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Goh LY, Limbachia K, Moonim M, Morley AMS. Primary lacrimal sac melanoma: a case report describing the novel use of fine needle aspiration cytology (FNAC) for diagnosis, together with literature review and immunotherapy treatment update. Orbit 2024; 43:270-279. [PMID: 36069101 DOI: 10.1080/01676830.2022.2119264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Primary lacrimal sac melanoma (PLSM) is exceedingly rare and associated with high morbidity and mortality. Unfortunately, PLSM often presents insidiously resulting in delayed detection and poor prognosis. A 69-year-old Black man was suspected of having a lacrimal sac tumour following presentation with a left sided watery eye, bloody tears, and a lacrimal mass. Due to the patient's implantable pacemaker, defibrillator, and high anticoagulation, an ultrasound-guided FNAC was performed instead of incisional biopsy, revealing a PLSM. Diagnosis was confirmed following complete tumour resection with free flap reconstruction and neck dissection. Unfortunately, disease progression ensued despite further neck dissection and three cycles of both pembrolizumab and iplimumab. This is the first description of FNAC to accurately diagnose PLSM and highlights its use as an accurate, rapid, and minimally invasive technique that may allow an earlier screening diagnosis of lacrimal sac tumours. We also discuss the outcome of immunotherapy in recent similar cases.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ketan Limbachia
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Mufaddal Moonim
- Department of Histopathology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ana M S Morley
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
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2
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Dan N, Norin C, Dafgård Kopp E, Strömberg O, Tani E, Bohman E. Fine-Needle Aspiration Biopsy as a Diagnostic Modality for Orbital Adnexal Lymphoma. Acta Cytol 2023; 68:26-33. [PMID: 38081151 PMCID: PMC10994578 DOI: 10.1159/000535694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate fine-needle aspiration biopsy (FNAB) as a diagnostic tool for lymphoproliferative orbital lesions in light of recent improvements in cytomorphological and immunologic analyses. METHOD Retrospective case series including all orbital FNABs with a lymphoproliferative outcome at Karolinska University Hospital, Stockholm, Sweden during the period 2005-2015. RESULTS Of the 38 patients included, 31 (82%) were conclusively diagnosed as having lymphoma according to the first FNAB. Disease in 20 patients (65%) could be subclassified. The diagnosis in 7 patients (18%) was either inconclusive, suggestive of lymphoma, or reactive lymphatic infiltrate. These 7 patients were re-investigated, and the initial suspected diagnosis of malignant lymphoma was confirmed in four. Two of the remaining 3 patients were initially diagnosed as having non-lymphoproliferative disease; however, this was later changed to a lymphoproliferative diagnosis following reinvestigation, while the results of both reFNAB and incisional biopsy were inconclusive in the third. CONCLUSION In the majority of the 38 patients, a definitive diagnosis of lymphoma could be made based on FNAB alone, using cytomorphological and immunological workup, and subclassification was possible in 20 patients (65%). Primary low-grade malignant orbital lymphomas are traditionally treated with low-dose radiotherapy regardless of subtype, and incisional biopsy was not needed to initiate treatment. Our findings suggest that FNAB is a valid first option for the diagnosis of suspected orbital lymphomas due to the minimal risk of complications compared to incisional biopsy, and the fact that it can be performed as an outpatient procedure with no anesthesia.
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Affiliation(s)
- Nicole Dan
- Oculoplastic and Orbital Services, St. Erik Eye Hospital, Stockholm, Sweden
| | - Cecilia Norin
- Oculoplastic and Orbital Services, St. Erik Eye Hospital, Stockholm, Sweden
| | - Eva Dafgård Kopp
- Oculoplastic and Orbital Services, St. Erik Eye Hospital, Stockholm, Sweden
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Olga Strömberg
- Department of Hematology, Stockholm South General Hospital, Stockholm, Sweden
| | - Edneia Tani
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Elin Bohman
- Oculoplastic and Orbital Services, St. Erik Eye Hospital, Stockholm, Sweden
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Sellami M, Ayadi S, Abbes A, Mnejja M, Hammami B, Boudaouara T, Zouche I, Chaabouni MA, Charfeddine I. Diplopia Secondary to Gastric Adenocarcinoma Metastasis to the Superior Oblique Muscle. EAR, NOSE & THROAT JOURNAL 2022:1455613221145277. [PMID: 36472409 DOI: 10.1177/01455613221145277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
While gastric cancer often metastasizes to the liver, lymph nodes, and lungs, skeletal muscle metastasis is a rare event. The most common primary tumor metastasizing to the extraocular structures is breast cancer. Gastric carcinoma metastatic to the extraocular muscles is a rare event announcing a spreading disease with a bad prognosis. Here, we report a case of an asymptomatic gastric carcinoma metastasizing to the superior oblique muscle diagnosed via an endoscopic endonasal biopsy.
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Affiliation(s)
- Moncef Sellami
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Syrine Ayadi
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Asma Abbes
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Malek Mnejja
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Boutheina Hammami
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Tahia Boudaouara
- Department of Pathology and Research Laboratory LR18SP10, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouche
- Department of Anesthesiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ilhem Charfeddine
- Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
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Alkatan HM, Alyousef NA, Alshabib NS, Aljasser IH. A comprehensive review of biopsy techniques for oculoplastic and orbital surgeons from ophthalmic pathologists' perspective. Saudi J Ophthalmol 2021; 35:174-178. [PMID: 35601859 PMCID: PMC9116098 DOI: 10.4103/sjopt.sjopt_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 11/04/2022] Open
Abstract
This narrative review aims to discuss different modalities for obtaining diagnostic orbital biopsies, compares the available updated methods, and provides recommendations on the choice of technique. It also highlights special precautions in the handling of orbital specimens from various pathologies. A search was performed in PubMed and Google Scholar with no language or study type restriction. The keywords orbital biopsy, core biopsy, fine-needle aspiration biopsy, and orbit were used, and titles and abstracts were screened for relevance.
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Affiliation(s)
- Hind M. Alkatan
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Ibrahim H.J. Aljasser
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
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Alkatan H, Alyousef N, Alshabib N, J. Aljasser I. A comprehensive review of biopsy techniques for oculoplastic and orbital surgeons from ophthalmic pathologists' perspective. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_161_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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6
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Bata BM, Martin A, Connolly D, Mudhar HS, Hersey N, Salvi SM. Computerized Tomography-Guided Core-Needle Biopsy of Orbital Space-Occupying Lesions: A Case Series. Ocul Oncol Pathol 2020; 7:54-61. [PMID: 33796518 DOI: 10.1159/000510867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose To describe our experience in performing biopsy of post-septal orbital masses with core needle under computerized tomography guidance (CT-CNB). Methods The medical records of all patients who underwent this procedure were reviewed. The procedure was performed under local anesthesia on a day case basis under a peribulbar block. A planning non-contrast computerized tomography (CT) scan of the orbits was performed to localise the mass. A 6-cm 18-G Temno Evolution® semi-automated biopsy needle was inserted through the skin into the orbit. Prior to further advancement of the needle, a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy. Results Five patients who underwent CT-CNB were identified. The CNB was successful in 4 patients and revealed a metastatic prostate adenocarcinoma, diffuse large B-cell lymphoma, a metastatic neuroendocrine tumour, and orbital inflammatory disease. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localisation on CT. He was eventually diagnosed with fibrous meningioma of the greater wing of sphenoid on open biopsy. None of the patients had any complications other than peri-ocular bruising which was present in all of them. Conclusion CT-CNB of mass lesions located in the lateral aspect of the orbit can be an alternative to open biopsy in selected cases. It avoids major surgery and allows the use of radiotherapy, if required, without any delay.
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Affiliation(s)
- Bashar M Bata
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Andrew Martin
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Daniel Connolly
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS) Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Naomi Hersey
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Sachin M Salvi
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Timmis A, Touska P, Uddin J, Pilcher J. The role of ultrasound-guided tissue sampling techniques in the management of extra-ocular orbital lesions. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:145-152. [PMID: 30147738 DOI: 10.1177/1742271x18759824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
Abstract
Background Multiple disease processes may arise within the orbit and imaging plays a vital role in the evaluation of such lesions. The anterior orbital contents are readily amenable to evaluation by ultrasonography. Furthermore, the modality can be used to guide tissue sampling (fine needle aspiration or core biopsy) and may obviate the requirement for invasive surgical biopsy. Methods We carried out a retrospective review of ultrasound-guided fine needle aspirations/core biopsies of extra-ocular orbital lesions undertaken at our institution. The anatomical locations, sonographic appearances and sampling techniques were analysed. Results There were 7 fine needle aspirations and 1 core biopsy carried out during the period analysed. Multimodality imaging was available in all cases. The majority of lesions were located in the region of the lacrimal gland. All procedures were well-tolerated and there were no post-procedure complications. Conclusion Many extra-ocular, orbital neoplasms are amenable to ultrasound-guided tissue sampling and the procedure is well tolerated. However, a clear understanding of orbital anatomy, differential diagnosis and technique is required to enable safe sampling. Furthermore, a collaborative, multimodality approach is imperative for optimal patient management.
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Affiliation(s)
- Antonia Timmis
- Department of Clinical Radiology, St George's University Hospitals NHS Foundation Trust, UK
| | - Philip Touska
- Department of Clinical Radiology, St George's University Hospitals NHS Foundation Trust, UK
| | | | - James Pilcher
- Department of Clinical Radiology, St George's University Hospitals NHS Foundation Trust, UK
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Munakomi S, Chaudhary S, Chaudhary P, Thingujam J, Mohan Kumar B, Cherian I. Case Report: Orbital metastasis as the presenting feature of lung cancer. F1000Res 2017; 6:430. [PMID: 28580129 PMCID: PMC5437950 DOI: 10.12688/f1000research.11247.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 12/02/2022] Open
Abstract
Orbital metastasis from lung cancer as an initial presenting symptom is a rare entity, which may paradoxically delay the diagnosis and initiation of correct management, due to the confusion of it being primary orbital pathology. Herein we report a case of a 58 year old woman, who presented with painful orbital swelling along with diminution in her vision. The patient was initially thought to have a primary eye lesion; however chest X-ray was suggestive of a lung mass, which was confirmed by chest computed topography followed by ultrasound guided fine needle aspiration cytology. The patient was then referred to a cancer centre for further management. This case report aims to increase the knowledge about this metastasis as a probable cause of orbital symptoms in certain subsets of patients, so that correct therapeutic decisions may be made in the future.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Samrita Chaudhary
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Pramod Chaudhary
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Jagdish Thingujam
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Bijoy Mohan Kumar
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Iype Cherian
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
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9
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Kanavi MR. Fine Needle Aspiration Cytology of Orbital and Ocular Adnexal Lesions. J Ophthalmic Vis Res 2016; 11:243-4. [PMID: 27621778 PMCID: PMC5000523 DOI: 10.4103/2008-322x.188391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Wiktorin AC, Dafgård Kopp EM, Tani E, Söderén B, Allen RC. Fine-Needle Aspiration Biopsy in Orbital Lesions: A Retrospective Study of 225 Cases. Am J Ophthalmol 2016; 166:37-42. [PMID: 27018233 DOI: 10.1016/j.ajo.2016.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and analyze results from the fine-needle aspiration biopsy (FNAB) technique, used as a diagnostic tool, in patients with orbital lesions. DESIGN Retrospective case series. METHODS setting: Institutional (Karolinska Hospital, Stockholm). STUDY POPULATION 207 patients with 210 orbital lesions. INTERVENTION 225 FNABs of the orbit. MAIN OUTCOME MEASURES Successful diagnosis from FNAB. RESULTS Of the 210 orbital lesions evaluated with FNAB, a successful cytologic diagnosis was achieved in 176 (84%). In more than half of the orbital lesions (54%), the FNAB diagnosis in addition to imaging appearance, clinical appearance, and clinical history provided sufficient information for treatment, and the patient did not require an incisional or excisional biopsy. Ninety-seven patients underwent additional excisional or incisional biopsy; FNAB diagnoses and the histopathologic diagnoses corresponded in 87% of the cases with an intraclass correlation coefficient of 0.84 (95% confidence interval [CI] 0.76-0.90). The difference was statistically significant between the ability to make a successful cytologic FNAB diagnosis in palpable lesions vs nonpalpable lesions (successful diagnosis in 90% [CI = 85%-95%] vs 75% [CI = 66%-84%]; P < .01). Neither the orbital quadrant location, nor the radiologic appearance (diffuse vs encapsulated), nor size of the lesion affected the success of FNAB diagnoses (all P > .7). There was a complication in 6 cases (3%). All complications were temporary and none led to permanent damage. CONCLUSIONS FNAB proved effective and exceedingly safe. With the current healthcare climate of minimally invasive surgery and cost control, FNAB should be considered as a valid alternative to open surgery in the evaluation and management of orbital lesions.
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11
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Ducasse A, Merol JC, Bonnet F, Litré F, Arndt C, Larré I. [Adult orbital tumors]. J Fr Ophtalmol 2016; 39:387-99. [PMID: 27017475 DOI: 10.1016/j.jfo.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 11/16/2022]
Abstract
Orbital tumors are a rather frequent pathology. Their diagnosis and treatment may be difficult. They can be benign or malignant. All the tissues of the orbit can give rise to a tumor, resulting in their large number. Among the benign tumors, we have meningiomas and cavernous hemangiomas, and for the malignant tumors, lymphomas, metastasis, ENT tumors and lacrimal gland tumors in the adult. Usually the signs are nonspecific, with proptosis, oculomotor disturbance, inflammatory signs, pain and sometimes a mass. Imaging (CT, MRI and color Doppler ultrasound) shows the tumor, its location, extent and possible metastases. Biopsy and anatomic and cytopathologic examination confirm the type of benign or malignant tumor. Based on these three elements: clinical appearance, imaging and histology, the tumor will be treated, usually by a surgical approach according to the recommendations of a multidisciplinary tumor conference. Radiation therapy and chemotherapy may supplement the treatment.
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Affiliation(s)
- A Ducasse
- Hôpital Robert-Debré, CHRU de Reims, avenue du M.L.-Koenig, 51092 Reims, France.
| | - J C Merol
- Hôpital Robert-Debré, CHRU de Reims, avenue du M.L.-Koenig, 51092 Reims, France
| | - F Bonnet
- Hôpital Robert-Debré, CHRU de Reims, avenue du M.L.-Koenig, 51092 Reims, France
| | - F Litré
- Hôpital Maison-Blanche, CHRU de Reims, 51092 Reims, France
| | - C Arndt
- Hôpital Robert-Debré, CHRU de Reims, avenue du M.L.-Koenig, 51092 Reims, France
| | - I Larré
- Hôpital Robert-Debré, CHRU de Reims, avenue du M.L.-Koenig, 51092 Reims, France
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Wang X, Qian J, Yuan Y, Ping B, Feng L, Bi Y, Li X. Accuracy of fine needle aspiration biopsy processed by cytologic smear and cell block techniques for the diagnosis of lacrimal gland tumors: a study of 48 cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:3684-3693. [PMID: 25120744 PMCID: PMC4128979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study the accuracy of fine needle aspiration biopsy (FNAB) processed by smear cytology and cell block (CB) techniques for the diagnosis of lacrimal gland tumors (LGTs). STUDY DESIGN In a prospective study, we enrolled 48 consecutive patients with LGTs. Immediately after excision of LGTs, the tissues were underwent FNAB with 23-gauge needles. The FNAB samples were processed to produce cytologic smears and CB from which slides were cut for immunohistochemical staining. The remainders were submitted for routine histopathologic processing. The diagnostic value of FNAB was assessed by comparing the FNAB diagnoses to those made by routine histopathology. RESULTS Cytopathologic evaluations based on smear cytology and CB with sections stained immunohistochemically can distinguish non-epithelial lesions from epithelial ones in all cases. The diagnostic sensitivities, specificities, and accuracies for distinguishing benign from malignant lesions were: cytologic smears--76%, 68%, and 71%, respectively; CB with immunohistochemical staining--88%, 87%, and 88%, respectively. The accuracy of the tissue diagnosis compared to routine histopathology was less for cytologic smears (58%) than for CB with immunohistochemistry (81%; P < 0.05). CONCLUSIONS FNAB of LGT processed using a CB technique capable of producing immunohistochemically stained slides results in a greater percentage of accurate tissue diagnoses than do cytologic smears, when compared to routine histopathology.
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Affiliation(s)
- Xiangning Wang
- Department of Ophthalmology, Eye and ENT Hosoital of Fudan UniversityShanghai, China
| | - Jiang Qian
- Department of Ophthalmology, Eye and ENT Hosoital of Fudan UniversityShanghai, China
| | - Yifei Yuan
- Department of Ophthalmology, Eye and ENT Hosoital of Fudan UniversityShanghai, China
| | - Bo Ping
- Department of Pathology, Eye and ENT Hosoital of Fudan UniversityShanghai, China
| | - Liqing Feng
- Department of Pathology, Eye and ENT Hosoital of Fudan UniversityShanghai, China
| | - Yingwen Bi
- Department of Pathology, Fudan University Shanghai Cancer CenterChina
| | - Xiaping Li
- Department of Pathology, Fudan University Shanghai Cancer CenterChina
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Yarovoy AA, Bulgakova ES, Shatskikh AV, Uzunyan DG, Kleyankina SS, Golubeva OV. CORE needle biopsy of orbital tumors. Graefes Arch Clin Exp Ophthalmol 2013; 251:2057-61. [PMID: 23515750 DOI: 10.1007/s00417-013-2315-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In some orbital mass lesions, histology may be the only way to establish an accurate diagnosis. Core needle biopsy (CNB) is widely performed in oncology, and unlike fine needle aspiration biopsy (FNAB), it can provide sufficient tissue sample for histology and immunohistochemistry. The purpose of this study was to evaluate the usefulness and possible complications of CNB of orbital tumors. METHODS Fifty orbital lesions from 46 patients (age: 2-84 years) were biopsied using 20-gauge and 18-gauge semi-automated needles; 11 procedures were performed under ultrasound guidance. All 50 samples received routine histopathological examination and immunohistochemical analysis. RESULTS Specimens diagnostically sufficient for histological analysis were obtained in all biopsies. The histopathological diagnosis was established in 94% of specimens: 30 tumors were malignant: lymphoma (20); rhabdomyosarcoma (six); lacrimal gland carcinoma (one); breast carcinoma metastasis (two); melanoma (one); three were benign; ten inflammatory; and four were orbital fibrosis. Three biopsies were nondiagnostic: two (lymphoma, angiofibroma) showed undetermined identification and one was a false-negative (lacrimal gland adenocarcinoma was misdiagnosed as fibrous tissue). The diagnoses were confirmed by excisional or incisional biopsy in 26 patients. The concordance rate in patients with a surgically confirmed diagnosis was 88%. The sensitivity, specificity and accuracy for differentiating malignant from benign lesions were 94%, 100%, and 96%, respectively. Two patients suffered complications: mild retrobulbar hematoma with no decreased visual acuity. There was no damage to the globe or optic nerve, motility disorder, or infection. CONCLUSIONS CNB of orbital mass lesions is a safe procedure that provides a sufficient amount of tissue for histology and immunohistochemistry, and may be useful for improving the quality of the pathological diagnosis of orbital tumors.
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Affiliation(s)
- Andrey A Yarovoy
- Ocular Oncology Department, The S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky blvd., 59A, 127486 Moscow, Russia.
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Gupta N, Kaur J, Rajwanshi A, Nijhawan R, Srinivasan R, Dey P, Singh U, Gupta P. Spectrum of orbital and ocular adnexal lesions: an analysis of 389 cases diagnosed by fine needle aspiration cytology. Diagn Cytopathol 2011; 40:582-5. [PMID: 21309008 DOI: 10.1002/dc.21586] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/29/2010] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to evaluate the scope and the limitations of fine needle aspiration cytology (FNAC) in orbital and ocular adnexal lesions. This study was a retrospective audit of 389 cases of orbital and ocular adnexal lesions subjected to FNAC over a period of 12 years (1998-2009). The cyto-smears were reviewed and the lesions were categorized under different diagnostic categories in adult and pediatric population. Three hundred and one adult patients (age ≥15 years) and 88 pediatric patients (age ≤14 years) constituted the study group. In the adult population, there were 23.3% cases of infectious and lymphoproliferative lesions and 12.6% of benign cysts. In the pediatric population, 18.2% cases had infectious and lymphoproliferative lesions and 8% had benign cysts. Various benign tumors (9.6% in adults) included pleomorphic adenoma, meningioma, and schwannoma. Benign vascular tumors predominated in the pediatric population. A majority of malignant tumors in adults were lymphoreticular malignancies (12.6%); non-Hodgkin's lymphoma being the most common followed by malignant epithelial tumors (10.3%). Nearly 3.6% cases of soft tissue/bone sarcomas and 6.3% of metastatic tumors were seen in adult population. However, most of the orbital tumors in the pediatric population were malignant small blue round cell tumors (33%). FNAC is a cost-effective technique with good diagnostic value in the assessment of ophthalmic lesions, especially when sampling and interpretation are performed by experienced personnel in the light of clinico-radiological information.
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Affiliation(s)
- Nalini Gupta
- Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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15
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Azad A. Metastatic non-small cell lung cancer presenting with an orbital metastasis: a case report. CASES JOURNAL 2008; 1:89. [PMID: 18700958 PMCID: PMC2526067 DOI: 10.1186/1757-1626-1-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 08/13/2008] [Indexed: 11/10/2022]
Abstract
Metastatic disease to the orbit occurs in up to 7% of cancers. In approximately 20% of cases, there is no diagnosis of cancer at the time of presentation with orbital metastatic disease. This is a case of a 53-year-old female smoker whose initial presentation of metastatic non-small cell lung cancer was with an orbital metastasis.
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Affiliation(s)
- Arun Azad
- Ludwig Institute for Cancer Research, University of Melbourne, Austin Hospital, Austin Health, 145-163 Studley Road, Heidelberg, Victoria, 3084, Australia.
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Abstract
Experience with the differential diagnosis of lacrimal gland illnesses is limited in daily practice due to their rarity. It is therefore of particular importance to have guidelines for the practitioner by which he can decide on the application of conservative or surgical therapy, and whether it is necessary to take a biopsy to clarify the diagnosis. There is a wide spectrum of possible illnesses which include systemic diseases, inflammatory disorders, neoplastic, benign and malignant tumors. When a pleomorphic adenoma cannot be excluded, biopsy is contraindicated and complete tumor excision with its capsule is necessary to prevent the possibility of malignant transformation and a negative effect on long-term prognosis. In this overview, special interest is placed on the typical clinical aspects and imaging features of lesions of the lacrimal gland fossa, their differential diagnosis and management.
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17
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Tani E, Seregard S, Rupp G, Söderlund V, Skoog L. Fine-needle aspiration cytology and immunocytochemistry of orbital masses. Diagn Cytopathol 2005; 34:1-5. [PMID: 16355380 DOI: 10.1002/dc.20375] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A series of 85 fine-needle aspiration (FNA) biopsies from orbital space occupying lesions of 82 patients are reviewed. A total of 32 benign lesions and 49 malignant lesions were conclusively diagnosed. In two cases the aspirates were insufficient for diagnosis. Of two cases, which were cytologically suspicious for lymphoma, a repeat FNA resulted in a conclusive diagnosis of lymphoma in one case, while the second case proved to be a pseudotumor on an open biopsy material. Of the 32 benign lesions seven were fibrosis, six pseudotumors, four epidermal cysts, four meningiomas, and three pleomorphic adenomas. The remaining cases included two hematomas, one granuloma, three inflammations, and one malformation. In 43 of 49 malignant tumors cytomorphology was corroborated with immunocytochemistry. Thirty five of these were low- or high-grade lymphomas, nine metastases, two sarcomas, two plasmacytomas, and one chloroma. All lymphomas were of B phenotype with monoclonal light chain expression. The rate of cell proliferation as measured by Ki-67 immunostaining varied between 4-25% and 30-80% for low- and high-grade lymphomas, respectively. These results confirm previous reports on the usefulness of FNA biopsy in diagnosing orbital masses and emphasize the value of immunocytochemistry in tumor characterization.
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Affiliation(s)
- Edneia Tani
- Department of Pathology and Cytology, Karolinska University Hospital, Solna, Stockholm, Sweden.
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18
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Mooy CM. Comments on 'Clinical and cytopathologic correlation in chronic inflammations of the orbit and ocular adnexa: a review of 55 cases' by Upreet Dhaliwal et al. Orbit 2004; 23:211-2. [PMID: 15590521 DOI: 10.1080/01676830490512170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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19
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Abstract
PURPOSE To present the clinical features and facts on prognosis, therapy and diagnostics of orbital metastases treated in the Orbital Center Kiel. METHODS We reviewed the records of 20 patients with orbital metastases (ca. 2% of all orbital patients seen in a 10-year period). RESULTS The mean age at first manifestation of orbital symptoms was 64 years. On average, 64 months was the period of time between the onset of the primary disease and orbital manifestation. The sites of the primary tumors were breast (8), choroid (2), prostate (2), gastrointestinal tract (3), lung (2), urinary bladder (1), Schmincke tumor of the throat (1) and unknown origin (1). Eleven patients were female, 9 male. The main primary symptoms consisted of lid swelling (11), red eye (9), diplopia (10), and proptosis (7). Although the majority (16/20) were treated by chemotherapy, radiotherapy or surgery, 19 patients died after a mean survival time of 14.7 months. CONCLUSION Orbital metastases remain an unfavorable prognostic factor, but the diagnosis and treatment are still important in order to prevent loss of vision and improve the patient's quality of life. As previous studies have shown, the overall survival rate is still as limited as nearly half a century ago.
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Affiliation(s)
- Detlef Holland
- Ophthalmology Clinic, Christian-Albrechts University, Orbital Center Kiel, Hegewischstrasse 2, D-24105 Kiel, Germany.
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20
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Abstract
PURPOSE. The study was performed to evaluate the efficacy of fine needle aspiration biopsy (FNAB) in orbital lesions. METHODS. Seventeen patients with orbital masses who had been fully investigated by non-invasive techniques participated in this study. FNAB was performed by standard technique, as an outpatient procedure, with ultrasound guidance in lesions posterior to the equator. A trained cytologist analysed all the smears. RESULTS. Specific results were obtained in 14 of the 17 (82%) patients studied by FNAB. Ten cases were neoplastic (8 malignant and 2 benign), 3 were inflammatory and 1 was a case of histiocytosis X. In 3/17 cases the results were non-specific. These were treated as pseudotumours and responded well to systemic steroids. In 7 cases the clinical and radiological diagnosis was confirmed by FNAB. Non-invasive investigations like USG, CT and MRI, however, failed to provide accurate diagnosis in the other 7 (41%) cases. In these patients, FNAB yielded a pathological diagnosis (histiocytosis X, cryptococcosis, non Hodgkin's lymphoma, adenocarcinoma, pleomorphic adenoma, Schwannoma and cysticercosis), helping us to modify treatment with an excellent response. No significant complications were encountered following the aspiration biopsies. CONCLUSION. FNAB proved to be a reliable method for distinguishing between malignant and non-malignant lesions. It was found to be rapid, accurate, cost-effective, safe and a valuable addition to ultrasound, CT scan and MRI in the diagnosis of orbital lesions. This tool may help in avoiding a traumatic surgical intervention.
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Affiliation(s)
- Anju Rastogi
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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21
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Gupta S, Sood B, Gulati M, Takhtani D, Bapuraj R, Khandelwal N, Singh U, Rajwanshi A, Gupta S, Suri S. Orbital mass lesions: US-guided fine-needle aspiration biopsy--experience in 37 patients. Radiology 1999; 213:568-72. [PMID: 10551243 DOI: 10.1148/radiology.213.2.r99nv24568] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of using ultrasonographic (US) guidance for performing fine-needle aspiration biopsies of orbital mass lesions. MATERIALS AND METHODS Thirty-seven patients with mass lesions in the orbit underwent US-guided fine-needle aspiration biopsy. Computed tomographic scans were available in all patients. In 19 patients, the lesions were located in posterior orbit, whereas in 18 patients the lesions were located in (n = 3) or extended up to (n = 15) the anterior compartment. Fine-needle aspiration biopsy was performed with 22-25-gauge needles and use of the freehand technique. RESULTS Needle biopsies were performed safely and easily, and real-time US monitoring of the needle position was used to avoid injury to the eyeball. No major complications were encountered. Diagnostic specimens were obtained in 29 (78%) of the 37 patients, and 19 benign and 10 malignant disease processes were diagnosed. In eight patients (22%), an appropriate diagnosis could not be made, as aspiration samples yielded insufficient tissue. CONCLUSION US provides safe and effective guidance for performing fine-needle aspiration biopsy in orbital mass lesions and is especially useful in deep-seated nonpalpable retrobulbar lesions.
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Affiliation(s)
- S Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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22
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Abstract
Extraocular muscle involvement in orbital disease is most frequently seen as a feature of thyroid orbitopathy (Graves' disease). However, a wide range of other conditions may alter the size, shape, and function of these muscles, with characteristic clinical manifestations or abnormalities visible on orbital imaging. The differential diagnosis of muscle disease can be narrowed by careful analysis of clinical features and ancillary tests. Imaging facilitates recognition in many cases, but in some instances, accurate diagnosis requires biopsy. This review highlights the differential diagnoses for diseases of extraocular muscles based on the clinical and investigative records of 103 patients at our institution combined with data from the world literature. We found that the most common nonthyroid causes of muscle disease were inflammatory, vascular, and neoplastic processes (in decreasing order of frequency). Emphasis is placed on investigations that provide a logical approach to, and appropriate management of, disease of the extraocular muscles.
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Affiliation(s)
- B Lacey
- Department of Ophthalmology, University of British Columbia and the Vancouver General Hospital, Canada
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23
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Zeppa P, Tranfa F, Errico ME, Troncone G, Fulciniti F, Vetrani A, Bonavolontà G, Palombini L. Fine needle aspiration (FNA) biopsy of orbital masses: a critical review of 51 cases. Cytopathology 1997; 8:366-72. [PMID: 9439888 DOI: 10.1111/j.1365-2303.1997.tb00566.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
FNA biopsy of 51 orbital masses is critically reviewed. Aspiration was performed with a 23 G needle inserted by an ophthalmologist; the smears were prepared by a cytologist. Forty-two cases (83%) were correctly diagnosed as benign or malignant either with (68%) or without (15%) correct specification of the histology. There were two false-negative and seven inadequate cases. Immunocytochemical stains were performed in five cases using the following antibodies: L26 (Pan B), UCHL1 (Pan T), kappa and lambda immunoglobulin light chains (three cases) in order to distinguish inflammatory pseudotumours from low-grade non-Hodgkin's lymphomas. In two cases we used CAM 5.2 (a monoclonal cytokeratin cocktail) and vimentin to ascertain the epithelial origin of two metastatic tumours. In five other cases cytospins were not adequately cellular for immunocytochemistry. Insufficient material and one false-negative sample were obtained from very fibrotic lesions or from posteriorly located lesions. The results are discussed and compared with other series reported in the literature. Orbital FNA biopsy may be considered a useful tool in the diagnostic approach to orbital masses in which the relatively high number of inadequate aspirations is offset by a low cost-benefit ratio.
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Affiliation(s)
- P Zeppa
- Cytopathology Service, Faculty of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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24
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Abstract
AIMS Three issues were investigated in adult outpatients with orbital metastases. One, how accurate are current diagnostic methods? Two, what is the survival associated with orbital metastases? Three, did any clinical factors correlate with prognosis in this patient cohort? METHODS Retrospective analysis of patients with orbital metastases managed in an ocular oncology unit. RESULTS 11 of 31 (35%) patients had no known primary malignancy at the time of orbital diagnosis. In eight of 31 (26%) computed tomography and/or magnetic resonance imaging data did not yield the diagnosis of metastases. In 15 of 17 (88%) cases a fine needle aspiration biopsy was diagnostic. Several types of therapy were used. The median survival was 1.3 years. CONCLUSION Orbital metastases, even with newer diagnostic techniques can be difficult to diagnose. Management was based on location and extent of both orbital and systemic disease as well as vision. In most cases, orbital symptoms were palliated; however, survival was dismal. No clinical factor correlated with prognosis.
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Affiliation(s)
- D H Char
- Department of Ophthalmology, University of California, San Francisco, USA
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25
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Mombaerts I, Schlingemann RO, Goldschmeding R, Noorduyn LA, Koornneef L. The surgical management of lacrimal gland pseudotumors. Ophthalmology 1996; 103:1619-27. [PMID: 8874435 DOI: 10.1016/s0161-6420(96)30454-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Lacrimal gland pseudotumors belong to the group of orbital pseudotumor. Systemic corticosteroids are advocated as the primary treatment of choice in orbital pseudotumor, but recurrent and refractory cases are commonly described. In this retrospective study, the authors evaluate alteerative treatment options such as surgical excision or debulking of lacrimal gland pseudotumors. METHODS The records of 26 patients referred to the Orbital Center of Amsterdam between 1976 and 1994 with a diagnosis of lacrimal gland pseudotumor were reviewed with special reference to computed tomography scans, histopathologic specimens (in 23 patients), treatment regimens, and final clinical outcome. RESULTS Histopathologic review showed 15 nonsclerosing (classic) and 8 sclerosing lacrimal gland pseudotumors. Initial treatment consisted of corticosteroids alone (9/26), surgery alone (7/26), a combination of surgery and irradiation (5/26), a combination of surgery and corticosteroids (4/26), or indomethacin alone (1/26). Surgery comprised tumor excision or tumor debulking. Of the patients treated with corticosteroids alone, 55% (5/9) responded initially but only 22% (2/9) obtained a cure. However, all patients treated with surgery combined with corticosteroids/irradiation (9/9), with surgery alone (7/7), or with indomethacin alone (1/1) responded well without recurrences. The main complication of therapy was dry eye syndrome, the incidence being highest in patients who received surgery of the palpebral lobe or irradiation. The mean follow-up was 4.9 years. CONCLUSION Surgical excision or debulking is a safe and effective treatment option in lacrimal gland pseudotumors, even in the histopathologic sclerosing variant.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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26
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Abstract
We have reviewed the literature in order to delineate the clinicopathologic definition of orbital pseudotumor, also called idiopathic nonspecific orbital inflammation. The clinical picture of orbital pseudotumor varies widely, with signs of mass effect, inflammation and/or infiltration. On computed tomography, orbital pseudotumor presents as a unilateral focal or diffuse mass. The histopathologic hallmark of orbital pseudotumor is a mixed inflammatory infiltrate with fibrosis of varying degree. Contrary to an old belief, orbital pseudotumor is not related to orbital reactive lymphoid hyperplasia (pseudolymphoma) and is not a lymphoid tumor. Atypical histopathologic findings of orbital pseudotumor include dominant sclerosis, granulomatous inflammation, vasculitis, and tissue eosinophilia. In the absence of systemic fibroinflammatory, granulomatous, and vasculitic disease, these atypical histopathologic patterns can be considered to represent subclasses of orbital pseudotumors rather then distinct entities. Clinical and prognostic characteristics of both histopathologically classical and atypical orbital pseudotumors appear to be heterogeneous. The etiology of orbital pseudotumor is unknown, but infection, autoimmune disorder, and aberrant wound healing have all been put forward as possibilities. In conclusion, orbital pseudotumor is one distinct disease albeit with many clinical and histopathologic guises.
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Affiliation(s)
- I Mombaerts
- Orbital Center, Department of Ophthalmology, University of Amsterdam, The Netherlands
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27
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Scott JA, Williams R. Transitional cell carcinoma of the bladder metastatic to the orbit. Eye (Lond) 1995; 9 ( Pt 5):664-6. [PMID: 8543102 DOI: 10.1038/eye.1995.170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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28
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Tijl J, Koornneef L, Eijpe A, Thomas L, Gonzalez DG, Veenhof C. Metastatic tumors to the orbit--management and prognosis. Graefes Arch Clin Exp Ophthalmol 1992; 230:527-30. [PMID: 1427135 DOI: 10.1007/bf00181773] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In a retrospective study the records of 34 consecutive cases with tumors metastatic to the orbit were reviewed with special attention to the management and prognosis of these patients. The primary tumor site was the breast in 20 patients, prostate in 5, kidney in 2 and skin in 2. The remaining 5 patients had other primary tumour sites. The symptoms of orbital metastasis preceded the detection of the primary tumor in 8 cases (24%). Twenty patients died after a mean interval of 25 months following the diagnosis of the orbital metastasis. This study gives a summary of the clinical features of these patients. With improved methods of treatment it was possible to obtain a relief of orbital symptoms in 24 patients (71%). Although the life expectancy of these patients remains poor, treatment can result in symptomatic relief and in an improvement in the quality of life, which is the main goal in the management of these patients.
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Affiliation(s)
- J Tijl
- Orbital Centre, University of Amsterdam, The Netherlands
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