Malignant fibrous histiocytoma of the lateral wall of the orbit

Myxofibrosarcoma of the orbit: an underrecognized entity? Case report and review of the literature

PURPOSE

To describe the clinicopathologic and immunohistochemical features of a rare case of myxofibrosarcoma (MFS) involving the orbit.

DESIGN

Retrospective interventional case report and review of literature.

METHODS

The clinical history, systemic imaging studies, and histopathologic results of the orbital biopsy are reviewed.

MAIN OUTCOME MEASURES

Clinical, radiologic, and histologic features of MFS.

RESULTS

A 63-year-old Chinese male sought treatment for a history of rapidly progressive proptosis associated with decreased vision in the left eye over 10 days. Magnetic resonance imaging of the orbit revealed a homogenous mass extending to the optic canal. The mass was excised partially and was submitted for histologic and ultrastructural examination. Histologic testing revealed features of MFS with characteristic diffuse proliferation of atypical, spindle-shaped fibroblasts with prominent myxoid stroma. Tumor cells were reactive for vimentin. Ultrastructural examination revealed spindle-shaped tumor cells, rich in dilated rough endoplasmic reticulum and prominent vacuoles.

CONCLUSIONS

For historical reasons, MFS involving the orbit is likely to be underrecognized and categorized erroneously as malignant fibrous histiocytoma or other soft tissue sarcoma. Although orbital MFS is an extremely rare diagnosis, ophthalmologists should be aware of the possibility and consider a diagnosis of MFS when an adult seeks treatment for an orbital tumor with aggressive growth.

Facial Dismasking Flap for Removal of Tumors in the Craniofacial Region

OBJECTIVE

This study was aimed at estimating the usefulness of the facial dismasking flap for craniofacial surgery.

STUDY DESIGN

Anatomical study and retrospective case study.

MATERIALS AND METHODS

The facial dismasking flap is a combination of a coronal skin incision and a circumpalpebral incision. By adding a circumpalpebral incision, the skin can be detached from the orbital structures and the coronal skin flap can be elevated more inferiorly together with the facial nerves and muscles. We retrospectively reviewed patients who underwent the facial dismasking flap with regard to the extent of the surgical field and resectability under this flap. Postoperative facial scarring and movements were also evaluated. Facial palsy was estimated according to the House-Brackmann grading system.

RESULT

Twenty-three patients with tumors in various locations, such as, the nasal cavity, paranasal sinus, zygoma, and infratemporal fossa, who had undergone a facial dismasking flap, were studied. Sufficient surgical fields were obtained for removal of the tumor in all patients. Tumors were totally resected in 21 patients and were subtotally resected in two patients to avoid optic nerve damage. Facial nerves were anatomically preserved and facial scarring was minimal in all patients. No facial palsy remained in any patients except one who showed a deterioration of the facial palsy (House-Brackmann grade V-VI).

CONCLUSION

This flap allows the surgeon to obtain wide exposure of the upper two-thirds of the facial skull. Moreover, damage to the facial skin is minimal and facial movements are well preserved. This technique is not well known to head and neck surgeons, and this is the first comprehensive report of this technique applied to removal of craniofacial lesions.

Orbital malignant fibrous histiocytoma with extension to the base of the skull--case report

An 18-year-old woman presented with a malignant fibrous histiocytoma (MFH) originating in the orbit and invading the frontal and temporal base of the skull manifesting as exophthalmos and double vision that had persisted for 2 months. Magnetic resonance imaging revealed a tumor in the left orbit that extended as far as the frontal and temporal base of the skull. The tumor was treated by radical resection with conservation of the eyeball and its contents, followed by orbit wall reconstruction. The histological diagnosis was MFH. Local radiotherapy was administered postoperatively. The preoperative symptoms improved, and there has been no evidence of local recurrence or metastasis in the year since the surgery. In this case, radical resection of the tumor was essential. Furthermore, the adjuvant therapy was apparently successful, probably because this histological type of tumor is highly sensitive to radiotherapy.