Cases reported "Orbital Neoplasms"

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241/1499. Orbital granulocytic sarcoma: an unusual presentation of acute myelocytic leukemia.

    Granulocytic sarcoma is an unusual manifestation of acute myelogenous leukemia in children and presents a diagnostic dilemma when it precedes the development of systemic disease. We present CT and MRI findings of an extraconal mass proven to be granulocytic sarcoma in a 6-year-old otherwise healthy boy with several months' history of worsening unilateral proptosis. This case is unique in providing exquisite CT and MRI correlation and in demonstrating rapid response to therapy. Further, as cytogenetics were positive for the t(8,21) translocation, this case provides opportunity for discussion of the associated incidence of this translocation and concomitant better prognosis. ( info)

242/1499. diplopia as an initial manifestation of disseminated non-hodgkin's lymphoma.

    A 37-year-old male presented a sudden diplopia. Ocular examination showed a partial paresis of the left eye (LE) on the left gaze, progressing in a few days towards a total ophthalmoplegia. Further investigation revealed an intra-orbital mass, immunohistologically diagnosed as a Diffuse Large B-cell lymphoma (DLBCL), according to the WHO classification. Since the patient was in an advanced, disseminated stage of the disease (IVA-E), treatment was based on systemic and intrathecal chemotherapy with a pancranial radiotherapy. The clinical course was poor with only a 10-month survival. We wish to stress that the possibility of orbital malignancy in young adults with acute onset of ophthalmoplegia should be included in the differential diagnosis. ( info)

243/1499. Orbital involvement in multiple myeloma: first sign of insufficient chemotherapy.

    Orbital involvement in multiple myeloma is unusual. We describe the case of a 60-year-old male who presented with left proptosis, reduced visual acuity, diplopia and progressing signs of globe indentation 2 months after chemotherapy for multiple myeloma. MRI showed a well-defined tumor filling the mediobasal part of the left orbit. Incisional biopsy and reduction of tumor mass were performed using an anterior transconjunctival orbitotomy. Histopathologic findings and further systemic examination confirmed the reactivation of the multiple myeloma. Proptosis, intraocular pressure and visual acuity improved following external beam radiation therapy of the left orbit and repeated systemic chemotherapy. Orbital involvement in multiple myeloma was the only sign of insufficient chemotherapy. ( info)

244/1499. Retroorbital hemangiopericytoma and cavernous sinus schwannoma--case report.

    An 18-year-old male presented with severe proptosis and blindness in the right eye. neuroimaging revealed a large and hypervascular tumor in the right retrobulbar region and a large tumor in the left cavernous sinus. angiography showed the right tumor was extensively vascular, fed by a hypertrophic ophthalmic artery, and the left tumor was moderately vascular, fed by a large middle meningeal artery. Following embolization of the feeder vessels, the right retrobulbar hemangiopericytoma and the left cavernous sinus schwannoma were uneventfully and successfully resected. Such combinations of different pathological lesions present unusual therapeutic challenges. ( info)

245/1499. Malignant mesenchymoma of the orbit: case report and review of the literature.

    OBJECTIVE: Malignant mesenchymoma are rare tumors of the orbit. From 1961 using English-language literature, we present the sixth such case and the first case with three malignant components. DESIGN: Interventional case report. methods: The clinical presentation, workup, surgical treatment, and pathology of a case of malignant mesenchymoma of the orbit are presented. RESULTS: Although very rare, these tumors should be in the differential diagnosis of any tumor of the orbit. The prognosis is unknown because of the lack of follow-up of reported patients. CONCLUSIONS: This malignant orbital mesenchymoma, an entity not accepted by all pathologists, was more complex than cases previously reported in the English literature in demonstrating rhabdomyosarcomatous, chondrosarcomatous, and osteogenic differentiation. ( info)

246/1499. Metastatic gastroesophageal junction adenocarcinoma to the extraocular muscles.

    OBJECTIVE: To present one definitive and one probable case of gastroesophageal adenocarcinoma metastases to the extraocular muscles. DESIGN: Two observational case reports. methods: Two interventional case reports with clinical pathologic correlation and review of the literature. Vanderbilt University Institutional review Board approval was obtained for this report. MAIN OUTCOME MEASURES: We analyzed the presenting symptoms, visual acuity, motility, and external examination. RESULTS: Computed tomography showed nodular enlargement of an isolated rectus muscle. Histopathologic examination confirmed the diagnosis of metastatic gastrointestinal carcinoma in one case. The orbital neoplasm contained signet ring cells, classically seen in gastrointestinal malignancy. CONCLUSIONS: Metastasis from gastrointestinal carcinoma should be considered in the differential diagnosis of a patient presenting with diplopia or visual loss, particularly with a recent history of gastrointestinal malignancy. ( info)

247/1499. Gaze-evoked amaurosis: a report of five cases.

    OBJECTIVE: To highlight the various causes of gaze-evoked amaurosis. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Five patients treated at our facility over the past 6 years. methods: Clinical presentation, radiologic studies, surgical management, and postsurgical results are presented. MAIN OUTCOME MEASURES: visual acuity, clinical findings of gaze-evoked amaurosis. RESULTS: Only two patients had classic intraorbital etiologies, one with an intraconal cavernous hemangioma and one with an intraconal foreign body. Three patients had extraorbital processes, two with orbital fractures and one with a sinus tumor. Only two of our patients initially were aware of the gaze-evoked amaurosis at presentation. Appropriate surgery was curative in all cases. CONCLUSIONS: Gaze-evoked amaurosis is a rare condition, classically implicating intraconal orbital pathology. In one of the largest case series published to date, we found extraorbital etiologies are also capable of producing gaze-evoked vision loss. Gaze-evoked amaurosis should be suspected and tested for in any orbital condition. ( info)

248/1499. July 2002: 66-year-old female with a one-year history of progressive left proptosis.

    The July 2002 Case of the Month (COM). This 66-year-old Caucasian female presented with gradually increasing protrusion of her left eye over a one-year period. She complained of increased tearing and foreign body sensation. The physical examination revealed a visual acuity of 20/20, normal color testing, full vision field with motility of her left eye limited in lateral gaze. Pupils were round, symmetric, with no afferent pupillary defect noted. On external examination, her left eye was grossly proptotic with resistance to retropulsion. She had 4 mm proptosis of the left eye. Computed tomography and MR imaging demonstrated a left retro-orbital mass with gadolinium enhancement and focal remodeling of orbital bones. She underwent surgical resection of tumor with a diagnosis of solitary fibrous tumor, and postoperatively she was symptom free. The histopathological differential diagnoses of spindle cell neoplasms of the orbit are discussed. Five months after surgery, no evidence of tumor recurrence was seen on neuroimaging and her vision was 20/20. ( info)

249/1499. Fibrous histiocytoma of orbit: a case report.

    A fifty year male (K.S.) presented with protrusion (Proptosis) of left eye which was gradually increasing in size for the last one year. The swelling was accompanied by pain for the last fifteen days. Preoperative X-ray & computed tomography showed erosion of frontal sinus & roof of maxillary sinus. Clinical diagnosis of a malignant tumour of eye was made & enucleation of the left eye, along with the mass was done. The specimen was received in the pathology department on 16.9.98. Grossly, encapsulated mass attached with the intact eye ball was received. The mass measured 5x3x2.5 cms. Microscopic examination revealed a benign spindle cell neoplasm and a diagnosis of fibrous histiocytoma (dermatofibroma) was made. ( info)

250/1499. enophthalmos associated with primary breast carcinoma.

    BACKGROUND AND OBJECTIVE: The most common source of metastases to the orbit is from breast carcinoma. The orbital presentation can be the presenting sign of the cancer. Proptosis or exophthalmos is the more usual way metastases present, associated with ocular motility problems or diplopia. We present a case of enophthalmos associated with breast carcinoma whereby there is as yet no radiological evidence of an actual orbital metastatic lesion. patients AND methods: A 51-year-old Caucasian woman with a known history of breast cancer presented with a 10-month history of vertical diplopia, particularly on upgaze. She noted that her left eye was becoming more "sunken" and examination confirmed an 8-mm enophthalmos on that side with restricted vertical eye movements and abduction. RESULTS: A provisional diagnosis of metastatic breast cancer was made. CT and MRI scans were performed. The main feature noted was that of orbital fat atrophy with no evidence of an orbital mass. She has been followed up for a period of 2(1/2) years with 6-monthly scans. There has been no progression of her clinical signs and no orbital lesion found so far. We are continuing to review her. CONCLUSION: Although no actual orbital mass has been found yet, we are treating her case as enophthalmos associated with scirrhosing breast carcinoma; she may, however, have spontaneous orbital fat atrophy, triggered by the cancer. ( info)
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