251/1499. Primary orbital leiomyosarcoma: a case report with MRI findings. PURPOSE: To present a case of a primary orbital leiomyosarcoma and the corresponding magnetic resonance imaging (MRI) appearance. DESIGN: Observational case report. methods: Correlation of MRI with clinicopathologic findings. RESULTS: A 56-year-old woman presented with a 10-month history of diplopia in left gaze and left exophthalmos. An enhanced MRI of the left orbit revealed an extraconal, peripheral-enhancing mass measuring 2 cm in maximal diameter with displacement of the medial rectus muscle. The mass was excised, and the diagnosis of leiomyosarcoma was made by pathologic examination. CONCLUSIONS: Although computed tomography scan and ultrasound have been the imaging modalities used previously to evaluate cases of primary orbital leiomyosarcoma, MRI can provide important additional information regarding tumor characterization that is useful in the diagnosis and treatment of this rare malignancy. ( info) |
252/1499. Simultaneous ipsilateral temporal fossa and orbital dermoid cysts. PURPOSE: To describe a case of simultaneous dermoid cysts in the lateral orbit and temporal fossa. DESIGN: Interventional case report. methods: A 7-year-old boy with a lateral orbital mass and infratemporal fossa mass underwent computed tomography and surgical excision. RESULTS: Intraoperatively, two distinct cystic lesions were identified. The orbital lesion extended just beneath the lateral rim. The temporal fossa lesion extended posteriorly along the temporal fossa. No bony defect in the lateral orbital wall was identified, and each distinct lesion was completely excised. CONCLUSIONS: To our knowledge, this is the first reported case of multiple dermoid cysts in the orbital region. When imaging studies demonstrate separate cystic lesions and do not reveal a bony defect in the lateral orbital wall, multiple lesions should be suspected. ( info) |
253/1499. Intramuscular hemangiomas of extraocular muscles. PURPOSE: To report two patients, 3 and 40 years of age, respectively, each of whom had an isolated intramuscular hemangioma of an extraocular muscle. DESIGN: Two retrospective, interventional case reports. INTERVENTION: Incisional biopsy and short-term oral corticosteroids. MAIN OUTCOME MEASURES: Clinical observation and pathologic examination of specimens and tumor status, visual acuity, and ocular motility at final follow-up. RESULTS: Orbital magnetic resonance imaging revealed that, compared with other extraocular muscles, the tumor was isointense on T1-weighted scans and hyperintense on T2-weighted images. Marked homogeneous enhancement was observed after contrast agent administration. biopsy results showed a hemangioma of the lateral rectus muscle with predominantly capillary-like small vessels in the child and a mixed small and large vessel type hemangioma of the medial rectus muscle in the adult. CONCLUSIONS: Intramuscular hemangiomas may cause painless, isolated extraocular muscle enlargement in children and in adults without disturbing the ocular motility. The tumors do not seem to be sensitive to systemic corticosteroid therapy. ( info) |
254/1499. Metastatic hypernephroma to the head and neck. Hypernephroma is one of the most common visceral adenocarcinomas which metastasize to the head and neck. The metastasis may precede discovery of the primary or follow it. The most common sites of metastatic hypernephroma to the head and neck are the sinonasal tract, skin, cervical lymphatics, and mandible. Three cases of metastatic hypernephroma are presented and one of these is the first documented report of a metastasis to the parotid gland. The other two were found in the sinonasal tract. ( info) |
| PURPOSE: To describe a patient with liposarcoma metastatic to the left orbit. methods: A 72-year-old man was admitted with diplopia and proptosis of the left eye. Previously, a retroperitoneal liposarcoma had been surgically removed followed by postoperative radiation. visual acuity was normal. There was proptosis of the left eye, increased retrobulbar resistance and reduced mobility. Trans-septal orbital biopsies showed liposarcoma. The patient was initially treated with prednisolone and later received radio- and chemotherapy. Despite treatment he lost vision of the left eye and died a few months later. RESULTS: Histological examination of the orbital tumor revealed a spindle-cell liposarcoma similar to the primary tumor of the retroperitoneum. CONCLUSIONS: liposarcoma metastatic to the orbit is rare, but should be suspected in a patient with proptosis caused by a space-occupying lesion and a history of liposarcoma. ( info) |
256/1499. Solitary plasmacytoma with intracranial intraorbital and, paranasal sinus extension. Intracranial solitary plasmacytomas (ICSPs) are extremely rare tumours in neurosurgical practice, and are often misdiagnosed preoperatively. Here we present a solitary intracranial plasmacytoma with orbital, nasal and paranasal sinus extension. A subtotal excision of the tumour was performed and the complete response was seen after postoperative radio-chemotherapy. The neuroradiological and neurosurgical features of the case are discussed with the pertinent literature. ( info) |
| We report a rare case of transitional cell carcinoma of the urinary bladder metastatic to the orbit, review the histopathology, and highlight characteristics of the few previously reported cases. A 68-year-old man with a remote history of transitional cell carcinoma of the urinary bladder presented with decreased visual acuity, afferent pupillary defect, and limited extraocular motility OS. Computed tomography scan of the orbits showed a diffuse infiltrate surrounding the left globe and optic nerve. biopsy revealed metastatic transitional cell carcinoma. The patient expired one month later. With only seven cases previously reported, we conclude that transitional cell carcinoma of the urinary bladder rarely metastasizes to the orbit. When present, orbital metastases signify aggressive disease and a poor prognosis. Mean survival following orbital diagnosis is 2.2 months in the cases reported. ( info) |
258/1499. Orbital metastasis from prostatic carcinoma. A rare case of orbital metastasis from carcinoma of the prostate in a 76-year-old man who presented with pain in his left eye, mild proptosis and reduced visual acuity is reported. Cranial CT scanning demonstrated large bone metastases in the left orbit. The patient underwent orbital evisceration. The histopathological studies that were based on the morphological and immunohistochemical findings confirmed the histological diagnosis of orbital metastasis arising from prostatic carcinoma with neuroendocrine features. ( info) |
259/1499. Nasal-type NK/T cell lymphoma of the orbit with distant metastases. A case of a nasal-type NK/T cell lymphoma of the orbit with distant metastases is reported. The orbital lymphoma was angiodestructive with prominent necrosis and frequent apoptosis. lymphoma cells were positive for CD56, cytotoxic molecules (granzyme B and TIA-1), and EBV. Despite local radiotherapy, the patient had a highly aggressive clinical course. A postmortem examination revealed distant metastases to the heart and lungs exhibiting angiocentric growth. TCR and Ig genes of a cardiac lesion were in germ line configuration. This case demonstrated that nasal-type NK/T cell lymphomas with a poor prognosis can occur in the orbit. ( info) |
260/1499. Small choroidal melanoma with massive extraocular extension: invasion through posterior scleral emissary channels. Massive orbital extension arising from a small posterior pole uveal melanoma is rare. A 75-year-old male followed for an asymptomatic choroidal nevus developed a two and a half month history of mild decrease in visual acuity. Upon clinical examination minimal enlargement of the tumor with surrounding serous retinal detachment was observed. Pre-operative magnetic resonance imaging disclosed massive extrascleral extension. Histopathology revealed that the tumor was composed of spindle B malignant melanoma cells. Multiple serial sections of the entire tumor area failed to demonstrate permeation through scleral lamellae. Instead, peripapillary perivascular short posterior ciliary vessel invasion was observed. This route of dissemination may explain the rapid growth and clinically undocumented behavior of small malignant melanomas at this location. ( info) |