Orbital hemangiopericytoma--case report

Preoperative embolisation of orbital solitary fibrous tumour

Solitary fibrous tumours (SFT) is an encompassing terminology comprising of tumours with proliferating CD34 positive specialised fibroblasts. Orbital SFTs are rare slowly progressive highly vascular neoplasms. Complete surgical excision is considered the mainstay treatment. Incomplete resection is a known risk factor for recurrence and malignant transformation. Recently preoperative embolisation of SFT has shown promising results in reducing the vascularity of these tumours rendering them amenable to complete surgical excision. Less than 10 cases of embolisation of orbital solitary fibrous tumours have been described in literature. Our patient underwent an attempted surgical excision elsewhere with significant intraoperative haemorrhage which precluded its complete excision. Herein, we report successful outcome in a case of hypervascular orbital SFT managed with preoperative embolisation, surgical resection and adjuvant radiotherapy along with a review of relevant literature.

Endovascular preoperative embolization of orbital hemangiopericytoma with n-butyl cyanoacrylate glue

Hemangiopericytoma is an uncommon neoplasm that may present in myriad locations, including the lower extremities, pelvic area, and the head and neck area, including the orbit. Orbital hemangiopericytoma is often described as synonymous with orbital solitary fibrous tumor, giant cell angiofibroma, and fibrous histiocytoma, as they all belong to a spectrum of collagen-rich fibroblastic tumors that are often CD34-positive and have overlapping histopathologic features. Many cases of orbital hemangiopericytoma have been reported in the literature along with various surgical approaches, long-term outcomes, and techniques to manage recurrence; however, few have discussed preoperative embolization., Intraoperative hemorrhage is a concern in both the congenital and the adult form of these cases, and may be an indication for preoperative embolization. A unique case of preoperative embolization was presented with n-butyl cyanoacrylate for surgical resection of a large orbital hemangiopericytoma in a 58-year-old woman.

Percutaneous embolization of an orbital hemangiopericytoma with Onyx facilitates its surgical excision

This is a case report on the surgical treatment of orbital hemangiopericytoma. The patient initially underwent an attempted excision of the tumor with significant hemorrhage elsewhere, which precluded its complete excision. Due to continued growth and pain, the patient underwent percutaneous embolization with Onyx-18 under fluoroscopic radiographic guidance. The patient continued to have pain, progressive enlargement of the tumor, and underwent surgical excision. The excision was noted to have minimal bleeding and was relatively easy to dissect and excise compared with the typical hemangiopericytoma. Embolization with Onyx-18 may be a useful preoperative treatment option for hemangiopericytomas and other vascular lesions of the orbit, and elsewhere.

Atypical presentation of a case of solitary fibrous tumor of the orbit

PURPOSE

To describe a rare case of solitary fibrous tumor of the orbit in a child, clinically misdiagnosed as arterious hemangioma.

METHODS

A nine-year-old child presented a hard-elastic palpable mass located in the right inferotemporal orbit. Computed tomography, orbital pulsed-wave Doppler and internal carotid artery angiography consented diagnosis of high-vascularization mass probably related to arterious hemangioma with feeder vessel arising from a branch of ophthalmic artery. The orbital mass was surgically removed.

RESULTS

The histological examination showed mesenchimal tumor, CD34 positive, related to solitary fibrous tumor of the orbit.

CONCLUSIONS

Solitary fibrous tumor of the orbit should be considered in the differential diagnosis of arterious hemangioma.

Orbital Cavernous Hemangioma: Role of Imaging

CT and MR imaging are particularly important in the diagnostic investigation of patients with vascular disorders of the orbit. The improved image quality of CT and MR imaging, along with dynamic CT angiography, MR angiography, MR venography, and multiphase dynamic contrast CT/MR imaging, has proven useful to delineate as well as differentiate various orbital vascular lesions. This article presents the current classification of orbital vascular disorders and describes the CT/MR imaging characteristics of orbital cavernous hemangiomas and simulating lesions.