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Although an extremely rare neoplasm, orbital mesenchymal chondrosarcoma has a characteristic radiologic appearance. Suspicion of this lesion preoperatively can be of great value to the ophthalmologist because it tends to produce profuse bleeding at biopsy. This article reviews the clinical presentation, pathologic features, and radiologic findings of patients with orbital mesenchymal chondrosarcoma.
Based upon experience with 10 cases of surgical excision of orbital tumors, we describe a modification of the supraorbital and lateral approaches to the orbit. This technique gives a wide superior and lateral exposure of the orbital contents for microsurgical removal of orbital tumors. It is particularly applicable to large orbital neoplasms, tumors in the orbital apex, growths with intracranial extension, and medial orbital tumors. Two separate bone flaps are removed: a craniotomy (or cranio-orbital) flap that includes the superior and lateral orbital rim and a smaller, more posterior flap that includes the remainder of the roof and lateral wall of the orbit. After excision of a tumor, the orbital walls can be reconstructed in their entirety or the surgeon can leave out the smaller, posterior flap for orbital decompression. After reconstruction there are no significant anatomic, functional, or cosmetic deficits.
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Fine needle aspiration (FNA) biopsy was performed on 35 patients with orbital and adnexal masses. Histopathologic study was performed on 15 of the cases. Examples of benign and malignant primary orbital neoplasms, as well as inflammatory lesions diagnosed this way, are described. The diagnostic accuracy of the technique in evaluating orbital masses was 97.1%; there was one false-negative case. The study indicated that this simple technique has considerable diagnostic value in palpable orbital masses.
OBJECTIVE: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome and to stimulate thought regarding this neoplasm's fundamental pathobiology specific to its orbital involvement. DESIGN: Interventional case report and literature review. PARTICIPANTS: A 47-year-old woman with an acquired, bilateral, diffusely infiltrative orbital process is described. INTERVENTION: The clinical and radiographic features of the patient's orbital process are reported. The review of two prior fine-needle aspiration biopsy specimens failed to reveal a diagnosis. Histopathologic examination of an open surgical biopsy specimen included standard light microscopy of frozen and formaldehyde-fixed, paraffin-embedded tissue. RESULTS: Characteristics light microscopy findings suggested the diagnosis of metastatic lobular carcinoma of the breast. The patient refused all therapeutic intervention and died 9 months after orbitotomy. CONCLUSION: The presentation of breast carcinoma metastatic to the orbit as a bilateral infiltrative process is far more common than appreciated previously. Its rate of bilateral orbital involvement is 20%, whereas this rate for other adult neoplasms is much lower. The authors report an additional case, review the clinical features of previous case reports and series, and discuss aspects of the metastatic process. Breast carcinoma must be included in the differential diagnosis of infiltrative orbital processes encountered in adult female patients. When "orbital pseudotumor" is detected in an adult female patient, a thorough medical history must be obtained and physical examination performed. If a possible primary breast carcinoma is indicated, one must be wary of metastatic disease, and a histologic orbital diagnosis is warranted. The frequency of orbital metastasis and bilateral orbital involvement of this neoplasm reinforces the possibility for organ-specific metastases.
OBJECTIVE: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome. CASE REPORT: The case of a 61-year-old woman, diagnosed and treated seven years ago for a scirrhous breast carcinoma is presented. She complained of blurred vision and proptosis of the left eye and these symptoms were the first manifestation of tumor relapse. DISCUSSION: When orbital inflammation is detected in an adult female patient, a full medical history must be obtained and physical examination performed, as orbital metastases have been reported to be the initial manifestation of malignancy in 30 to 50% of cases.
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Head and neck surgeons enter the peripheral orbit for the therapy and/or biopsy of the most common expanding lesions, i.e., thyroid ophthalmopathy, direct extension of paranasal disease, pseudotumor and metastases. It is in this space between the bony orbital walls and the extraocular muscle cone that a majority of primary orbital neoplasms occur. The four basic approaches to posterior orbital tumors are: lateral orbitotomy through the temporal fossa with a modified Kronlein procedure, medial orbitotomy utilizing a Lynch incision and lacriminal sac mobilization, superior orbitotomy via a Naffziger frontotemporal crainotomy, and inferior exposure/decompression through the maxillary sinus. Case examples of the former two approaches are presented. None of these standard procedures allows full exposure of the posterior orbit. A combined cranio-facial-orbital access to this region utilizing a modified maxillectomy and frontotemporal craniotomy is detailed.
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