareyev Clinic of Nephrology, Internal and Occupational Diseases, with a diagnosis of GPA. The frequency and association of ophthalmic manifestations with systemic involvement were statistically analyzed using PASW Statistics 18. The organ of vision was impaired in 48.1% of the patients with GPA. The most common manifestations were orbital space-occupying lesion (22.9%), conjunctivitis/episcleritis (14.7%), dacryocystitis (6.0%), and scleritis (4.6%). Orbital space-occupying lesions occurred more frequently in the local type of the disease (p=0.0003), and, on the contrary, the involvement of the conjunctiva and eyeball was seen in patients with the systemic types of GPA (p=0.02). The findings may suggest that the orbital lesion is an independent manifestation of GPA, which develops more commonly in its local type. Conjunctivitis/episcleritis is, on the contrary, more frequently seen in the active phase of the disease and generally in the involvement of other organs and systems.

Contrast-enhanced ultrasound in the diagnosis of orbital space-occupying lesions

To summarise the sonographic findings and assess the feasibility of contrast-enhanced ultrasound (CEUS) as an imaging method for the diagnosis of orbital space-occupying lesions. This was a prospective study of 53 patients who underwent orbital ultrasound at Xijing Hospital. Two-dimensional ultrasound, colour Doppler flow imaging (CDFI), and CEUS imaging were obtained and compared in patients with orbital haemangioma, pseudotumour, melanoma of the choroid, and retinoblastoma. CEUS imaging cannot only visualise the location, shape, border, acoustic properties of a lesion, and interactions between the lesion and surrounding tissues, but also display the microvasculature and tissue perfusion within the lesion. The information obtained from CEUS imaging is valuable for diagnosis and differential diagnosis of orbital space-occupying lesions. CEUS imaging allowed better visualisation of the lesions, enabled detection of vascular changes, increased the signal-to-noise ratio, and increased the sensitivity of detection of changes in perfusion in the microcirculation. It has relatively high sensitivity and specificity in the diagnosis of orbital space-occupying lesions and increases the accuracy of diagnosis.

Recurrent orbital space-occupying lesions: a clinicopathologic study of 253 cases.

To analyze the clinical features, histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions. A retrospective study was carried out in 253 consecutive patients with recurrent orbital space-occupying lesions treated by surgical excision in the Institute of Orbital Diseases, the General Hospital of the Armed Police Force from January 2009 to December 2010. The patients included 123 males and 130 females aged 2 to 78 years (mean, 36.2 years), and the last recurrence interval after operation ranged from 1 month to 40 years (median, 4.75 years). Of all the cases, 159 (62.8%), 65 (25.7%), 20 (7.9%), 8 (3.2%) and 1 (0.4%) had previously experienced once, twice, three, four and six times of surgeries, respectively. Among them, 29 (11.5%) cases had recurred 3 times or over, and 37 (14.6%) cases got recurrence in 10 or more years postoperatively. Most of the patients with local recurrence presented with various clinical manifestations, while 31 (12.3%) cases were symptom-free. Two hundred and thirty-one (91.3%) cases underwent surgical removal of the recurrent orbital lesions, and another 22 (8.7%) cases had to receive the exenteration of orbit. Categories of these recurrent orbital lesions after operation were as follows: lacrimal gland tumors, 65 (25.7%) cases; vasogenic diseases, 54 (21.3%) cases; neurogenic tumors, 42 (16.6%) cases; secondary tumors, 24 (9.5%) cases; orbital inflammation, 21 (8.3%) cases; myogenic tumors, 14 (5.5%) cases; fibrous and adipose tumors, 12 (4.7%) cases; lympho-hematopoietic tumors, 7 (2.8%) cases; bone or cartilage tumors, 7 (2.8%) cases; orbital cysts, 6 (2.4%) cases; and indefinitely differentiated tumor, 1 (0.4%) case. The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma, hemangiolymphangioma, lacrimal gland adenoid cystic carcinoma, meningioma, inflammatory pseudotumor, neurofibroma, sebaceous gland carcinoma, vascular malformation, rhabdomyosarcoma and hemangioma. The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions. The lacrimal gland epithelial tumor is most prone to relapse after resection, and early and longer-term postoperative follow-up is needed.

An Analysis of 2,480 Space-Occupying Lesions of the Orbit From 1976 to 2011

To evaluate the frequencies of orbital space-occupying lesions seen at single orbital unit in a period of 35 years. In this retrospective case series, the authors reviewed the medical records of 2,480 consecutive patients referred to the authors' Orbital Unit for evaluation of an orbital mass between 1976 and 2011. The final diagnosis in each case was established by a combination of history, ocular findings, diagnostic imaging, and histopathologic analysis, when available. The number and percentage of benign and malignant tumors were determinated, also according to the age of the patients and the tumor location within the orbit. This study adhered to the principles of the Declaration of Helsinki. Of the 2,480 lesions, 1,697 (68%) were benign and 783 (32%) were malignant. The most frequent benign tumors were dermoid cyst (14%) and cavernous hemangioma (9%). The most common malignant tumors were non-Hodgkin lymphoma (12%), basal cell carcinoma (3%), and orbital metastases (3%). In patients younger than 60 years, benign tumors are more frequent, whereas in patients older than 60 years, the frequency of malignant tumors increased. Regarding the distribution in the orbit, the most common tumors were dermoid cyst (206 cases) in the upper-outer quadrant, mucocele (155 cases) in the upper-inner quadrant, basal cell epithelioma (35 cases) in the lower-inner quadrant, cavernous hemangioma (68 cases) in the lower-outer quadrant, and meningioma (90 cases) in central space. Most of the tumors were located in the upper-outer quadrant. In the lower-inner quadrant, malignant tumors were more frequent than benign tumors. The authors' findings highlight the distinctive nature of the orbital oncology experience at an ocular oncology department.

Lesões expansivas da órbita: distribuição de casos com estudo histopatológico em 11 anos no Hospital das Clínicas da FMUSP

To report the incidence of orbital space-occupying lesions in an 11-year interval study of patients examined at the Hospital das Clínicas of FMUSP, and to evaluate which are the main specialties involved in the diagnosis and treatment of such conditions. All cases of orbital space-occupying lesions in the period from 1993 to 2004 were revised. Of 924 obtained medical records, 155 were selected after histopathological analysis. Another 111 cases were gathered from the personal archives of a pathologist responsible for Ophthalmic Histopathology, from which 45 cases were excluded because they had already been included in the first source analysis. The data were analyzed and compared with the results from other institutions. Of the studied 181 orbital space-occupying lesions, 70% were primary, 23% secondary, 6% metastatic and lymphomas, and 1% was not classified. The most common specialties involved ophthalmologists in 72.37% of all 181 cases, head and neck surgeons in 14.36%, neurosurgeons in 6.62%, and others in 6.62%. The orbital mass lesions were treated mostly by an expert ophthalmologist. When other specialties were included, there was a modest increase in secondary tumor incidence when the final result was compared with previous studies on this subject. Our findings indicate that the creation of a trustworthy register of all orbital space-occupying lesions in Brazilian specialized services is necessary. The multidisciplinary character of the orbital mass lesions is corroborated by this review.

Value of the new 5-sector approach for orbital imaging division in diagnosis of orbital space-occupying lesions

Value of the new 5-sector approach for orbital imaging division in diagnosis of orbital space-occupying lesions

The pathological analysis of 233 patients with orbital space-occupying lesion

目的 分析眼眶占位性病变的组织病理学分类.方法 对河南省眼科研究所2001年1月～2007年9月眼科病理室存档的233例眼眶占位性病变手术切除标本进行组织病理学分类.结果 良性病变191例(81.97%),其中前3位依次为海绵状血管瘤60例(25.75%),炎症22例(9.44%),皮样囊肿13例(5.58%).恶性病变42例(18.03%),其中原发性恶性肿瘤20例(8.97%),包括淋巴瘤10例(4.29%),泪腺上皮性恶性肿瘤4例(1.72%).横纹肌肉瘤3例(1.29%),纤维肉瘤1例(0.43%),其他2例(0.86%);继发性恶性肿瘤22例(9.87%),分别为眼睑皮脂腺癌眼眶蔓延9例(3.86%),眼睑鳞状细胞癌眼眶蔓延6例(2.58%),眼睑黑色素瘤眼眶蔓延3例(1.29%),视网膜母细胞瘤眶内蔓延3例(1.29%),眼睑基底细胞癌眼眶蔓延1例(0.43%).结论 眼眶占位性病变中脉管源性肿瘤最常见,其中最多见的是海绵状血管瘤,恶性病变中最多见的是淋巴瘤。

Orbital Space-Occupying Lesions in Indian Children

To present a review of all patients younger than 16 years who presented to us with orbital space-occupying lesions. Retrospective case study. We analyzed the records of 119 children younger than 16 years of age who had presented to us with proptosis during the 10-year study period. Myogenic tumors were the most common lesion seen (24%), followed by metastatic and secondary orbital tumors (17%), vasculogenic lesions (15%), cystic lesions (10%), inflammatory lesions simulating tumors (7.5%), optic nerve and meningeal tumors (7.5%), peripheral nerve tumors (5%), lacrimal fossa lesions (4%), lymphoid tumors and leukemias (2.5%), primitive neuroectodermal tumors (3%), and others (2.5%). We analyzed the profile of orbital lesions that underwent surgical procedures and were proven histopathologically. We found 63 malignancies among the 119 cases, for a malignancy rate of 53%. Orbital rhabdomyosarcoma and retinoblastoma with orbital spread were the most common causes of proptosis among the children.

Orbital tumors in the older adult population

Purpose To determine the types and frequency of orbital tumors in the older adult population. Design Retrospective consecutive case series. Participants Two hundred consecutive patients aged 60 years or older with an orbital tumor managed at a tertiary referral center. Main outcome measures The relative incidence and management of orbital tumors in patients aged 60 years or older. Results Of approximately 950 consecutive patients with orbital space-occupying lesions managed over a 25-year period on the Oncology Service, 200 patients (21%) were 60 years or older at the time of diagnosis. The orbital tumor was unilateral in 183 patients (92%) and bilateral in 17 patients (8%). The most common clinical features at presentation included mass in 51 patients (26%), proptosis in 36 (18%), and pain in 30 (15%). The mean duration of symptoms was 11 months before referral. The orbital tumor was malignant in 125 patients (63%) and benign in 75 (27%). The most common diagnoses were malignant lymphoma in 47 patients (24%), idiopathic orbital inflammation in 19 (10%), and cavernous hemangioma in 15 (8%). The diagnosis was made with clinical findings and imaging studies in 58 patients (29%) and additional histopathologic examination in 142 patients (71%). Of 217 tumors, the main tumor location was in the superior half of the orbit in 106 lesions (49%), in the anterior orbit in 100 (46%), and in the extraconal space in 135 (62%). Imaging studies showed a mass with well-defined margins in 90 tumors (41%) and ill-defined margins in 127 (59%). The tumors were solid in 203 cases (94%), cystic in 6 (3%), and mixed in 8 (3%). Over a mean of 31 months follow-up, 50 (25%) patients had orbital tumor-related systemic involvement (metastasis or lymphoma), and 150 (75%) remained free of systemic involvement. Conclusions Orbital tumors in the senior adult population are malignant in 63% of cases. Malignant lymphoma is the most common tumor in this age group, accounting for 24% of cases. Overall, 25% of patients have systemic problems related to the orbital process develop, so systemic evaluation is warranted.

Orbital space-occupying lesions in Denmark 1974-1997.

To determine the frequency, distribution according to diagnosis and the recurrence frequency of orbital space-occupying lesions in Denmark, to determine sex and age of the patients and to establish a national orbital data register. All biopsied/surgically removed orbital lesions collected by Danish pathological departments during the period 1974-1997 were identified by SNOMED codes. In addition, in each case gender and age of the patients and number of recurrences were registered. 965 orbital lesions from 841 patients were identified during the 24-year period. The incidence of orbital lesions increased significantly over the study period and at present about 80 cases/year are registered. The ratio benign/malignant lesion per year remained constant during the observation period. Lesions in children constituted a total of 152 (16%), the percentage of lesions in children being constant during the period. Malignant tumors comprised a total of 364 (45%) in adults and 34 (22%) in children. Malignant tumors were in adults distributed with 43% primary, 48% secondary invading and 9% metastatic tumors, and in children with 65% primary, 29% secondary invading and 6% metastatic tumors. Normal tissue was only found in 6% of the cases recorded. A registration of all histologically evaluated orbital space-occupying lesions in Denmark during a period of 24 years was performed and a national orbital database established. Orbital lesions are rare and primarily benign.

Computed tomography of orbital space-occupying lesions

Computed tomography of orbital space-occupying lesions