Primary differentiated neuroblastoma of the orbit

Primary orbital neuroblastoma with intraocular extension

Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.

Presumed primary orbital neuroblastoma in a 20-month-old female

Neuroblastoma is the most common malignant disease of childhood, and it often arises from either the adrenal gland or along the sympathetic chain. The authors report a case of a 20-month-old female with a presumed primary neuroblastoma of the orbit. Radiologically, the tumor showed a brightly enhancing mass lesion of the left side with intraorbital, temporal extraorbital, transsphenoid, and intracranial components. Histopathologically, the tumor was composed of small round blue cells. Immunohistochemical staining was positive for neuron-specific enolase. To the best of the authors' knowledge, primary orbital neuroblastoma has only been previously reported once in children, although it has been reported twice in adults.

Rare orbitocranial tumour in an adult

A 35-year-old lady presented with recurrent episodes of painful right upper lid swelling and ptosis of 6 months' duration. The symptoms would subside with oral antibiotics and painkillers. She had also been undergoing treatment for 1 year for multiple painful osteolytic lesions in the long bones and axial skeleton for which no definite diagnosis had been made, despite several radiological and serological investigations having been performed. Computed tomographic scan showed a soft tissue lesion in the superolateral part of the right orbit with erosion of the adjacent bone. Lacrimal gland biopsy showed non-specific inflammatory changes. She was referred for full work-up to exclude lymphoma and metastasis. Magnetic resonance imaging revealed an enhancing soft tissue mass in the right anterior cranial fossa eroding the lateral orbital wall and extending into the orbit. Another mass encased the superior sagittal sinus. Bone marrow biopsy showed near total replacement of marrow cells by a round cell tumour. Immunohistochemical studies revealed that the tumour cells expressed neuron specific enolase and chromogranin. The pathological findings suggested a diagnosis of neuroendocrine tumour though neuroblastoma could not be unequivocally ruled out. A(131) I-metaiodobenzylguanidine scan showed no uptake. Radiologic studies suggested multiple bony metastases. No other site of primary tumour was found so there was a strong possibility of it being a primary orbito-cranial neurogenic tumour. Neuroblastomas and neuroendocrine tumours are very rare in adults. The orbit is an unusual site for a primary of this nature. In addition, it is quite difficult to make a specific diagnosis in a less differentiated tumour.

Rare orbitocranial tumour in an adult

A 35-year-old lady presented with recurrent episodes of painful right upper lid swelling and ptosis of 6 months' duration. The symptoms would subside with oral antibiotics and painkillers. She had also been undergoing treatment for one year for multiple painful osteolytic lesions in the long bones and axial skeleton for which no definite diagnosis had been made, despite several radiological and serological investigations having been performed. Computed tomographic scan showed a soft tissue lesion in the superolateral part of the right orbit with erosion of the adjacent bone. Lacrimal gland biopsy showed non-specific inflammatory changes. She was referred for full work-up to exclude lymphoma and metastasis. Magnetic resonance imaging revealed an enhancing soft tissue mass in the right anterior cranial fossa eroding the lateral orbital wall and extending into the orbit. Another mass encased the superior sagittal sinus. Bone marrow biopsy showed near total replacement of marrow cells by a round cell tumour. Immunohistochemical studies revealed that the tumour cells expressed neuron specific enolase and chromogranin. The pathological findings suggested a diagnosis of neuroendocrine tumour though neuroblastoma could not be unequivocally ruled out. (131) I-metaiodobenzylguanidine scan showed no uptake. Radiologic studies suggested multiple bony metastases. No other site of primary tumour was found so there was a strong possibility of it being a primary orbito-cranial neurogenic tumour. Neuroblastomas and neuroendocrine tumours are very rare in adults. The orbit is an unusual site for a primary of this nature. In addition, it is quite difficult to make a specific diagnosis in a less differentiated tumour.

Primitive neuroectodermal tumor of the orbit in an adult. A case report and literature review

OBJECTIVE

The authors describe the salient clinical, radiologic, and histopathologic features of an orbital primitive neuroectodermal tumor in a 28-year-old man. This is an extremely rare tumor of the orbit, previously reported exclusively in children.

DESIGN

Case report.

INTERVENTION

Excisional biopsy of the tumor en bloc was performed.

MAIN OUTCOME MEASURES

Histopathologic examination was performed by standard techniques and immunohistochemical stains on formaldehyde-fixed, paraffin-embedded tumor tissues.

RESULTS

Histologic examination of the sections of the tumor showed small, blue, round cells with occasional Homer-Wright rosette formations. The tumor cells stained positively with neuron-specific enolase and vimentin.

CONCLUSIONS

This newly recognized, highly unusual peripheral primitive neuroectodermal tumor should be considered in the differential diagnosis of hypercellular, small, round cell tumor of the orbit in adults.

Primary malignant ectomesenchymoma of the orbit

Malignant ectomesenchymoma (MEM) is a rare soft tissue tumour believed to arise from a pluripotential migratory neural crest cell and composed of both a mesenchymal element (most often rhabdomyosarcoma) and a neuroectodermal element (often neuroblastoma). Reported sites of origin are the abdomen, perineum or scrotum, the extremities, the middle ear, nasopharynx, face, and neck. We report the first case of an orbital MEM, with a review of the 17 cases previously reported from other sites.

Orbital nonchromaffin paraganglioma. A case report and review of the literature

Nonchromaffin paraganglioma (NCP), also called glomus body tumor or chemodectoma, is rarely found in the orbit. The behavior of orbital nonchromaffin paraganglioma may potentially be more aggressive than in other head and neck locations. Diagnosis depends on electron microscopic demonstration of membrane-bound neurosecretory granules. Results of histopathologic study show a well-circumscribed lesion without a true capsule with alveolar or organoid arrangements of epithelioid cells within a reticulin framework with thin-walled blood vessels. Cells are polygonal with round or oval nuclei containing rare mitotic figures and pale-staining cytoplasm. Differential diagnosis includes alveolar soft-part sarcoma, alveolar rhabdomyosarcoma, neuroblastoma, carcinoid, and granular cell tumor. Of 29 previously reported cases of orbital NCP, 16 have been reclassified as alveolar soft-part sarcoma. The authors report a patient with an electron microscopically established orbital NCP, with the history of a contralateral glomus jugulare tumor irradiated 14 years previously.

Metastatic colloid carcinoma versus primary carcinoma of the ciliary epithelium

Ocular metastases developed from breast carcinomas in two women 7 and 19 years after their mastectomies. They were both ciliary body metastases that had eroded through the root of the iris to present as unifocal globular, gelatinous (colloid) masses in the anterior chamber, and were amenable to local surgery. Histopathologically, small cellular clusters were widely separated in a sea of mucin; the tumor cells failed to display marked pleomorphism or mitotic activity. In each case, the distinction from a primary mucinous ciliary epithelial neoplasm had to be made both clinically and pathologically. For comparison, the authors also report a unique primary ciliary carcinoma that caused intractable glaucoma by spreading diffusely throughout the iris, ciliary body, and anterior chamber angle, and that necessitated enucleation. The tumor cells failed to produce hyaluronic acid but elaborated a mucosubstance which was histochemically indistinguishable from that of the metastatic carcinomas. This primary neoplasm, however, exhibited the following histologic differences from the metastases: more architectural variability, including garlands and festoons of cells not forming lumens that were suspended in a mucinous matrix; much more abundant intracellular mucin; foci of sheet-like and pleomorphic cellular proliferations with mitotic activity; and partial replacement of the ciliary processes by a comparatively benign-appearing mucinous columnar epithelium.