Regression of a paraganglioma tumor of the orbit

Orbital Paraganglioma

BACKGROUND

Paragangliomas are groups of neuroendocrine neoplasms originating from neural crest cells throughout the body, but are rarely observed within the orbit.

CASE REPORT

Two patients, a 4-year-old male and 27-year-old female, presented with a slow-growing proptosis. Well-defined masses were located in the superomedial (male) and temporal (female) portion of the right orbit and involved the entire bodies of either the superior (male) or lateral (female) rectus muscles. B-mode ultrasound scan revealed a homogeneous, well-defined, hypoechoic mass, with rich blood flow signals inside the mass on CDI. CT scans indicated a well-defined, homogeneous mass with moderate enhancement, while MRI showed a well-defined mass with a salt and pepper appearance due to the prominence of blood vessels in the form of flow-void areas. Anterior orbitotomy and total tumor excision were performed on both patients. Subsequent histological and immunohistochemistry assays confirmed the diagnosis of orbital paraganglioma. The male patient is currently at 14 years of follow-up without recurrence or metastasis. The female patient developed recurrence at 3 months post-surgery. After a second surgery and local radiotherapy, there were no signs of the recurrence as assessed at 13 years of follow-up in this female patient.

CONCLUSION

Orbital paraganglioma is an extremely rare benign tumor. The salt-and-pepper appearance as observed with MRI scan represents a relatively salient characteristic of this condition. Total excision of the lesion by orbitotomy is the treatment of choice and the possibility of tumor recurrence warrants diligent consideration. Radiotherapy is useful in patients with tumor recurrence or subtotal surgical excision.

Orbital Paraganglioma in Infancy: Does It Behave More Aggressively?

BACKGROUND

Paragangliomas of the head and neck region are not only rare but also unique in that they are derived from the parasympathetic system and are nonsecretory. Orbit represents 1 of the least common sites for head and neck paragangliomas. Orbital paraganglioma remains predominantly a disease of adults, and it has never been reported in infancy earlier. Therefore it is not known if these tumors in infancy behave any differently than their adult counterparts.

CASE REPORT

A 1-year-old boy presented with left-sided proptosis and restricted ocular movement for 3 months. On examination, the proptosis was nonaxial and nonreducible and the child could follow objects with the left eye with normal pupillary reactions bilaterally. On neuroimaging, a rounded enhancing mass was seen in the superomedial aspect of the left retrobulbar space closely abutting the optic nerve. The tumor was subtotally excised using a left fronto-orbital approach, leaving some tumor on the optic nerve. It was decided to closely observe the residual tumor in the follow-up period; however, the child developed recurrence with visual loss after 6 months of surgery.

CONCLUSION

Orbital paraganglioma in infancy may be more aggressive than the adult counterparts. Although simple excision without adjuvant radiation may be tried in localized tumors with intact vision, recurrence tends to be high. Orbital exenteration with or without radiotherapy remains the only salvage option in such recurrences.

Orbital Paraganglioma: A Systematic Review

Purpose  The purpose of this study was to perform a systematic review of the literature on orbital paragangliomas, evaluating clinical presentation, diagnosis, management patterns, and prognosis. Methods  The systematic review was conducted based on the principles described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Cochrane databases, Embase, and Web of Science were searched for articles related to orbital paragangliomas. Inclusion criteria included English language articles with original reports on human subjects. Data on clinical presentation, diagnosis, treatment, and prognosis were collected. Results  Twenty-seven articles met inclusion criteria (28 total patients). The mean patient age was 37.1 years (range, 3-75 years); 13 (46.4%) patients were male. The most common presenting symptoms were proptosis (89.2%), visual acuity changes (67.9%), and extraocular muscle restriction (64.2%). Lesions were most commonly intraconal (92.9%). Single modality therapy was employed in 19 patients (67.9%), including excision in 12 patients (42.9%) and exenteration in 5 patients (17.9%). Ten patients (35.7%) developed recurrence, and there was a 92.9% survival rate (mean follow-up, 29 months). Conclusion  Orbital paragangliomas are rare tumors with an excellent prognosis. These lesions commonly present with proptosis, and are primarily managed surgically with simple excision, although exenteration and adjuvant radiation may be necessary for invasive tumors. This series is the largest and most comprehensive systematic review of orbital paragangliomas conducted to date.

Orbital Paraganglioma and Succinate Dehydrogenase Staining for Genetic Testing Triage and Prognosis

PURPOSE OF THE STUDY

To describe the rare occurrence of a paraganglioma in the orbit and how to triage for genetic testing and assess the prognosis with succinate dehydrogenase subunit B (SDHB) immunohistochemical staining.

METHOD

Case report.

PROCEDURES

A 47-year-old 'healthy' male presented with painless exophthalmos and diplopia secondary to an infraorbital tumour mass.

RESULTS

The orbital biopsy was diagnosed as paraganglioma with positive staining with SDHB.

CONCLUSION

The rarity of an orbital paraganglioma was followed by the clinical search for a possible occult extraorbital primary paraganglioma. SDHB staining helped in the triage for genetic testing and gave an idea about the prognosis for this tumour.