[Neoplastic space-occupying lesions of the orbit. I. Review; hemangioma, lymphangioma and embryonal rhabdomyosarcoma]

Langerhans Cell Histiocytosis of the Orbit: Spectrum of Clinical and Imaging Findings

OBJECTIVE

To evaluate the clinical and imaging characteristics of orbital lesions of pediatric Langerhans cell histiocytosis (LCH).

STUDY DESIGN

A retrospective analysis of clinical data and central review of magnetic resonance imaging scans in patients with LCH, enrolled into one of the consecutive international trials LCH I-III, or submitted for a second opinion between 1994 and 2015.

RESULTS

Data from 31 children (34 involved orbits) were analyzed. Orbital LCH was the only disease manifestation in 15, part of a multifocal skeletal in 5, or a multisystem LCH in 11 patients. Orbital LCH was part of the initial disease presentation in 23 or developed at relapse in 8 cases. Orbital involvement was unilateral in 28 and bilateral in 3 patients (34 affected orbits). Proptosis was present in 9 patients. Frontal and zygomatic bone were most commonly affected. All orbital lesions were extraconal. Associated extraorbital imaging findings were dural tail sign in 19, neurodegeneration in 8, and hypothalamic-pituitary mass in 3 patients. Sixteen patients (52%) had at least 1 documented disease relapse. Permanent consequences were prominent proptosis in 1, diabetes insipidus in 8, growth hormone deficiency in 2, radiologic neurodegeneration in 8, and clinical neurodegeneration in 3 patients.

CONCLUSIONS

Predominantly unilateral orbital LCH can be the only disease manifestation or part of a disseminated disease. Orbital lesions in LCH are exclusively extraconal, typically located at the roof and the lateral wall of the orbit. The optimal treatment approach of unifocal LCH of the orbit remains controversial and warrants a prospective evaluation.

An analysis of 2,480 space-occupying lesions of the orbit from 1976 to 2011

PURPOSE

To evaluate the frequencies of orbital space-occupying lesions seen at single orbital unit in a period of 35 years.

METHODS

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.

RESULTS

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.

CONCLUSIONS

The authors' findings highlight the distinctive nature of the orbital oncology experience at an ocular oncology department.

[Bilateral anophthalmia and left-sided orbital tumor : case of an eight-month-old infant]

An 8-month-old infant from Russia with bilateral anophthalmia presented with an expanding orbital tumor. The tumor was extirpated and the histological examination revealed a non-malignant pseudocystic process with residual neuro-ectodermal structures.

Resection of orbital rhabdomyosarcoma in an infant with the aid of preoperative partial arterial embolization. A case report

Since the introduction of non-invasive imaging techniques (CT, US, MRI), super selective cerebrospinal angiography has been playing a major role as a diagnostic tool as well as a therapeutic procedure prior to surgery or as an alternative. Surgical neuroangiography is currently a well-established therapeutic technique in neuropediatrics even in newborns or infants with vascular lesions in different parts of the body. Rhabdomyosarcoma is a malignant solid tumor arising from mesenchymal tissue that primarily affects children. We describe the procedure used to treat a large vascularized orbital rhabdomyosarcoma in a 38-day-old infant with application of partial tumor vascular bed embolization via external carotid end internal maxillary artery using PVA particles prior to gross excisional biopsy. We stress the significance of the preoperative embolization in infants with large highly vascularized tumor in order to reduce surgical blood loss and increase the probability of maximum lesion resection.