Orbital angiosarcoma with subconjunctival presentation. Report of a case and literature review

Orbital Kaposi's sarcoma in acquired immunodeficiency syndrome

A 28-year-old white male with AIDS-C3 staging, presented with an extensive hemorrhagic dark mass localized in the left orbit. No other ophthalmic findings were disclosed. Ultrasonography and computed axial tomographic scans showed orbital involvement. Orbital Kaposi's sarcoma is a rare finding and only a few cases have been reported. Systemic examination revealed other lesions suggestive of disseminated mucocutaneous Kaposi's sarcoma, oral candidiasis, membranous esophagitis and granulomatous hepatitis. Eyelid incisional biopsy disclosed Kaposi's sarcoma. Despite intensive chemotherapy progression was aggressive with a fatal outcome.

Hemangioendothelioma of orbit

Hemangioendothelioma of the orbit is a rare condition which usually occurs in young adult with mean age group of 24 years. Very few cases had been reported in the literature. We describe here a case of hemangioendothelioma in a female of 30 years who came with history of pen-etrating foreign body entering into right eye and fluctuating painful swelling in the lower lid with decrease in the vision. The patient's presentation simulated malignancy of maxillary an-trum, however, the diagnosis was confirmed by histopathology.

Orbital exenteration: a review of 429 cases

The authors reviewed their experience with 429 cases of orbital exenteration between 1963 and 1993. Apart from the 22 cases operated in concert with other physicians, 407 cases were operated by an ophthalmologist and spontaneous granulation technique was used. Total or eyelid-sacrificing exenteration was carried out for lesions involving the eyelids and for recurrent/infiltrative malignant tumors. Two hundred and thirty-seven cases received total exenteration. The remaining 192 cases were treated with eyelid-sparing or subtotal exenteration. In each case, full exenteration was performed with the removal of the periosteum. Secondary tumors were the most frequent indication for exenterations accounting for 349 (81.3%) cases. Among the secondary tumors, there were 173 eyelid, 104 intraocular, 56 conjunctival tumors, 15 nasopharynx and one maxillary sinus carcinomas. The second leading indication was primary orbital tumors (50 cases, 11.7%). Of the primary orbital tumors, 35 were rhabdomyosarcomas, nine were neurogenic tumors, two were fibrocytic tumors, two were vascular tumors, one was teratoma and one was primary melanocytic tumor. The remaining cases included 16 lacrimal fossa tumors (3.7%), 10 lymphomas (2.3%) and four (1.0%) inflammatory pseudotumors. Squamous cell carcinoma was the single most frequent indication for which exenteration was carried out, accounting for 30.3% of the cases. Spontaneous granulation proved to be a simple technique and produces cosmetically better results for patients not wearing prosthesis.

Vascular tumors of the orbit

Eighty-five vascular lesions of the orbit examined and treated between 1963-1993 were reviewed retrospectively to reveal the types of vascular tumors, age and sex distribution, clinical characteristics, treatment options and prognosis. Capillary hemangioma was the most frequent orbital vascular tumor accounting for 37 of 85 cases making up 43.5% of the entire orbital masses. Cavernous hemangioma accounted for 35 cases (41.2%), varices for 3 cases (3.5%), anteriovenous malformations for 3 cases (3.5%), angiosarcomas for 3 cases (3.5%), lymphangiomas for 3 cases (3.5%) and hemangiopericytoma for one case (1.2%). Of the 85 vascular tumor cases 43 were encountered in children aged 18 years or less. Capillary hemangioma was the most frequent pediatric orbital vascular lesion, making up 86% of the vascular tumors in this age group. Capillary hemangiomas have been treated with observation and intralesional corticosteroid injections. Cavernous hemangiomas, vascular malformations, lymphangiomas and two cases of angiosarcomas received orbitotomy. One case each of angiosarcoma and hemangiopericytoma underwent exenteration because of the advanced stage of the lesion. There was one tumor-related death who was a 9-year-old boy diagnosed with angiosarcoma. Vascular tumors with the exception of angiosarcomas and hemangiopericytoma behaved as benign lesions.

Masquerade of eyelid tumours

Space-occupying processes in the eyelids can either be due to lesions which are specific for the eyelids, such as a chalazion or a meibomian carcinoma, or to non-specific lesions of the skin or ocular adnexa. An incorrect interpretation on clinical or histological grounds is often made; in other words, some eyelid processes masquerade as others. The correct diagnosis should be made on the basis of case history, localisation, the appearance of the tumour and the histological findings, so that adequate treatment can be given. One must be aware of the danger of mistaking one space-occupying process for another. In the Leiden Ophthalmological Clinic a study was made of the incidence of eyelid tumours in the period 1981-1987, with special attention to the most important masquerade phenomena observed. In a group of 956 eyelid tumours histological examination was necessary in 126 cases. Basal-cell carcinoma was the most frequent diagnosis, but other less common tumours such as a trichilemmoma, an eosinophilic granuloma, a haemangio-endothelioma, a metastasis from a mammary carcinoma and a granuloma annulare were also diagnosed.