Epithelial lacrimal gland tumors: a comprehensive clinicopathologic review of 26 lesions with radiologic correlation

To study the prevalence, clinicopathological and radiological correlations of epithelial lacrimal gland tumors and compare these with similar published literature. The study was also designed to look at the natural history of benign mixed tumors [BMT] in regard to recurrence and malignant degeneration. This was a retrospective study of all suspected epithelial tumors of the lacrimal gland surgically excised at King Khaled Eye Specialist Hospital [KKESH] for the period: 1983-2008. Exclusion criteria included structural lesions [dacryops] and inflammatory lesions. We included 26 cases of epithelial lacrimal gland tumors [from 24 patients]. The histopathologic slides and the radiologic findings were reviewed. The corresponding demographic and clinical data were obtained by chart review using a data sheet. BMT accounted for 12/26 of the lesions while malignant lesions including adenoid cystic carcinoma [ACC] were more common [14/26]. The mean age was 44.27 years [range 12-75]. Commonest clinical presentation was proptosis. Median duration of symptoms in the BMT cases was 30 months and 7 months in the ACC group. The 12 BMT cases were primary in 9 and recurrent in 3 patients. The 11 ACC cases showed mostly cribriform pattern and low histopathologic grade. We had 2 cases of malignant mixed tumor [MMT] one of which arising in a recurrent tumor. One case of primary mucoepidermoid carcinoma with histopathologic grade 2 was noted. Radiologically, a well-defined appearance with bone remodeling was observed in BMT in contrast to invasive appearance with destruction in malignant lesions. Our series information indicated a different distribution of benign and malignant epithelial lesions with a slightly higher rate of malignancy. BMT was the commonest benign tumor where recurrence was a squeal of incomplete surgical excision. ACC was the commonest malignant tumor with shorter duration of symptoms and radiologic evidence of invasiveness that correlated with the histopathologic features

Three dimensional MRI study: Safety of short versus long needle peribulbar anesthesia

The standard technique of Peribulbar block is to use 25 g 25 mm needle at the junction between the lateral one third and medial two third of the lower orbital rim in the infero-temporal quadrant of the orbit. Theoretically, insertion of longer needles increases the potential of injury to important structure; however, safety of the shorter needle had never been demonstrated. This study describes the anatomy of the orbital structures with magnetic resonance imaging [MRI] using the three-dimensional constructive interference in steady state [3D CISS] sequence to present a morphological basis for needle entry at 12.5 and 25 mm lengths. Statistical comparisons were performed at the 12.5 versus 25mm depths. Statistical significance was indicated by P<0.05. Fifty patients free of orbital pathology with normal axial length were selected for MRI with the 3D CISS sequence. Original axial and multiplanar image reconstruction [MPR] images were selected for image interpretation. Orbital structures were identified at 12.5 and 25 mm depths from the orbital rim to compare significant differences in anatomy between the two imaging planes at the expected needle depth and to assess the size of the globe and the orbit. The cross sectional area of the extraocular muscles were statistically significantly smaller at the 12.5 mm plane [P = 0.001]. The area of inferotemporal fat was statistically significantly larger at the 12.5 mm plane [P = 0.033]. There was no statistical difference in the inferonasal and superonasal fat areas at different depths [P = 0.34, P = 0.35 respectively]. The size of the orbit and globe was significantly larger at 12.5 mm [P = 0.001]. There was no difference between depths in the presence or absence of neu-rovascular bundles and supporting structures including the intramuscular septae. There is a larger structure-free space at a depth of 12.5 mm than at 25 mm. Therefore, the inference is that a needle inserted in the infero-temporal zone to a depth of 12.5 mm is less likely to injure the eyeball or extra-ocular muscles than one advanced to 25 mm

Primary orbital ganglioneuroma in a 2-year-old healthy boy

A 2-year-old healthy child presented with progressive unilateral proptosis. Complete work up including: general examination, detailed ophthalmic evaluation and radiological imaging were done. He underwent orbital exploration via anterior orbitotomy incision and debulking of the tumor was done. The histopathological examination confirmed the diagnosis of orbital ganglioneuroma. Ganglioneuroma is an unusual benign tumor of neuroplastic origin with extremely rare orbital involvement with only one prior reported case in a youth. The tumor is slow growing and non-metastasizing. Biopsy is necessary to differentiate it from the malignant neuroblastoma and excision is usually curative