Difficulty in Management of Advanced Pediatric Orbital Tumor

Introduction: Tertiary care centers often manage pediatric orbital tumors, especially in advanced lesions and complex management. We report a case of a young boy with a malignant orbital tumor involving intracranial infiltration. Case presentation: A four-year-old boy had proptosis on the left eye for two months accompanied with blurred vision, pain, and oftenly bleeds with ipsilateral nasal congestion. There was no history of trauma, eye disorders, systemic diseases, or growth disorders. The physical examination showed stable vital signs, however a weak general condition and no enlarged regional lymph nodes. Visual acuity of the left eye was no light perception. There was a mass with protrusion of the left eye, swelling of the eyelid with an irregular surface, and a tendency to bleeds. The cornea was hazy with partly scarring, so we could not evaluate the posterior segment. MRI of the head presented a malignant soft tissue mass of the left orbital region with intracranial infiltration. The patient was given adjuvant chemotherapy; however, he could not survive due to systemic complications. Conclusions: The definitive diagnosis for the orbital tumor is obtained by histopathological examination. The investigation with CT scan or MRI imaging could be considered if not possible. However, since the definitive diagnosis still not assessed, the management can be affected. It is essential to have a definitive diagnosis to provide adequate treatment for the patients. Delayed and inadequate management can make malignant orbital tumors potentially life-threatening.

Phakomatous Choristoma of the Orbit with Inferior Oblique Muscle Involvement

Purpose: We report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. Case summary: A 2-month-old male infant presented to our clinic with a right orbital mass that had been present since birth. Magnetic resonance imaging demonstrated a homogenous enhanced well-defined mass located in the inferomedial portion of the right orbit without bone erosion. By transconjunctival orbitotomy, the orbital tumor invading the inferior oblique muscle was identified and resected. Histopathology showed a thick basement membrane surrounding pseudoglandular structures embedded in a collagenous stroma, psammomatous calcific foci in the stroma, and eosinophilic material in the lumen. Immunohistochemical analysis showed positive staining for S-100 and cytokeratin. On histopathological evaluation, the tumor was diagnosed as phakomatous choristoma. Conclusions: To our knowledge, this is the first report in South Korea of phakomatous choristoma of the orbit with involvement of the inferior oblique muscle. Although rare, phakomatous choristoma should be included in the differential diagnosis of tumors occurring on the inferomedial side of the orbit.

Orbital tumor in a patient with chronic viral hepatitis С with systemic manifestations (case report)

Aim. To present the case report of orbital tumor in patient with chronic hepatitis C with systemic manifestations, diagnostic and treatment approaches in such patients. Material and methods. We describe a clinical case of 48 y.o. female patient complaining of right-sided upper eyelid swelling and ptosis. According to MRI an orbital tumor was previously visualized in the location of right lacrimal gland. It was known, that the patient suffers from HCV infection since 1992. She was prescribed local and systemic immunosuppressive treatment with a positive effect, however due to hemorrhagic vasculitis development and eyelid swelling recurrence 2 weeks later she was admitted to the hospital. In diagnostic purpose the orbital tumor was surgically excised followed by morphological and immunohistochemical investigation. Results. A differential diagnosis between chronic dacryoadenitis, lymphoid tissue hyperplasia (due to longstanding antigene stimulation (MALT – tissue) and marginal lymphoma (MALT – lymphoma) was performed. Immunohistochemical staining and PET – CT failed to confirm the lymphoproliferative disease. However, in 1 year due to tumor recurrence, repeated biopsy followed by previously described analyses confirmed extranodal marginal zone B-cell lymphoma (MALT – lymphoma). Repeated PET-CT showed metabolic activity in the right orbit and in the location of paraesophageal lymph node. The patient received polychemotherapy inducting lymphoma remission. Conclusion. Current clinical case shows that differential diagnosis of orbital tumors in patients with chronic hepatitis C should include lymphoproliferative diseases. Key words: orbit neoplasm, dacryoadenitis, lymphoma, chronic viral hepatitis C.

Karakteristik Pasien Tumor Orbita Di PMN RS Mata Cicendo Bandung Periode 2017-2018

Orbital tumors are tumors that occur in the orbital area where they can affect the outside of the orbit and the inside of the orbit. At present, it is still rare to report the prevalence of orbital tumors in the world. In developing countries such as Indonesia, reports on the incidence of orbital tumors are also rarely reported. Diagnosis and appropriate therapy if we recognize the characteristics of these orbital tumors. The purpose of this study was to determine the characteristics of orbital tumor patients at PMN Cicendo Eye Hospital Bandung. This research is a descriptive observational study with cross sectional method with total sampling technique. Data were collected retrospectively based on medical records in the form of age, sex, eyes involved, tumor location, surgery, clinical diagnosis, and histopathological results. The results showed that orbital tumors with the majority of age> 45 years (43.3%), male gender (55.4%), involvement of the left ocular eye (51.18%), with the most frequent location not in the conjunctiva, palpebral and retrobulbar (36.8%), clinical diagnosis of benign tumors (68.3%) were cysts (22.4%), the most histopathological results of benign tumor lesions (71.4%) were inflammation (17%). So it can be concluded that knowing the characteristics of this orbital tumor will have an impact on the therapy given will be appropriate.

Metastatic Orbital Tumor From Breast Ductal Carcinoma With Neuroendocrine Differentiation Initially Presenting as Ocular Symptoms: A Case Report and Literature Review

BackgroundOrbital metastases from cancers of various organs can arise via the hematogenous route, and many originate from breast, prostate, and lung cancers. Such metastatic orbital tumors may be diagnosed before the primary tumor. We have encountered a case of breast ductal carcinoma with neuroendocrine differentiation that metastasized to the orbit and responded to chemotherapy, with improvement in visual function.Case PresentationA woman in her fifties visited our ophthalmology department with a chief complaint of foreign body sensation and exophthalmos in her right eye. An elastic soft mass was palpated from the lateral orbit to the temporal region. A systemic examination revealed breast cancer and a metastatic orbital tumor. Excisional biopsy of the breast revealed a diagnosis of invasive ductal carcinoma with neuroendocrine differentiation, and immunohistochemical examination was negative for cytokeratin 7, making the case unusual. Chemotherapy was remarkably effective, and the tumor size decreased, resulting in improvement of visual function. Her general condition and quality of life are still good at present. We searched the PubMed English language literature focusing on metastatic orbital tumors from breast cancer in which ocular symptoms had been the initial presenting sign. No previous reports have documented neuroendocrine differentiation or cytokeratin 7 expression in isolated orbital metastases from breast cancer. Although it is not possible to be certain from this case alone, we speculated that some such cases might involve cytokeratin 7-negative invasive breast cancer with neuroendocrine differentiation.ConclusionWe have described our experience of a very rare case of cytokeratin 7 negative breast ductal carcinoma with neuroendocrine differentiation that metastasized to the orbit and formed a solitary giant tumor initially manifesting as ocular symptoms.

Relationship between Superoxide Dismutase Manganese Gene Polymorphism and Eye Tumors

ABSTRACT Background: Orbital tumor in Indonesia is one of the eye health problems that can cause blindness. The impact caused by orbital tumors on patients is quite large because it can result in blindness and even death due to its metastatic nature. The role that SOD plays in cancer biology is not well understood, most studies showing a more oxidative state, characterized by increased intracellular ROS, particularly superoxide. Objective: To determine the relationship between Manganese Superoxide Dismutase (SOD2) gene polymorphisms and the incidence of orbital tumors in Medan. Methods: This study is an analytic observational study with a cross-sectional data collection method using controls. Comparisons were made between the control group and the observed group to see the relationship between SOD2 polymorphisms and the risk of orbital tumor incidence in Medan. The ophthalmic examination, anterior and posterior segments, and assessment of CT orbit if deemed necessary for the orbital tumor patients. Histopathological examination was done by the Pathologist. Blood samples was taken for polymorphism examination on extracted DNA using the Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) methods. Results: About 30 patients that met the inclusion criterias. Laterality, the left eye is more likely to suffer from tumors when compared to the right eye. This study found as many as 16 patients, while malignant tumors was 14 patients. There was a relationship between the MnSOD gene polymorphism and the incidence of orbital tumors (p <0.001), there was a relationship between the MnSOD gene polymorphism and the incidence of orbital tumors in the female sex (p <0.001) Conclusion: There was a relationship between MnSOD gene polymorphisms and the incidence of orbital tumors (p <0.001)