Declining incidence and improving survival of ocular and orbital lymphomas in the US between 1995 and 2018

This epidemiological study examined ocular and orbital lymphomas in the United States from 1995 to 2018, using data from the North American Association of Central Cancer Registries database of 87,543 patients with ocular and adnexal malignancies. We identified 17,878 patients (20.4%) with ocular and orbital lymphomas, with an age-standardized incidence rate (ASIR) of 2.6 persons per million (ppm). The incidence was the highest in the orbit (ASIR = 1.24), followed by the conjunctiva (ASIR = 0.57). Non-Hodgkin B-cell lymphoma was the most prevalent subtype (85.4%), particularly marginal-zone lymphoma (45.7%). Racial disparities were noted, with Asia-Pacific Islanders showing the highest incidence (orbit, 1.3 ppm). The incidence increased significantly from 1995 to 2003 (Average Percent Change, APC = 2.1%) but declined thereafter until 2018 (APC = - 0.7%). 5-year relative survival (RS) rates varied, with the highest rate for conjunctival lymphoma (100%) and the lowest for intraocular lymphoma (70.6%). Survival rates have generally improved, with an annual increase in the 5-year RS of 0.45%. This study highlights the changing epidemiological landscape, pointing to initial increases and subsequent decreases in incidence until 2003, with survival improvements likely due to advancements in treatment. These findings underscore the need for further research to investigate the root causes of these shifts and the declining incidence of ocular lymphoma.

Comprehensive analysis of orbital lymphoma in a Turkish cohort: clinical characteristics, histological subtypes, treatment modalities, prognostic factors, and implications for management

The study analysed the clinical characteristics, treatment approaches, and survival outcomes of 97 consecutive patients with orbital lymphoma (OL) over a 25-year period at. The median age of the patients was 57.6 years, and 59.8% (n = 58) were male. Marginal zone lymphoma constitutes the most prevalent subtype, accounting for 67% of cases, whereas other common subtypes include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma, and T-cell lymphomas. Unilateral involvement was observed in the majority of cases (72.3%). Common clinical presentations included mass (30.9%), swelling (26.8%), and epiphora (11.3%). Of the patients, 7.2% received rituximab alone, 14.4% received radiotherapy alone, 48.5% received chemotherapy, 27.8% received radiotherapy plus rituximab, 22.7% received radiotherapy plus chemotherapy, and 5.2% underwent surgery as the first-line treatment. During a median follow-up of 4.3 years, 15.5% of patients experienced relapse or disease progression. The 5-year and 10-year progression-free survival rates were 84.1% and 79.1%, respectively. This study contributes to our understanding of OLs and provides a foundation for further investigations in this field. Male gender, presence of B symptoms, advanced stage, secondary orbital lymphoma, aggressive histological subtype, and elevated serum lactate dehydrogenase levels were associated with poorer (either inferior or worse) progression-free survival.

Clinical spectrum and clinicopathological correlation of pediatric orbital tumors: 20 years' experience from a tertiary eye care center

PURPOSE

To study the epidemiological profile of various pediatric orbital tumors and determine their clinicopathological correlation over 20 years.

METHODS

A retrospective analysis of all pediatric patients with orbital tumors from the medical records between 1995 and 2015 was done. Tumors were categorized based on their cellular origin. Demographic details, clinical and histopathological diagnoses, frequency, and clinicopathological correlation were studied.

RESULTS

A total of 265 pediatric patients with orbital tumors were analyzed, of which 145 (54.7%) patients were males and 120 (45.3%) were females. The mean age was 7 years (median: 6 years; range: 10 days-16 years). The distribution of lesions in each group was as follows: vasculogenic, 76 (28.7%); lipogenic and myxoid, 66 (25%); myogenic, 31 (11.7%); optic nerve and meningeal, 22 (8.3%); lymphoid and lymphoproliferative, 18 (6.8%); secondary orbital tumors, 14 (5.2%); histiocytic, 9 (3.4%); miscellaneous, 9 (3.4%), lacrimal gland, 8 (3%); mesenchymal with neural differentiation, 6 (2%); osseous, 4 (1.5%), and fibrocystic, 2 (0.8%). The most common benign and malignant pediatric orbital tumors were dermoid cysts (65, 24.5%) and rhabdomyosarcoma (31, 11.7%). A statistically significant ( P < 0.0001) clinicopathological correlation was observed in 208 (83.2%) out of 250 biopsy-proven cases.

CONCLUSION

Pediatric orbital neoplasms include a broad spectrum of benign and malignant lesions. Vasculogenic tumors constitute the majority of them, followed by lipogenic and myxoid tumors. A thorough knowledge of the incidence, clinical profile, imaging features, and histopathology of specific orbital tumors aids in accurate diagnosis and their successful management.

[OCULO-ORBITAL TUMOURS AT THE NATIONAL UNIVERSITY HOSPITAL CENTRE OF BANGUI (CNHUB), CENTRAL AFRICAN REPUBLIC, IN 2022]

Introduction

Oculo-orbital tumors are common. Their clinical and histological features are multiple. The management of oculo-orbital tumors is a real challenge in sub-Saharan Africa, especially in our context. The aim of this study was to contribute to the improvement of the management of oculo-orbital tumors at the Bangui Teaching Hospital (CNHUB).

Methodology

This was a prospective, observational study of oculo-orbital tumors over 12 months from January 1 to December 31, 2022 in the ophthalmology department of the CNHUB. All consenting patients with histologically proven tumors of the eyeball and/or its adnexa were included in this study, regardless of age and sex.The parameters studied were:epidemiological: age, sex, occupation, origin;clinical: time of consultation, functional signs and associated signs, physical examination signs, risk factors;paraclinical: report of the anatomopathological examination of the operating room;therapeutic: treatment modalities (chemotherapy, surgery, palliative treatment, radiotherapy).These data were collected on a pre-established survey form for direct administration. The processing and the production of the results were carried out with Excel and Epi Info 7.0 software.

Results

We included 97 patients with a mean age of 37.5 years, ranging from 2 to 70 years. There was a male predominance (sex-ratio = 1.8). Almost all patients lived in Bangui (96%). Patients under 40 years of age were most commonly affected (55%). The majority of tumors were benign (55%). Ocular pain (24%), lacrimation (22%) and orbital swelling (16%) were the main symptoms. Risk factors were mainly age (23%), diabetes (22%), HIV infection (16%) and alcohol and tobacco use (37%). The most common treatments were surgical removal (68%) and enucleation (16%). Chemotherapy was combined with surgery in 37% of cases.

Conclusion

Oculo-orbital tumors are frequent in our context. Their morpho-histological presentations are varied. A multidisciplinary approach is important for a good management.

Orbital Tumors and Tumor like Lesions: A Hospital Based Study

BACKGROUND

Orbital tumors have rare incidence, still they play a significant role in terms of morbidity and mortality. Orbital tumors may be primary, secondary or metastatic. These consist of benign and malignant lesions with extreme variations in pediatric and adult groups. These lesions can have acute or chronic onset, slow to rapid progression with or without bony destructions leading to vision loss, deformity and sometimes death.

METHODS

This retrospective cross-sectional study was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine in Biratnagar Eye Hospital. Fifty-one patients who underwent histopathological evaluation for their orbital lesions from June 2018 to December 2019 were included in the study.

RESULTS

Orbital tumor and tumor like lesions comprised 27 cases (52.94%) in adults and 24 (47.06%) in paediatrics. Histopathologically, the most common pediatric benign tumor was dermoid cyst and malignant was secondary to orbital extension of retinoblastoma. Also, the most common adult benign orbital tumor was cavernous hemangioma and malignant was non Hodgkins lymphoma. The clinico-pathological accuracy for diagnosis was 68.63%. Association between age groups and nature of orbital lesions and between clinical and histopathological diagnosis was found to be statistically significant (p<0.05).

CONCLUSIONS

Orbital tumors and tumor like lesions are uncommonly encountered. These masses showed significant variation in incidence in children versus adults. Combined efforts by different specialties help in early and prompt management of the orbital tumors.

Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry

INTRODUCTION

Limited data are available on the incidence of primary ophthalmic cancers worldwide. We describe the incidence and trends of primary ophthalmic cancers in Singapore.

METHODS

Data on ophthalmic cancers diagnosed in Singapore from 1996 to 2016 were retrieved from the Singapore Cancer Registry for analysis. All were histologically proven primary ophthalmic cancers. Calculations of incidence and age-specific frequency of ophthalmic malignancy were made.

RESULTS

A total of 297 cases were included, with males constituting 59.9%. The race distribution was 78.5% Chinese, 16.5% Malay, 3.7% Indians and 1.3% others. There was an overall increase in ophthalmic malignancies. The mean age of onset was 47.4 years. The most common cancers were retinoblastoma (93.3%) in patients younger than 15 years, and lymphoma (71.3%) in patients aged 15 years and older. There has been an increase in lymphomas from 16.7% in 1968-1995 to 71.3% in 1996-2016 in those aged 15 years and older. The most common types of ophthalmic cancer according to location are lymphoma of the orbit, conjunctiva, cornea and lacrimal gland; retinoblastoma of the retina; and malignant melanoma of the choroid and ciliary body.

CONCLUSION

Our study reported the incidence and trends of ophthalmic cancer in the Singapore population and showed an overall increase in ophthalmic malignancies in Singapore from 1996-2016. A substantial increase in lymphomas over the last 2 decades was noted. The data could aid clinicians, epidemiologists and policymakers in implementing strategies to address trends in ophthalmic cancers and spur aetiological research to improve quality of life in patients with such cancers.

Pediatric Periocular Dermoid Cysts: Incidence, Clinical Characteristics, and Surgical Outcomes

PURPOSE

To report the incidence, clinical findings, and surgical outcomes of periocular dermoid cysts diagnosed among children over a 20-year period.

METHODS

All patients ≤5 years of age, who were diagnosed with a periocular dermoid cyst in Olmsted County, Minnesota from 1986 to 2005 were reviewed to determine the population incidence, clinical presentation, and management outcomes.

RESULTS

A total of 54 children were diagnosed with a periocular dermoid cyst during the 20-year period, yielding a birth incidence of 1 in 638 live births. The mean age at diagnosis was 12 months (range, 1 month-60 months) and 29 (53.7%) were female. A total of 44 cysts (81.5%) occurred in the superotemporal orbital rim, 6 (11.1%) in the superonasal orbital rim, 3 (5.6%) in other periocular areas, and one (1.9%) within the orbit. A total of 34 (63%) children had an ophthalmic exam, all without amblyopia or other ocular sequelae. A total of 48 (88.9%) patients underwent surgical excision with 5 (10.4%) having documented intra-operative cyst rupture, none of whom had post-operative complications. Two (4.2%) other patients were, however, noted to have lesion recurrence following surgical intervention.

CONCLUSIONS

Periocular dermoid cysts occur in approximately 1 in 650 live births and most commonly occur in the superotemporal region of children aged 1 year or less. Ocular sequelae are rare and surgical excision often yields excellent results.

Orbital lymphoma

Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.

Nonleukemic granulocytic sarcoma of orbit after blunt trauma: A case report and review of literature

RATIONALE

Granulocytic sarcoma without invasion of bone marrow or blood is very rare. The diagnosis of it is usually overlooked and the treatment has not reached a consensus. Meanwhile, the onset of this kind of disease is not clear.

PATIENT CONCERNS

Diagnose patients in early stage and help choose the right treatment strategies.

DIAGNOSES

The ultimate diagnosis was nonleukemic granulocytic sarcoma after blunt trauma.

INTERVENTIONS

Surgery was the initial treatment option. Chemotherapy including idarubicin (70 mg, D1-D3) and cytosine arabinoside (100 mg, D1-D7) and radiotherapy of total 3,060 cGy were then administered but failed to control the disease. Hematopoietic stem cell transplantation was finally administered.

OUTCOMES

No evidence of disease progression or spread according to the latest follow-up.

LESSONS

The etiology of nonleukemic granulocytic still remains unclear, though trauma seems to be a potential predisposing factor and deserves more attention for early diagnosis and timely and proper treatment. Systemic chemotherapy is more effective than radiotherapy or surgery. Hematopoietic stem cell transplantation is an alternative choice after the failure of chemotherapy.

The impact of IgG-4-ROD on the diagnosis of orbital tumors: A retrospective analysis

This study was to determine the prevalence of immunoglobulin G4 (IgG4)-related orbital disease (IgG4-ROD) among patients who have previously undergone biopsy and were diagnosed to have idiopathic orbital inflammatory disease (IOID) or orbital lymphoproliferative disease (OLD), namely, lymphoma and benign reactive lymphoid hyperplasia (BRLH). This is a retrospective cross-sectional study. The charts and slides of all patients who underwent biopsies and were histopathologically diagnosed to have either IOID or OLD were reviewed. Demographics, clinical features, initial histopathological diagnoses, treatment received, and final outcome were noted. Using the diagnostic criteria for diagnosis for IgG4 disease, those cases that would classify as "possible IgG4-related disease (IgG4-RD)" were reviewed, reclassified, and reassigned a diagnosis of IgG4-ROD. We reviewed 105 patients' clinical charts. Of these 105 patients, upon reviewing the histopathology, 18 (17.15%) patients were found to fit the diagnostic criteria for possible IgG4-ROD. Of these 18 patients who were now reassigned the diagnosis of IgG4-ROD, the most common previous histopathological diagnosis was found to be IOID, for eight patients (44%), then BRLH, which was noted in five patients (27.8%), followed by lymphoma, which was noted in two patients (11.1%). Previously diagnosed cases of IOID and OLD were found to fulfill the criteria for IgG4-ROD. Given the advent of recent diagnostic and histopathological techniques, all cases of suspected IOID and OLD should be screened for IgG4-ROD and all previously diagnosed cases must be closely followed up, given the systemic implication of IgG4-RD. Histopathological reassessment of previously diagnosed cases may be considered.

Neural Tumors of the Orbit -- What Is New?

Primary neural tumors of the orbit account for approximately 10% of all orbital tumors. Different tumor entities include meningiomas, optic nerve gliomas, neurofibromas, schwannomas, malignant peripheral nerve sheath tumors, and granular cell tumors. This review summarizes current concepts regarding epidemiology, clinical presentation, diagnosis, pathology, immunohistochemistry, prognosis, and treatment for neural tumors of the orbit based on the available literature.

Ophthalmic involvement in nasopharyngeal carcinoma

This article desribes the ophthalmic involvement in patients with nasopharyngeal carcinoma (NPC) pre- and post-treatment. We retrospectively reviewed data for 354 consecutive patients diagnosed with or treated for NPC at a single tertiary centre between April 2007 and July 2015. We identified 27 (7.6%) patients with ophthalmic involvement due to NPC or its treatment. Symptomatic orbital invasion by tumor occurred in 13 of 27 patients (48.1%). The mean age of diagnosis in these patients was 54 years, and 8 (61.5%) had no prior diagnosis of NPC. Ocular signs, but no orbital invasion, was present in 8 patients (29.6%). Incidental orbital involvement was detected on imaging in 2 patients (7.4%). Radiotherapy-related ocular complications affected 4 patients (14.8%). Ophthalmic symptoms from orbital invasion can be the initial presentation of NPC. This disease tends to affect a younger group of patients and early recognition is important to minimize morbidity and mortality.

Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016

The aim of this review article is to provide an update of the current literature on orbital tumors. The authors conducted a PubMed literature search of English language articles published between January 2014 and December 2016 using the following search items: orbit, tumors, lacrimal gland, lymphoma, hemangioma, lymphangioma. The authors included reviews, original articles, case series, and case reports with relevant new information. There is new information about the clinical spectrum of orbital tumors, capillary hemangioma, cavernous hemangioma, lymphangioma, orbital venous malformation, lacrimal gland tumors, and orbital lymphoma. This review highlights the current understanding, practice, and guidelines in the diagnosis and management of common tumors of the orbit.

Metastases to oro-maxillo-facial region from distant sites: are they so rare? A single centre 8-years experience

AIM

The goal of our study is investigate the frequency of metastasis to oro-maxillo-facial region to understand if they are really so rare.

MATERIAL OF STUDY

In this eight year's retrospective study (2004-2012) we collected 15 cases of metastasis localized in the maxilla-facial region from distant primary tumor.

RESULTS

Our results show breast and kidney as the most frequent primary site (40% and 20% respectively), adenocarcinoma as most common histological type (60%). Bone involvement has found to be much frequent than the soft tissue one (53.3%). The mandible (5/15 cases) is more affected than the maxilla, and most common interested subsites are molar and retromolar region. In our study we found only one case of unknown primary tumor, it was a mandibular bone metastasis from a renal clear cell carcinoma.

CONCLUSION

Finally, according to our results and considering the increase of survival in cancer disease, even if metastases to oro- maxilla- facial region from distant sites are not frequent, it is important to suspect secondary lesions both in patients that was referred a tumor in their medical history and in those that present a head and neck lesion.

Childhood rhabdomyosarcoma in Kano, Nigeria: a retrospective analysis of 52 cases

BACKGROUND

Rhabdomyosarcoma is the most common soft tissue sarcoma in children ≤ 15 years of age. There is, however, a paucity of reports on the pattern of its occurrence in Nigeria and other parts of Africa.

OBJECTIVE

The aim of this review is to highlight the age and sex distribution, anatomical location and morphological characteristics of rhabdomyosarcoma among children in Kano, northwestern Nigeria.

PATIENTS AND METHOD

This is a 14 year retrospective study of all cases of rhabdomyosarcomas occurring in children diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano, Nigeria. Clinical data obtained included sex, age, tumour site and histologic subtype.

RESULTS

Fifty two children were seen with a male to female ratio of 1 : 1.3. The ages of these Patients ranged from 4 months to 15 years with a mean (SD) age of 6.99 (4.1) years and peak age frequency in the 0 to 5 years age group. The embryonal variant was the most common histological subtype (69%). The others were alveolar (27%) and pleomorphic (4%) variants. The head and neck was the most affected region (44%) and the most common primary site was the orbit (19.2%).

CONCLUSION

Rhabdomyosarcoma is the most common childhood soft tissue sarcoma in Kano. It occurs in females more frequently than males and the most common histologic subtype is embryonal rhabdomyosarcoma affecting predominantly the orbit.

Orbital tumors in USA: difference in survival patterns

INTRODUCTION

There is a wide range of tumors affecting the orbital adnexa. Key such tumors include lymphomas, carcinomas, melanomas and rhabdomyosarcomas. Several studies have proposed that these histological subtypes differ in their survival outcomes. In this study we aim to describe the difference in survival outcomes between such subtypes.

METHODS

The SEER database was used to gather patient information. All 18 SEER registries were used. Patients diagnosed from 1996 to 2005 were included in the analysis. Observed five-year survival rate was calculated using the SEER*Stat software version 8.1.2. Data were extracted into IBM SPSS version 20 to generate Kaplan Meier curve for each group.

RESULTS

There were 2180 patients in the SEER databases who met the selection criteria. Lymphomas were the most common histology in adults. The overall five-year observed survival for all lymphoma patients was 75.9% (95% CI: 73.7-78.1). There was statistically significant difference between observed survival rates of lymphoma subtypes. Carcinomas were the second most common tumors. Their five-year observed survival rate in our study was 60.4%. There was no statistically significant difference between carcinoma subtypes' observed survival rates in the 20-49 age group, while, in the older age group, the difference was found to be statistically significant. Rhabdomyosarcomas were the most common tumors in children. The overall five-year observed survival rate for rhabdomyosarcomas patients was 89.8%. There was no statistically significant difference between observed survival rates of rhabdomyosarcomas subtypes. There was no statistically significant difference between relative survival rates according to gender and treatment received except within melanomas.

CONCLUSION

In adults, lymphomas have better survival rates than carcinomas. Whereas the lymphoma subtype can be used as a determinant prognostic factor in any age, the carcinoma subtype can be used as such a determinant in older age groups only. In children, rhabdomyosarcomas are the predominant tumors affecting the orbital adnexa. Further studies are needed to determine if the difference between embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma observed survival rates are statistically significant.

Orbito-Ocular Tumours in Ibadan, South-West Nigeria

AIM

The aim of this study was to review the cases of orbito-ocular tumors in a single tertiary health facility, and determine changes in pattern of presentation.

METHODS

Medical records of all patients with histologically confirmed orbito-ocular tumors between January 1992 and December 2011 in a tertiary center were reviewed. Patients' demographics, types of orbito-ocular tumor and their presentation were recorded.

RESULTS

Records of 205 patients were analyzed with a male to female ratio of 1.1:1 and median age of seven years. Retinoblastoma was the most common tumor followed by ocular surface squamous neoplasia. Squamous cell carcinoma was the most common eyelid tumor while rhabdomyosarcoma was the most common orbital tumor. No case of melanoma was seen during the period. More than two thirds of patients had lost vision at presentation due to delay in seeking appropriate medical attention Conclusion: There appears to be a reduction in the cases of orbito-ocular tumors in Ibadan, however, there is little variation in the pattern of presentation. Encouraging early presentation to the appropriate health facility may possibly reduce the morbidity in these patients.

[Solitary fibrous tumor of the orbit: Possibly recurrent in the long-run]

Solitary fibrous tumor (SFT) is a rare etiology of progressive unilateral exophthalmia. The tumor is of mesenchymal origin and it is usually well defined. But recurrences can occur despite of complete surgical resection. Metastases have been observed. Tumors of the SFT spectrum are considered as benign or low-grade malignant. Histological features do not currently allow any prognosis. The most important prognostic factor is complete surgical resection. Craniofacial approaches provide a good view of the tumor extensions and orbital contents. Recurrent tumors must be surgically removed when possible. Complementary treatments have not proved effective. A very long-term follow-up is mandatory.

Choroidal and orbital metastases from thyroid cancer

BACKGROUND

Metastases of thyroid carcinomas to the choroid and/or orbit are infrequent. PubMed was searched for English-language articles and case reports published from 1977 to 2012. In our survey, we looked for reports of orbital and/or ocular metastases from the thyroid and found 31 reported cases from 1979 to 2012.

SUMMARY

At the time of onset of ocular symptoms, the vast majority of patients had a long history of thyroid malignancy and evidence of widely disseminated metastatic disease. The age of the reported patients ranged from 29 to 83 years. Among the 22 reported cases of thyroid carcinomas with metastases to the choroid from 1979 to 2012, the most common primary tumor was papillary thyroid carcinoma (PTC); this occurred in seven patients. This was followed by medullary thyroid carcinoma in six cases and follicular thyroid carcinoma (FTC) in five cases. Orbital metastases were reported in nine patients with thyroid carcinomas (PTC=4, FTC=3, Hürthle cell=1, not specified=1). Patients with choroidal metastases presented with decreased or blurred vision, eye pain, and flashes in 81%, 5%, and 5% of cases, respectively. The diagnosis of a choroidal tumor was usually based on noninvasive diagnostic techniques such as ultrasonography, transillumination, computer tomography (CT), and/or magnetic resonance imaging (MRI) scanning. ¹³¹I scanning revealed uptake in the orbit in 26% of cases with choroidal and/or orbital PTC or FTC. For a metastasis that causes a definitive loss of vision and/or persistent pain, the treatment of choice was enucleation. The other treatment options were brachyradiotherapy using ¹²⁵I episcleral radioactive plaque insertion, external beam radiation, ¹³¹I therapy, chemotherapy, and/or targeted therapy with small molecules.

CONCLUSIONS

The orbit and globe are not common sites for metastatic thyroid carcinomas. Diagnosis of a choroidal tumor is usually based on clinical judgment and results of noninvasive diagnostic techniques such as ultrasonography, transillumination, CT, and/or MRI scanning. Fundoscopic examination and ocular ultrasonography by an ophthalmologist are recommended for identification and monitoring of choroidal metastatic deposits.

[Orbit evisceration: retrospective study on a consecutive series of 10 years]

Exenteration of the orbit is challenging in its anatomical, surgical and postsurgical management-related issues. We describe a surgical series of 65 patients diagnosed at Neurosurgery and Ophthal-mology departments; between 2003 and 2012, 65 cases with intraorbital tumors were identified and underwent partial or total exenteration of the orbit. The most frequent dignosticated tumor which underwent exenteration were spinous and basal carcinoma of the orbit (41.5 %) followed by neurofibroma The most common preoperative sign was proptosis (100%), followed by ocular and orbital pain (6.1%) and visual acuity loss (3.07%). Preoperatively signs included alteration of the facial aspect (96.9%), behavioural, emotional and social difficulties, especially in young people (6,9%). Although there is an extremely mutilant surgical procedure, pain is often relieved. Therefore, the surgical aim should be life preserving and relief of leading symptoms; estetic aspect of the patients was also one of postoperative aims.

[Orbital tumors treated at the University Hospital Otolaryngology Clinic in Kraków between 1997 and 2011]

The main aim of the study was to establish the frequency of orbital tumor occurrence in the patients of the University Hospital Otolaryngology Clinic in Kraków as well as to analyze the clinical features, location in the orbit and to identify the group of patients with the highest risk of orbital tumor. The authors retrospectively analyzed 46 patients (29 women and 17 men) between the ages of 23 and 87. This group of patients was compared to a group of 80 patients who were surgically treated at the same clinic 10 years ago and to a group of 70 patients treated 15 years ago. We established that the tumors localized in the orbit were mainly benign. A variety of histological types of tumors arises in the orbit but it was significant that inflammatory pseudotumors were the most common cases in all three groups of patients treated in our clinic now, about 10 and about 15 years ago. Referring to the group of patients at the highest risk, we established that orbital tumors are definitely most common in women than men. It has turned out to be statistically significant that benign tumors were most common in younger patients and malignant in older people. That suggests the conclusion that being female is a risk factor for orbital tumors and age is a risk factor for them being malignant. Comparing different approaches for the resection of orbital tumors, we established that the lateral orbitotomy provides access to orbital tumors in the most common locations (intraconal and in the top corner of the orbit). Malignant and extensive tumors have to be treated by orbital exenteration.

[Clinical analysis for the treatment of 63 cases of orbital tumors in Xinjiang]

OBJECTIVE

To analyse the clinical features, histopathological classifications, treatments and prognosis of orbital tumors in Xinjiang.

METHODS

The authors retrospectively analyse 63 patients (64 eyes) with orbital tumors, including all nationalities which had been received and treated in ophthalmic department of the PLA 474th Hospital during 2005 to 2009.

RESULTS

The nationality composition in our cases was 37 Han, 16 Uygur (16 eyes), 4 Hui, 3 Mongol, and 3 Kazak. Our data mainly consisted of benign tumor., in which, the majority were the vascular tumors, and then were cysts, inflammatory pseudotumor, neurogenic tumors, mixed tumors of lacrimal gland, lipoma and hydatid. The malignant tumors mainly consisted of rhabdomyosarcoma and adenocarcinoma of lacrimal gland, then was non-Hodgkin lymphoma. The operation methods we selected were approaching by orbital skin or anterior skin incision, lateral orbitotomy and approaching by outer canthus incision plus lower fornical conjunctiva incision. The severe postoperative complication was impaired vision, and 2 patients with inflammatory pseudotumor had recrudesced.

CONCLUSIONS

There is no difference on the types and morbidity situation of orbital tumors between Xinjiang and other areas in general, in addition orbital hydatid which was closely related to regional characteristic of Xinjiang, Surgical excision is the main and effective treatment, the prognosis is related to the local tissue extension of tumor, comprehensive pre-operation preparations, careful operation, appropriate post-operative managements and rich clinic experience of doctor.

Patterns and incidence of sinonasal malignancy with orbital invasion

BACKGROUND

Sinonasal malignancy with orbital invasion is rare. The objective of the current study was to evaluate the clinical and pathological features, treatment outcomes and survival rates for these malignancies.

METHODS

Ninety-three patients who were treated between 1997 and 2007 were retrospectively reviewed. Age, life style, symptoms, location of lesions, previous occurrences, histological subtypes, and treatment modalities were analyzed.

RESULTS

Ninety-three patients were evaluated, including 51 men and 42 women: the gender ratio was 1.2 men to 1.0 women. The median age was 40.5 years old. The nasal cavity (34.4%), the maxillary sinus (29.0%) and the ethmoid sinus (19.4%) were the most common primary malignant tumor sites. Almost half of the patients, 44.1% had squamous cell carcinoma, 13.9% had neuroectodermal carcinoma, 11.7% had rhabdomyosarcoma, 9% had adenocarcinoma and salivary gland-type carcinoma, and 11% had other malignancy. The majority of patients presented with T3/T4 (99%), N0 (93.1%), M0 (98%) disease. The distant metastasis rate was 20.9%. The overall survival and disease-free survival rates were 68.1% and 40.9% at three years, respectively. When the overall survival rate was computed according to the epicenter of the original malignant tumor, patients with nasal cavity malignancy and maxillary sinus had the best survival, and patients with ethmoid sinus malignancy had the worse survival (P = 0.03). According to their pathology classification, patients with rhabdomyosarcoma had worse overall survival than those with squamous cell carcinoma, or neuroendocrine carcinoma (P < 0.001). Squamous cell carcinoma and rhabdomyosarcoma invaded the orbit more often and malignancy of the nasal cavity invaded the orbit more than malignancy of the nasal sinus.

CONCLUSIONS

For nasal orbital tumors early diagnosis is crucial. Orbital exenteration and postoperative rehabilitation should be carefully considered. The current data suggest that surgical resection with postoperative radiation therapy may offer durable local control.

[Risk factors of extraocular spread after local treatment of uveal melanoma]

14 cases of extraocular spread in patients with uveal melanoma after previous eye preserving treatment were analyzed. The time of manifestation and risk factors of extrascleral invasion were determined in patients after different local treatment modalities of uveal melanoma.

Incidence, ocular manifestations, and survival in children with neuroblastoma: a population-based study

PURPOSE

To determine the incidence, ophthalmic manifestations, and survival among children with neuroblastoma in a defined population.

DESIGN

Population-based retrospective cohort.

METHODS

The medical records of all pediatric (<19 years) residents of Olmsted County, Minnesota, diagnosed with neuroblastoma from January 1, 1969, through December 31, 2008, were retrospectively reviewed.

RESULTS

Fourteen children were diagnosed with neuroblastoma as residents of Olmstead County, Minnesota, during the 40-year period, yielding an age- and gender-adjusted incidence of 11.8 (95% confidence interval [CI]: 5.6-18.0) per million patients <15 years of age. The calculated incidence for patients presenting before the age of 5 in this cohort was 1 in 5970 children (95% CI: 3920-12 580 children). The mean age at diagnosis for the 14 study patients was 22.5 months (range, 10.4-42.6 months). Six of the 14 (43%; 95% CI: 18%-71%) had ocular manifestations, including orbital metastasis in 6 (100%), proptosis and ecchymosis in 4 (67%), ptosis in 2 (33%), and strabismus in 1 (17%). The Kaplan-Meier rate of survival for all 14 children was 57% at 1 year (95% CI: 36%-90%) and 50% at 5 years (95% CI: 30%-84%), while the 6 with eye findings had a survival rate of 17% at 9 months (95% CI: 3%-100%).

CONCLUSIONS

The incidence of neuroblastoma in this population was 11.8 per million patients <15 years, with ophthalmic involvement observed in 6 of the 14 study patients (43%). Orbital metastasis in the 6 children in this cohort was associated with poor prognosis.

Relapsed or refractory nongastric marginal zone B-cell lymphoma: multicenter retrospective analysis of 92 cases

Over its long survival duration, marginal zone B-cell lymphoma (MZL) routinely involves frequent relapses. In this study, we conducted a retrospective analysis to identify the clinical features and outcomes of relapsed or refractory MZL. From 1995 to 2008, a total of 92 patients with relapsed MZL were retrospectively analyzed. The median age of our subjects was 53.5 years (range: 23-82 years). The most common primary sites of involvement were the orbit and ocular adnexa (28.3%) followed by the lymph node and lymphatic organs (23.9%), and multiple mucosa-associated lymphoid tissue (MALT) sites (13.0%). The median time to relapse from initial diagnosis was 25.5 months. Of the 53 patients with Stage I or II at diagnosis, 42 patients (79.2%) evidenced locoregional recurrence. Among these locoregional relapsed patients, 27 patients achieved CR (54.1%) or PR (18.9%). In addition to the 39 patients initially in advanced Stage III or IV, a total of 50 patients were in advanced stage at relapse. Among those patients with advanced stage at relapse, 44 patients were treated. The overall response rate was 54.5% (24 patients), with 18 CRs and 6 PRs. The median time to progression (TTP) was 34.1 months (95% CI: 11.3-56.9 months) and the estimated 5-year overall survival (OS) was 84.3%. The majority of them was controlled well with salvage treatment, and could achieve prolonged survival. However, patients' refractory to initial therapy and advanced relapse evidenced shorter TTP and OS. Thus, we need to consider more aggressive treatment in cases of refractory MZL or advanced relapsed MZL.

[Orbito-sphenoidal expansive processes: an anatomopathological study of 82 cases]

PURPOSE

To describe the orbito-sphenoidal expansive processes diagnosed at the Anatomo-Pathological Laboratory of the Fundação Faculdade Federal de Ciências Médicas de Porto Alegre - Complexo Hospitalar Santa Casa de Porto Alegre during a period of 15 years, evaluating their relative frequencies among other tumoral processes.

METHODS

We performed a statistical analysis of all orbital tumors with anatomicopathological diagnosis from January 1968 to December 1982, comparing the frequency of orbital tumors with the total number of tumors diagnosed at this Laboratory in a period of 5 years.

RESULTS

Eighty-two cases were diagnosed of expansive processes involving the orbit in 15 years - 20.7% of the total (17 cases) affecting children (up to 14 years-old) and the remaining 79.3% (65 cases) affecting adults. Children presented more frequently optic nerve gliomas (4 of 6 cases 66.6%), retinoblastomas (4 cases - 100%) and rhabdomyosarcomas (3 of 4 cases - 75%). Less frequent diseases in children were optic nerve meningioma, neurofibroma, inflammatory pseudotumor, chronic dacryoadenitis, neuroma and chronic inflammatory process. The adult population presented more cases of basal cell carcinomas (18 cases), squamous cell carciomas (12 cases), meningiomas (10 cases), choroidal malignant melanoma (3 cases) and lacrimal gland tumors (7 cases). Tumors originated from bone or vascular structures, pseudo-tumors, and intraorbital epidermic cysts were also diagnosed, among others. Of a sum of 2,639 tumors diagnosed at this Laboratory in the time period of 5 years (1976 to 1980), there were 22 cases of orbital tumors, reaching a total of 0.8% of all cases.

CONCLUSIONS

The anatomicopathological study of these processes is somehow important to diagnose and to establish an adequate therapy. The incidence of the expansive processes involving the orbit allows an epidemiological characterization of the different medical services responsible for the treatment of eye diseases. Despite its lower frequencies when compared to the diagnosis from other branches of Anatomical Pathology, Eye pathology has developed considerably over the past few years, contributing to more accurate diagnosis and to a better understanding of mechanisms responsible for these processes.

Orbito-ocular lesions in Lagos

OBJECTIVE

we present a 10year retrospective clinicopathologic study of 135 cases of orbito-ocular lesions. The aim is to document pattern of orbito-ocular lesions, with their site, age and sex distribution.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all orbito-ocular samples received at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos between 1994 and 2003.

RESULTS

A total of 135 samples from 75(56%) males and 60(44%) females were analysed. The conjunctival, intraocular, orbital and eye lid lesions accounted for 27(20.1%), 75(55.5%), 18(13.4%) and 15(11%) cases respectively. The ages ranged from 20 days to 79 years with a mean age of 35 years. Sixty nine cases (51.1%) of all orbito-ocular lesions were seen in children of age 15 years and below. Squamous cell carcinoma was the commonest malignant conjunctival lesion (4 out of the 5 cases) occurring in adults with a mean age of 45 years. Retinoblastoma accounted for 46(85%) of all orbito-ocular malignancies with the peak in the 1-5year age group accounting for 37(80 %). Panophthalmitis, endophthalmitis and phthisis bulbi were common non neoplastic lesions requiring enucleation. Pseudotumour and rhabdomyosarcoma accounted for 5(27.8 %) and 4(22.2 %) cases respectively of all orbital lesions.

CONCLUSION

Retinoblastoma remains the commonest ocular malignancy while rhabdomyosarcoma was the commonest orbital malignancy with both occurring in childhood. Inflammatory lesions unfortunately are important orbito-ocular lesions requiring surgery in our environment.

Orbito-ocular neoplasms in Enugu, South-Eastern, Nigeria

BACKGROUND

Orbito-ocular neoplasms are important causes of ophthalmic morbidity and mortality. Various reports have shown that they occur more commonly among Africans than Caucasians. In this era of HIV pandemic, an increase in the frequency of AIDS-related orbito-ocular neoplasms has also been reported.

OBJECTIVE

This study was carried out to determine the pattern of orbito-ocular tumours in Enugu, South-Eastern Nigeria and to compare it with the findings from earlier studies in the same area, other parts of Nigeria and other countries.

METHODS

In a retrospective, non-comparative case series study the records of all the cases of orbito-ocular neoplasms seen in the Histopathology departments of the two tertiary multidisciplinary hospitals with major eye clinics in Enugu (ParkLane Specialist and University of Nigeria Teaching Hospitals) between January 2001 and August 2005 were analysed for types of tumours, frequency of occurrence, sex and age of patients.

RESULTS

A total of 43 cases were analysed. There were 17 males and 26 females (M: F-l:1.4). Retinoblastoma was the most commonly occurring neoplasm accounting for 25.6% of all the tumours; followed by squamous cell carcinoma of the conjunctiva which was seen in 5 (11.6%) of cases. Squamous papilloma and Burkitt's lymphoma each accounting for 9.3% of the tumours in the series were the third most commonly occurring ones.

CONCLUSION

In spite of the limitations of the study our findings suggest that the spectrum of orbito-ocular neoplasms has generally remained the same in Enugu, South-Eastern Nigeria as well as in other parts of the country.

[Orbital metastases of breast cancer]

Orbital metastases are a defined subgroup within ocular affection secondary to the distant spread of breast cancer. We review the published experience on the incidence of orbit extension from this type of tumour, with reference made to our experience as medical oncologists, together with the most common clinical features and the relevant aspects for imaging and histopathological diagnoses. The therapy for orbital metastases from breast cancer is included within the systemic therapy required by the distant spread of the disease, with some clinical benefits obtained from hormone therapy, chemotherapy and monoclonal antibodies. Palliative radiation and surgery may also play an important role in providing care to these patients. Although there are some published cases with long-term survival, the prognosis for these patients is poor, and new advances in knowledge and therapy are needed for this complication due to breast cancer.

Orbital space-occupying lesions in Indian children

PURPOSE

To present a review of all patients younger than 16 years who presented to us with orbital space-occupying lesions.

METHODS

Retrospective case study.

RESULTS

We analyzed the records of 119 children younger than 16 years of age who had presented to us with proptosis during the 10-year study period. Myogenic tumors were the most common lesion seen (24%), followed by metastatic and secondary orbital tumors (17%), vasculogenic lesions (15%), cystic lesions (10%), inflammatory lesions simulating tumors (7.5%), optic nerve and meningeal tumors (7.5%), peripheral nerve tumors (5%), lacrimal fossa lesions (4%), lymphoid tumors and leukemias (2.5%), primitive neuroectodermal tumors (3%), and others (2.5%).

CONCLUSION

We analyzed the profile of orbital lesions that underwent surgical procedures and were proven histopathologically. We found 63 malignancies among the 119 cases, for a malignancy rate of 53%. Orbital rhabdomyosarcoma and retinoblastoma with orbital spread were the most common causes of proptosis among the children.

Intracranial vascular anomalies in patients with periorbital lymphatic and lymphaticovenous malformations

BACKGROUND AND PURPOSE

The purpose of this study was to determine the nature, incidence, and radiologic appearance of intracranial vascular anomalies that occur in association with periorbital lymphatic malformation (LM) and lymphaticovenous malformation (LVM).

MATERIALS AND METHODS

We retrospectively reviewed clinical records and imaging studies of 33 patients ranging in age from the neonatal period to 39 years (mean age, 5.1 years; median age, 1.0 year) who were evaluated for orbital LM or LVM at our institution between 1953 and 2002. Imaging studies, including CT, MR imaging, and cerebral angiograms, were evaluated by 2 radiologists to determine morphologic features of orbital LM and to identify associated noncontiguous intracranial vascular and parenchymal anomalies, including arteriovenous malformations (AVM), cerebral cavernous malformations (CCM), developmental venous anomalies (DVA), dural arteriovenous malformations (DAVM), and sinus pericranii (SP).

RESULTS

The malformation was left-sided in 70% of patients. Twenty-two patients (70%) had intracranial vascular anomalies: DVA (n = 20; 61%), CCM (n = 2; 6%), DAVM (n = 4; 12%), pial AVM (n = 1; 3%), and SP (n = 1; 3%). Arterial shunts were present in the soft tissues in 2 patients (6%). Three patients had jugular venous anomalies. Three patients (9%) had cerebral hemiatrophy, 2 (6%) had focal cerebral atrophy, and 2 had Chiari I malformation.

CONCLUSIONS

Intracranial vascular anomalies, some of which are potentially symptomatic and require treatment, are present in more than two thirds of patients with periorbital LM. Initial imaging of patients with orbital LM should include the brain as well as the orbit.

Pathological evaluation of orbital tumours in Japan: analysis of a large case series and 1379 cases reported in the Japanese literature

PURPOSE

To review epidemiological features of orbital tumours in Japan.

METHODS

Retrospective, observational case series and systematic review. A total of 104 patients with orbital tumours collected at the authors' institution during 1983-2002 were assessed. In addition, 1379 cases from a large series of orbital tumours diagnosed by histopathological analysis that were previously published in Japanese ophthalmological journals from 1980 to 2004 were analysed.

RESULTS

After combining the current data with the previously published cases, there were a total of 1483 lesions with 47% classified as primary, 30% as secondary and 22% as inflammatory. The most common primary tumour was malignant lymphoma (12%) followed by pleomorphic adenoma (7%). Carcinomas from the lung, breast and thyroid were found to predominate among orbital metastases. Inflammatory pseudotumour had the highest lesion frequency (18%).

CONCLUSIONS

Malignant lymphoma by far was found to have the most dramatic increases within the recent reported series. Pleomorphic adenomas in Japan were found to be much more common compared with that reported for American and European studies.

Clinical implications of hepatitis C virus infection in MALT-type lymphoma of the ocular adnexa

BACKGROUND

A pathogenic link between hepatitis C virus (HCV) and MALT-type lymphomas has been suggested. However, studies assessing the role of HCV infection separately in different forms of MALT lymphomas are not available.

PATIENTS AND METHODS

The prevalence and clinical implications of HCV seropositivity were analyzed in 55 patients with ocular adnexa lymphoma (OAL) of MALT-type.

RESULTS

HCV seropositivity was detected in seven (13%) patients. At presentation, HCV infection was significantly associated with concomitant extra-orbital disease, lymph node dissemination and involvement of additional extranodal organs. HCV seropositivity was associated also with a higher relapse rate and worse progression-free survival. In fact, 16 patients experienced relapse after first-line treatment: five (71%) were HCV-seropositive and 11 (23%) were HCV-seronegative, with a median TTP of 31 and 50+ months (P = 0.01), and a 5-year progression-free survival of 43 +/- 18% and 77 +/- 7% (P = 0.005), respectively. HCV-seropositive patients experienced frequent relapses despite further lines of therapy; relapses were systemic in all cases but one; multiple subcutaneous nodules were common at relapse.

CONCLUSIONS

HCV seropositivity is present in 13% of OAL of MALT-type. Concomitant HCV infection is associated with more disseminated disease and aggressive behavior in OAL, with a consequent potential negative impact in patients managed with radiotherapy alone.

Clinical manifestations of orbital mass lesions at the Jules Stein Eye Institute, 1999-2003

BACKGROUND AND OBJECTIVE

To describe the clinical manifestations, diagnoses, treatments, and outcomes of orbital mass lesions at a tertiary care referral center.

PATIENTS AND METHODS

All cases of newly diagnosed or referred orbital tumors at the Jules Stein Eye Institute from 1999 to 2003 were reviewed retrospectively. Demographic and clinical data were extracted from the electronic oculoplastics registry of the Division of Orbital and Ophthalmic Plastic Surgery.

RESULTS

Three hundred sixty-nine cases of orbital mass lesions were evaluated (167 males and 202 females; mean age = 48 years). The most common presenting symptoms were mass/proptosis, pain, swelling, inflammation, and diplopia. The most common categories of diagnosis were cystic or structural lesions, benign tumors, inflammatory processes, neuronal processes, and fibrous processes. Increasing age was associated with an increased incidence of primary and metastatic malignant tumors. Half of all cases required surgical intervention consisting of excision, debulking, or exenteration; 20% to 30% of cases were managed conservatively.

CONCLUSIONS

The differential diagnosis of orbital mass lesions differs across age groups. No clinical sign or symptom is specific for the underlying diagnosis and the biological behavior of the abnormal process may be misleading. Therefore, a careful diagnostic approach that considers the benefit of imaging studies must be undertaken. Almost 50% of these mass lesions can be managed with nonsurgical intervention.

Orbitaerkrankungen im Kindesalter

BACKGROUND

Orbital diseases in childhood are rare and differ from orbital lesions occurring in adults. Most paediatric orbital tumours are benign, but rapid tumour growth can nevertheless threaten vision or lives.

PATIENTS

Retrospectively, we analyzed data of 41 consecutive patients with orbital disease, treated in our hospital between 2000 and 2004. The data was evaluated using descriptive statistics and case reports.

RESULTS

All children (from neonatals up to 16 years of age) with orbital disease were included in the study. The most common benign disease of the entire collective was an epidermal cyst (n = 18), followed by orbital capillary haemangioma (n = 4) in children under 3 years, and preseptal cellulitis in children older than 3 years. 5 patients were treated for malignant tumours, of which one patient under 3 years had an orbital metastasis of an abdominal neuroblastoma.

CONCLUSION

Awareness of orbital diseases in childhood, as a rare entity, is crucial for timely diagnosis and appropriate treatment, to save the vision and lives of affected children.

Épidémiologie des lésions oculaires et orbitaires adressées à un centre d’oncologie oculaire

PURPOSE

To study the epidemiology of ocular and orbital lesions referred to an ocular oncology center.

MATERIAL AND METHODS

Prospective study of ocular lesions referred between November 1997 and November 2002.

RESULTS

A total of 1,257 lesions were recorded in 640 females and 617 males. The mean age at the initial visit was 52 years (range, 0 to 94 years). Patients more than 60 years old accounted for 46% of our series. The lesions were classified into four groups: intraocular lesions (69%), superficial layer lesions (18%), adnexal tissues lesions (7%) and orbital lesions (6%). The posterior uvea was the most frequent localization. The clinical diagnosis of 374 lesions (30%) was confirmed by histological examination. The most frequent tumors were retinoblastoma in children and teenagers, conjunctival nevus young adults, choroidal melanoma in slightly older patients and posterior choroidal nevus in elderly people.

CONCLUSION

This study reviewed the epidemiological characteristics of ocular and orbital lesions referred to an ocular oncology center for their diagnosis, treatment and follow-up.

A Review of 244 Orbital Tumors in Japanese Patients During a 21-Year Period: Origins and Locations

PURPOSE

To review 244 cases of orbital tumors to determine the distribution of patient age, pathology, and tumor origin and location.

METHODS

We reviewed cases of histopathologically or radiologically verified orbital tumors at our institution from 1981 through 2002, and studied the distribution of patient age, pathology, origin of tumors, and tumor location in the orbit in 244 consecutive patients (aged from 0 to 90 years, mean, 48.7 years; 114 men, 130 women).

RESULTS

Among the 244 cases, 213 (89%) were primary orbital tumors, 23 (9%) were secondary tumors originating in contiguous spaces, and 8 (2%) were metastatic tumors. Regarding the location in the orbit, 122 tumors (50%) were extraconal, 36 (15%) were intraconal, and 86 (35%) were in the lacrimal gland area. The common tumors were reactive lymphoid hyperplasia (22%) and malignant lymphoma (20%) in the extraconal area; cavernous hemangioma (25%), optic nerve glioma (14%), and optic nerve sheath meningioma (14%) in the intraconal area; and malignant lymphoma (40%) and pleomorphic adenoma (24%) in the lacrimal gland area. The age distribution of the 244 patients exhibited two peaks, at 0 to 9 years and 60 to 69 years. In the 0- to 9-year-old patients, the most common tumors were dermoid cyst (26%), optic nerve glioma (11%), capillary hemangioma (11%), and hemorrhagic lymphangioma (11%). On the other hand, in patients over 40 years of age, the common tumors were malignant lymphoma (31%), orbital pseudotumor (24%), pleomorphic adenoma (10%), and cavernous hemangioma (9%).

CONCLUSIONS

The pathologic profiles of orbital tumors were characterized according to patient age and the location of the tumor in the orbit. The age of onset, tumor location, and radiological findings provide us with important information for the diagnosis of a tumor prior to biopsy or tumor resection and for the determination of the treatment strategy.

[Primary extranodal non-Hodgkin's malignant orbital lymphomas treated surgically in ENT Department of Medical Academy of Silesia in Katowice in the years 1996-2001]

The authors presented 7 cases of primary extranodal non-l-odgkin's malignant orbital lymphomas in patients treated surgically in the ENT Department of the Medical University of Silesia in the years 1996-2001. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography (USG), computer tomography (CT) and magnetic resonance imaging (MRI). We also used the needle aspiration biopsy, as an additional examination. However the material was no significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumors. In each case the postoperative material was examined using histopatological and immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological and Radiotherapy Departments.

High incidence of orbital malignant lymphoma in Japanese patients

PURPOSE

To review 244 cases of orbital tumors to determine pathologic findings in Japanese patients.

DESIGN

Observational case series.

METHODS

We studied the pathology and origin of tumors in the orbit in 244 consecutive Japanese patients with orbital tumors at our institution from 1981 through 2002 (age 0 to 90 years, mean, 48.7 years; 114 men, 130 women).

RESULTS

The most common tumors were lymphoproliferative diseases (n = 114, 42.5%), including malignant lymphoma (n = 59, 24.1%) and reactive lymphoid hyperplasia (n = 45, 18.4%), pleomorphic adenoma (n = 21, 8.6%), and cavernous hemangioma (n = 18, 7.4%).

CONCLUSION

The incidence of lymphoproliferative diseases, especially malignant lymphoma, was very high in Japanese patients.

Orbital embryonal rhabdomyosarcoma in Karachi (1998-2002)

OBJECTIVE

To study the epidemiology of ocular Rhabdomyosarcoma (ORMS) in Karachi.

METHODS

Incident ORMS cases resident of Karachi, registered at Karachi Cancer Registry (KCR) during 1st January 1998 to 31st December 2002 were included in the study. The data were classified using ICD-O2; computerized with Canreg-3, and analyzed using SPSS 10.0.

RESULTS

Ten cases of ORMS were reported to KCR during 1998-2002. RMS originated in the orbit in eight cases, conjunctiva in one and eyelid in one. Nine cases presented with proptosis, associated with conjunctivitis in four cases. One case presented with eyelid swelling. The crude annual incidence rate was 0.13/100,000, the age standardized rate was 0.3/100,000. The mean age of childhood cases was 10.4 years (95% CI 4.0; 16.7); and adult cases was 24.8 years (95% CI 12.8; 36.7). At presentation, eight patients were older than 10 years and three were older than 20 years. Five cases were categorized as childhood malignancies. Tumors were a TNM stage III disease at presentation in eight cases; survival at the end of one year was 70%, and at the end of two years 20%. There were no survivors at the end of three years.

CONCLUSION

ORMS in Karachi is a disease with a dismal survival. It may reflect a late presentation, or shorter adult ORMS survival or a manifestation of a different genetic pattern, associated with rapid evolution and poor prognosis. Health education for the population, especially parents and health providers is essential for early ORMS diagnosis. Pediatricians, ophthalmologists and health professionals, can play a vital role. Healthcare planning should focus on capacity building for ophthalmologic screening. Cytogenetic studies are advised to determine the genetic pattern.

Orbital involvement in juvenile nasopharyngeal angiofibroma: prevalence and treatment

PURPOSE

To assess the prevalence of orbital invasion by juvenile nasoangiofibroma and to discuss its surgical treatment.

METHODS

A retrospective review of the medical records and tomographic scans of a case series of 19 patients with juvenile nasoangiofibroma was performed. All scans were reviewed by a radiologist and an orbital surgeon. The presence of the tumor was assessed in the pterygopalatine fossa, nasal cavity, nasopharynx, paranasal sinuses, inferior orbital fissure, orbit, and middle cranial fossa.

RESULTS

The most common structures invaded were pterygopalatine fossa (100%), nasal cavity (94.7%), sphenoid sinus (84.2%), and nasopharynx (73.7%). The orbit was invaded in 6 (31.6%) patients. In 5 of these patients, the tumor extended in the orbit through the inferior orbital fissure. Four patients with orbital invasion were successfully operated with the Le Fort I approach.

CONCLUSIONS

Orbital involvement is relatively common in the setting of juvenile nasoangiofibroma extension. The main route of orbital invasion is the inferior orbital fissure. The Le Fort I osteotomy is an adequate approach for managing juvenile nasoangiofibroma when it invades the orbit.

Survey of 1264 patients with orbital tumors and simulating lesions

OBJECTIVE

To determine the incidence of specific orbital tumors based on patients referred to an ocular oncology center.

DESIGN

Retrospective, observational case series.

PARTICIPANTS

A total of 1264 consecutive patients referred to an ocular oncology service because of space-occupying orbital lesions.

METHODS

A retrospective chart review was carried out for 1264 consecutive patients referred for a suspected orbital mass over a 30-year period. The lesions were grouped into general categories, as shown in "Results." The specific diagnosis in each case was based on clinical findings, computed tomography scan results, magnetic resonance imaging results, and histopathologic analysis results, when available. The number and percentage of benign and malignant tumors per age group also was determined.

MAIN OUTCOME MEASURES

The incidence of orbital tumors and pseudotumors.

RESULTS

Among 1264 consecutive patients, the number and percentage of lesions in each general category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13 (1%); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1%); lipocytic and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%); primary melanocytic lesions, 11 (<1%); metastatic tumors, 91 (7%); lymphoma and leukemia lesions, 130 (10%); secondary orbital tumors, 142 (11%); histiocytic lesions, 17 (1%); thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11%); and miscellaneous other lesions, 13 (1%). The most common diagnoses were: lymphoid tumor (139 cases;11%), idiopathic orbital inflammation (135 cases; 11%), cavernous hemangioma (77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35 cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst (26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The percentage of malignant lesions was 20% in children (age range, 0-18 years), 27% in young adults and middle-aged patients (age range, 19-59 years), and 58% in older patents (age range, 60-92 years). Rhabdomyosarcoma was the most common malignancy in children, representing 3% of all orbital masses, and lymphoma was the most common malignancy in older patients, representing 10% of cases.

CONCLUSIONS

A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions, 64% were benign and 36% were malignant. The percentage of malignant tumors increased with age, with malignancies being common in older patients because of the higher incidence of lymphoma and metastasis in the elderly.

[MRI findings of orbital hemangiomas]

PURPOSE

To evaluate the MR imaging findings of orbital hemangiomas in pediatric and adult groups.

MATERIALS AND METHODS

MR imaging findings of seven orbital hemangiomas were reviewed. All patients had axial and coronal T1 and T2 weighted images. Axial and coronal fat suppressed (STIR) images and postcontrast T1 weighted images in three planes were obtained in order to evaluate the relation with surrounding structures. Localization, size, margins and signal characteristics of the lesions were analyzed.

RESULTS

Four of the cavernous hemangiomas were intraconal, one was extraconal. The location of the lesions was superomedial in two, middle medial, inferomedial and inferolateral in one lesion. The lesions were iso-hypointense to muscle on T1W, hyperintense on T2W and markedly hyperintense on STIR images. All cases had a capsule. In four cases a chemical shift artifact was seen. Contrast enhancement was patchy in early images and homogenous in late images. Cavernous hemangiomas were well circumscribed. All cases underwent operation and had a histopathologic diagnosis. The capillary hemangioma seen in a ten-year-old case was superomedial in localization and had irregular contours. The other case was a one year old. The lesion surrounded the superolateral margin of the bulbus and involved the lateral rectus, the eyelid and neighboring skin. The lesions were hypointense on T1W and hyperintense on T2W images, with diffuse homogenous contrast enhancement.

CONCLUSION

With MRI, orbital hemangiomas, the most common cause of chemosis and proptosis are easily detected. MR findings are not only helpful for diagnosing the lesion but also for choosing the appropriate surgical approach.

[Orbital tumors in the material of Department of Ophthalmology of Medical University of Gdańsk in years 1991-2002]

PURPOSE

Aim of the study was to determine the types and frequency of orbital tumors and to assess the method of treatment relevant to patient, orbital and tumor data.

MATERIAL AND METHODS

Current classification of orbital tumors is presented. The retrospective analysis of 127 patients with orbital tumor treated in the Ophthalmology Clinic in Gdańsk in years 1991-2002 was carried out. The diagnosis was made with orbital biopsy in available cases, the clinical findings, imaging studies and histopatological examination.

RESULTS

There were 91 cases of primary tumors, 33 of secondary lesions and 3 metastatic neoplasms. The surgical treatment was involved in 87 cases. 14 of them required the synergic action with radiotherapy and 4 with chemotherapy.

CONCLUSIONS

The age of the studied group is an important factor affecting relative incidence of orbital tumors. With increasing age, malignant orbital tumors become more common. Orbital lesion may manifest the systemic neoplastic disease.