Turbo Gradient and Spin Echo PROPELLER-Diffusion Weighted Imaging for Orbital Tumors: A Comparative Study With Readout-Segmented Echo-Planar Imaging.

Purpose: To qualitatively and quantitatively compare the image quality and diagnostic performance of turbo gradient and spin echo PROPELLER diffusion-weighted imaging (TGSE-PROPELLER-DWI) vs. readout-segmented echo-planar imaging (rs-EPI) in the evaluation of orbital tumors. Materials and Methods: A total of 43 patients with suspected orbital tumors were enrolled to perform the two DWIs with comparable spatial resolution on 3T. The overall image qualities, geometric distortions, susceptibility artifacts, and lesion conspicuities were scored by using a four-point scale (1, poor; 4, excellent). Quantitative measurements, including contrast-to-noise ratios (CNRs), apparent diffusion coefficients (ADCs), geometric distortion rates (GDRs), and lesion sizes, were calculated and compared. The two ADCs for differentiating malignant from benign orbital tumors were evaluated. Wilcoxon signed-rank test, Kappa statistic, and receiver operating characteristics (ROC) curves were used. Results: TGSE-PROPELLER-DWI performed superior in all subjective scores and quantitative GDR evaluation than rs-EPI (p < 0.001), and excellent interobserver agreement was obtained for Kappa value ranging from 0.876 to 1.000. ADC lesion of TGSE-PROPELLER-DWI was significantly higher than those of rs-EPI (p < 0.001). Mean ADC of malignant tumors was significantly lower than that of benign tumors both in two DWIs. However, the AUC for differentiating malignant and benign tumors showed no significant difference in the two DWIs (0.860 vs. 0.854, p = 0.7448). Sensitivity and specificity could achieve 92.86% and 72.73% for TGSE-PROPELLER-DWI with a cutoff value of 1.23 × 10-3 mm2/s, and 85.71% and 81.82% for rs-EPI with a cutoff value of 0.99 × 10-3 mm2/s. Conclusion: Compared with rs-EPI, TGSE-PROPELLER-DWI showed minimized geometric distortion and susceptibility artifacts significantly improved the image quality for orbital tumors and achieved comparable diagnostic performance in differentiating malignant and benign orbital tumors.

Locally aggressive orbital giant cell reparative granuloma in an infant: case report and literature review.

Giant cell reparative granuloma (GCRG) is a non-neoplastic hyperplasia of bones that mostly happens in the mandible and maxilla in any age group but has a predilection for children and young adults. GCRGs that cause bone destruction are of very low frequency. Orbital-involved cases have been rarely reported since 1981, especially in children. We now report a 1-year-old girl with a rapidly enlarging post-traumatic orbital mass. CT scan and surgical resection showed a well-defined mass occupying the upper right orbit, causing bone destruction. Microscopically there was a proliferation of histocytes and some osteoclast-like multinucleated giant cells with hemosiderin, finally confirmed to be GCRG. 22 months' follow up showed no evidence of recurrence. This case suggests infant orbital GCRG can be locally aggressive.

The underestimated incidence of an orbital angioleiomyoma is possibly associated with an orbital cavernous hemangioma: illustrative case.

BACKGROUND: Orbital angioleiomyoma is generally considered a rare tumor; approximately 40 cases have been reported. However, after their experience with 6 consecutive cases in their single institution during 3 years, the authors speculate that the incidence of orbital angioleiomyomas is possibly underestimated. OBSERVATIONS: A 34-year-old female presented with progressive exophthalmos of 2 years' duration. Orbital computed tomography and magnetic resonance imaging revealed a well-circumscribed orbital tumor with partial and heterogeneous gadolinium enhancement. Technetium-99m red blood cell single-photon emission computed tomography showed positive perfusion in the late blood-pool phase, which was exactly consistent with the finding of a cavernous hemangioma. Under the impression of a cavernous hemangioma, the authors accessed the mass with an endoscopic endonasal approach and completely removed it without neurological deficit. Pathological examination revealed that the final diagnosis was an angioleiomyoma with positive immunostaining results for smooth muscle actin (SMA). LESSONS: The incidence of orbital angioleiomyomas may not be very low, as these lesions have possibly been misdiagnosed as orbital cavernous hemangiomas because of their histological similarity. Preoperative presumption and differentiation from cavernous hemangiomas are very challenging because of the rarity of orbital angioleiomyoma and similar radiological findings. SMA immunostaining may be critical to differentiate orbital angioleiomyomas from cavernous hemangiomas.

Isolated intraosseous extra-gnathic orbital myxoma: a clinicopathologic case report.

A 19-year-old female student presented with painless, progressive proptosis in the right eye for the past six months causing significant cosmetic blemish and double vision. Clinical evaluation revealed normal visual acuity, normal pupillary reflex, severe proptosis, and dystopia. Orbital imaging revealed a heterogeneous mass in superior orbit displacing the globe inferiorly and causing extensive bony erosion of frontal bone superiorly and invading the frontal sinus. Excision biopsy was performed with en-bloc removal of the tumor. Surgical delivery of a slimy mass with infiltrated bony tissue led to a presumptive diagnosis of myxoid liposarcoma. Careful histopathologic analysis coupled with immunohistochemical studies were performed which established the rare diagnosis of low-grade myxoid spindle cell neoplasm with features suggestive of intraosseous myxoma. On follow-up at 15 months, our patient revealed no signs of recurrence. Isolated intraosseous orbital myxoma is a rare entity; only two such cases have been reported in the literature.

Persistent macular puckering following excision of causative orbital tumor.

PURPOSE: To describe the clinical course of a patient with a retrobulbar orbital tumor causing myopic shift and macular pucker. OBSERVATION: Following complete surgical removal of a retrobulbar orbital cavernous hemangioma, the myopic shift improved but the macular pucker persisted even 3 years after orbital surgery, with no sign of tumor recurrence. CONCLUSION AND IMPORTANCE: Chorioretinal folds secondary to chronic mechanical force from an orbital tumor may persist long after the tumor is removed. This case may assist ophthalmologists in their discussions with, and counseling of, patients regarding visual prognosis following excision of orbital tumors that are causing retinal changes.

Tumor de la órbita como forma poco común de presentación de un linfoma no hodgkiniano extranodal de la zona marginal / Orbit tumor as an uncommon way of presentation of a no-Hodgkin extranodal lymphoma of marginal zone

Los linfomas no hodgkinianos (LNH) representan la mitad de los tumores de la órbita, sin embargo, su incidencia en nuestro medio es poco frecuente. Se presenta una paciente de 52 años de edad, femenina, blanca, con antecedentes patológicos personales de hipertensión arterial, sin otros datos relevantes al interrogatorio, que acude a consulta por epífora y discreta ptosis palpebral del ojo derecho acompañada de tumoración dura y fija en zona ínfero medial de la órbita derecha. Las principales pruebas de laboratorio no mostraron nada relevante. En la resonancia magnética se comprobó tumoración de 2 × 1 cm, de contornos irregulares en relación con la pared posteroinferior de la órbita derecha. Se realizó biopsia de la lesión que se concluyó como un LNH con inmunofenotipo compatible con proceso linfoproliferativo de linfocitos B kappa. En la biopsia de médula ósea se informó infiltración nodular por proceso linfoproliferativo de bajo grado. Se concluyó el caso como un LNH primario de la órbita tipo zona marginal con expresión leucémica de células B monocitoides en estadio IVA. Se realizaron 8 ciclos de CHOP y se obtuvo respuesta parcial. Posteriormente se pasó a un esquema de segunda línea consistente en rituximab-fludarabina-ciclofosfamida-dexametasona, que se mantiene.

The no-Hodgkin lymphomas (NHL) accounted for the half of orbit tumor; however, its incidence in our environment is very uncommon. This is the case of a white female patient aged 52 with personal pathological backgrounds of high blood pressure without other relevant data in questioning, referred to consultation due to epiphora and a discrete palpebral ptosis of right eye accompanied by hard and fixed tumor in inferior medial of right orbita. Main laboratory tests were normal. In magnetic resonance (MR) it was demonstrated the presence of a 2 x 1 cm tumor with irregular borders in relation to posteroinferior wall of right orbit. A lesion biopsy was carried out with diagnosed as a primary NHL con immunophenotype compatible with a lymphoproliferative process. We conclude that this case is a primary orbit NHL of principal zone with leukemic expression of monocytic B cells in IVA state. We performed 8 cycles of CHOP with a partial response. Subsequently, we passed to a second-line maintained scheme consistent in Rituximab-Fludarabine-Cyclophosfamide-Dexamethasone.

Intradiploic Meningioma of Orbit Minicking Osteoma: A Case Report

Approximately 1% of all the meningiomas arise from the extradural space. Intradiploic meningiomas constitutes only a very small percentage of this figure. Because of its rarity, it is often confused preoperatively with primary bone tumors of the skull. The intradiploic meningioma of the orbital wall may be considered as a subgroup of intradiploic ectopic meningioma. The following is our report of a recently observed case of intradiploic meningioma of the orbital wall without intracranial or intraorbital involvement. The preoperative tentative diagnosis was osteoma of the orbital wall. Nomenclature and histogenesis of this type of meningioma are discussed.

Intradiploic Meningioma of Orbit Minicking Osteoma: A Case Report

Approximately 1% of all the meningiomas arise from the extradural space. Intradiploic meningiomas constitutes only a very small percentage of this figure. Because of its rarity, it is often confused preoperatively with primary bone tumors of the skull. The intradiploic meningioma of the orbital wall may be considered as a subgroup of intradiploic ectopic meningioma. The following is our report of a recently observed case of intradiploic meningioma of the orbital wall without intracranial or intraorbital involvement. The preoperative tentative diagnosis was osteoma of the orbital wall. Nomenclature and histogenesis of this type of meningioma are discussed.