Pseudo-tumours, a clinical concept

Immunohistology of eye muscle in idiopathic orbital inflammatory disease (pseudotumor), Graves' ophthalmopathy and healthy controls

Inflammatory orbital disease can be triggered by a variety of causes. Two such diseases are pseudotumor orbitae and Graves' ophthalmopathy, and both involve extraocular muscles. Biopsies were obtained from ocular muscles during a quiet phase in these two diseases. Biopsies obtained from a previous pseudotumor orbitae showed complement deposits and increased expression of HLA class-I antigens in the intermuscular tissue. The biopsies from two out of four pseudotumor cases and two out of four Graves' ophthalmopathy cases contained increased numbers of intermuscular HLA class-II-expressing cells. In spite of clinical remission, the local condition in all four pseudotumor cases and in two out of four cases of Graves' ophthalmopathy still suggests active inflammatory disease.

Lymphoid proliferations in the orbit: malignant or benign?

Clinical, pathological, and immunological analysis of 20 patients with ocular adnexal lymphoid disease has demonstrated several parameters which are useful for distinguishing malignant from benign lesions. Patients in the fourth or fifth decade of life presenting with an acute history of pain, oedema, epiphora, double vision, and ptosis, with a mass localised in the lacrimal gland area, are more likely to have a pseudolymphoma or a chronic inflammatory lesion than a true non-Hodgkin lymphoma (NHL). It is not possible to obtain a definite diagnosis without surgical intervention, because only three out of nine patients with orbital NHL had evidence of a monoclonal B cell population in peripheral blood on admission to the Orbital Centre. Furthermore it was confirmed that the identification of the various orbital lymphoid infiltrates becomes more distinct when immunological techniques are added to the clinical and histopathological methods of investigation. Multidisciplinary cooperation leads to further improvement of diagnosis and treatment of ocular adnexal lymphoproliferative disease.