Secondary and metastatic tumors of the orbit

We have presented three cases of metastatic tumor to the orbit. The first case illustrated metastatic tumor that originated from a cutaneous basosquamous cell carcinoma. This lesion, first reported by MacCormac as being morphologically intermediate between basal and squamous cell carcinoma, has become a topic of some controversy. Conley reported these tumors to represent 1% of basal cell carcinomas. Several authors have reported a higher incidence of recurrence with these lesions, as compared with the ordinary basal cell tumors. Recurrence of basal cell carcinomas are reported as approximately 10%, but are four times greater in the basosquamous cell tumors. The incidence of metastasis with the basosquamous cell tumors has been reported in between 37% and 51% of cases. The second case represented involvement of the orbit by direct extension of a facial squamous cell carcinoma. As illustrated by this case, these tumors can be very aggressive and should be treated with respect. The third case showed the metastatic potential of the nephroblastoma with metastatic tumor that involved the eye, orbit, and maxilla. Diagnostic techniques available in evaluation of these tumors include CT scan, magnetic resonance (MR) imaging, ultrasound, open biopsy, and fine-needle aspiration. Li et al., in an article that compared MR imaging, CT scan, and ultrasound concluded that MR imaging, with the use of the 0.15 T resistive magnet, offered no distinct advantage over the combination of CT and ultrasound in evaluation of patients with orbital tumors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical treatment of tumors of the carotid body

In the period between 1967 and 1985 the authors operated on 5 patients with chemodectoma; their ages ranged from 29 to 39. The duration of the disease ranged from 2 to 4 years. The tumor was on the right side in 3 and on the left side in 2 patients. Carotid angiography, which was conducted in all cases, revealed a richly vascularized tumor in the region of the carotid artery bifurcation with characteristic "angulation" and "cuff" signs. Damage to the carotid arteries was avoided during the operation in 3 patients and the chemodectoma was removed subadventitionally. In 2 patients the arteries were injured. There were neither neurological complications nor fatal outcomes.     

Multiple glomus tumor: a case report and review of the literature.

Multiple glomus tumors are extremely rare and differ from the more common solitary glomus tumors in their clinical presentation and histological features. The authors report a case of multiple glomus tumors of the right hand in a 65-year-old man, its treatment, and a review of the features of this uncommon tumor. The tumor usually presents as a painful, firm, purplish, solitary nodule of the extremities, especially in the nail bed. Multiple glomus tumors are described as softer, more compressible, bluish nodules and they occur with less frequency than solitary tumors. They are often inherited in an autosomal dominant pattern. The authors present a case of multiple glomus tumors of the right hand, in which many small, painful, red papules were grouped in the right hypothenar region. The patient was treated by wide excision of the lesion and coverage of the defect with an ulnar artery forearm flap.     

Solitary fibrous tumor of the orbit. Case report and review of the literature.

BACKGROUND: Solitary fibrous tumor (SFT), which usually presents in the pleura and is thought to be mesothelial in nature, has been recently discovered in extrapleural sites, including the orbit. Presently ultrastructural studies show absence of epithelial-mesothelial features, and reactivity of the tumor cells to CD34 antigen on immunohistochemical analysis suggests the mesenchymal origin of such tumors. CASE DESCRIPTION: A 40-year-old woman had a 4-year history of progressive swelling of her right upper lid and a slow-growing palpable mass of the orbit. CT and MR imaging showed a well circumscribed, nonenhanced extraconal mass with mild erosion of the right orbital roof. The tumor was totally excised. Histological examination disclosed a spindle-cell tumor in a dense fibrous tissue. Immunohistochemistry showed positive staining for vimentin and CD34. We review the clinical, diagnostic, and surgical features of 22 orbital SFTs including the present case. CONCLUSIONS: Orbital SFT generally pursues a slow, indolent, and nonaggressive course, reaches a size up to 4.5 cm, and can be cured by a single excision. It must be immunohistochemically differentiated from other spindle-cell tumors of the orbit.     

Skull Metastasis From Intrahepatic Cholangiocarcinoma: Report of 3 Cases and Review of the Literature

Skull metastases occur in patients with various malignancies; however, those resulting from intrahepatic cholangiocarcinoma (ICC) have been rarely reported. In our hospital, 324 patients were diagnosed with metastatic brain or skull tumors from June 1969 to June 2011, but only 3 of them (0.9%) developed skull metastases from ICC. We report the case of 3 patients with skull metastases from ICC. A combination of computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and methionine-PET were used for imaging. Sites of tumors were the lateral left orbit and right parietal bone in case 1, the left parietal bone, left temporal bone, and lateral left orbit in case 2, the right petrous bone, right occipital bone, and upper cervical vertebra in case 3. The metastases were confirmed to have originated from ICC by biopsy in two of the cases and diagnosed by MRI and FDG-PET in case 2. Radiosurgery and radiotherapy had positive effects on symptom improvement and cosmetic problems.     

Diagnosis of a carotid body chemodectoma with dynamic radionuclide perfusion scanning.

The first case of a carotid body chemodectoma that was diagnosed using dynamic radionuclide perfusion angiography and subsequently excised is presented. The value of this technic in the investigation of pulsatile tumors is emphasized.     

Paranasal sinusitis, orbital abscess, and inflammatory tumors of the orbit

We present the clinical, radiological, and histopathological findings from a case of unilateral inflammatory mass of the right orbit, originating in the ipsilateral paranasal sinuses. A connection between inflammatory tumors of the orbit and paranasal sinusitis has been suspected for many years. This case shows a definite association between chronic paranasal sinusitis, orbital cellulitis, subperiosteal abscess, and formation of an inflammatory orbital tumor. Early diagnosis combined with appropriate therapeutic measures is essential in order to prevent adverse consequences, which can include severe visual loss.     

An unusual case of primary lymphoma of the skull base extending from cerebellopontine angle to cavernous sinus and orbit. A case report

The authors describe a rare case of a primary central nervous system lymphoma of the cerebellopontine angle, extending into the right cavernous sinus and orbit. The patient presented with multiple right sided cranial nerve palsies and rapidly progressive proptosis and ophthalmoplegia of the right eye. Imaging revealed a cerebellopontine angle mass extending into cavernous sinus. Surgical decompression of the tumor was undertaken through a right sided retromastoid craniectomy. Histopathology revealed Non Hodgkin's lymphoma of diffuse large cell type. There was no evidence of systemic lymphoma. Primary lymphoma of cerebellopontine angle with direct extension into cavernous sinus and orbit is rare and to our knowledge this is the only case reported.     

Frontal sinus approach to the orbit. Technical note

The authors have previously advocated a supraorbital approach to tumors of the orbit. In this paper, they describe a technique in which they take advantage of a large frontal sinus as a means of entering the orbit without the necessity of intracranial exposure, as required by the more conventional supraorbital approach. This is achieved without frontal burr holes, allowing for a superior cosmetic result. The anterior wall of the frontal sinus is removed, and with it the roof of the orbit as a single bone flap. A case in which this technique was used is described.     

Multiple cavernous hemangiomas of the orbits

Intraocular tumors were detected in both orbits simultaneously by computed tomography scanning in a 45-year-old woman complaining of proptosis of the right eye, decreased visual acuity, and diplopia. The tumor in the right orbit was resected by the subfrontal extradural approach, and that in the left orbit by the Kr?nlein-Berke method. The right tumor was found on the side of the external ear of the muscle cone and the left tumor was located inferiorly on the side of the external ear of the muscle cone. Both tumors were cavernous hemangiomas with identical macroscopic and histologic features.     

Aggressive syringomatous carcinoma of the orbit.

A 68-year-old woman with an unusual tumor involving the right orbit presented with painful exophthalmos of the right eye. Excision biopsy of her right eyelid was performed. The specimen showed ductal differentiation with comma-like extensions identical to syringoma. Cellular atypia, an invasive growth pattern, and remarkable perineural invasion led to the diagnosis of syringomatous carcinoma. Magnetic resonance imaging showed that the tumor exhibited maxillary involvement, invading the supraorbital fissure and bone of the middle skull base. The patient underwent craniofacial resection and has been alive with no sign of recurrence for 2 years. This case suggests that wide excision of these tumors with a clear surgical margin using skull base surgical techniques may offer a good prognosis.     

Excision of a glomus jugulare tumor after embolization

The authors report the case of a patient with a glomus jugulare tumor. After embolization of the external carotid artery branches feeding the tumor, a complete removal had been performed by a combined otoneurological approach. Although clearly defined and cleavable at the jugulare foramen, the chemodectoma had invasive characteristics in its intrapetrous extension, indicative post operative radiotherapy. In addition a review of publications support preoperative embolization and otoneurosurgical cooperation.     

Solitary fibrous tumor of the orbit with extraorbital extension: case report

OBJECTIVE AND IMPORTANCE: Solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth. CLINICAL PRESENTATION: A 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [(18)F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion. INTERVENTION: Resection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor. CONCLUSION: The natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.     

腹部化学感受器瘤7例诊治分析

化学感受器瘤较少见，尤以发生于腹部者更为罕见，常易误诊。本文报告７例（包括２例术后复发者），结合文献复习，着重讨论了本病的诊治问题。认为提高对本病的认识是正确诊断的关键，以影像学检查作为主要辅助手段，并建议慎用术前穿刺活检。术中应据此瘤的肉眼特点做判断，必要时术中行冰冻病理检查。本病的有效治疗是手术及放疗，但化疗不敏感。术后应长期随访。本病术前应有充足的血源、止血措施、血管移植吻合及联合脏器切除准备。     

Right temporal lobe glioblastoma presenting in the left orbit. Case report

Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.     

A new case of cystic lymphangioma of the pancreas

The authors describe a new case of cystic lymphangioma of the pancreas treated surgically by cephalic duodeno-pancreatectomy associated with right hemicolectomy. Following a review of the literature, they recall the anatomo-pathological and clinical characteristics of vascular connective tissue tumors of the pancreas. From a therapeutic viewpoint, they conclude on the necessity for complete removal of these unusual tumors, either by tumor resection or by appropriate pancreatic resection, which are the only guarantees of a definitive curve.     

纱布填塞治疗骶前静脉丛大出血

目的探讨骶前静脉丛大出血的治疗。方法回顾性分析12例骶前静脉丛大出血的患者,原发病为直肠癌9例,骶前肿瘤2例,右盆腔化学感受器瘤1例。出血时可用纱布填塞压迫止血。结果本组12例中1例用一般止血无效,致出血性休克死亡,其余11例用纱布填塞压迫均治愈。结论骶前静脉丛损伤大出血用纱布填塞压迫,止血效果好,最适合基层医院,值得推荐。     

Intracranial metastasis of a choroid plexus papilloma originating in the cerebellopontine angle region: a case report

The authors present a rare case in which a choroid plexus papilloma originating in the left cerebellopontine angle region metastasized and formed a space-occupying lesion in the right temporal region. A 46-year-old woman with choked disks presented with two separate mass lesions in the right temporal and the left cerebellopontine angle regions. Magnetic resonance imaging exhibited the relationship between the tumors and the surrounding structures. To our knowledge, no case has been reported in which a choroid plexus papilloma originating in the cerebellopontine angle region formed a space-occupying lesion in the right temporal region.     

Unilateral exophthalmos caused by organized hematoma of the orbit--report of a case (author's transl)

The authors reported a case with unilateral proptosis of over ten years' duration due to organized hematoma of the orbit. It has generally been accepted that any given hemorrhage within the orbit can be resolved in a relatively short period of time. Persistent intraorbital hematoma, therefore, in the form of organized hematoma is very unusual in incidence and has been reported very few in the literature. Our patient presented himself with a ten-and-several-year history of unilateral exophthalmos, limited ocular movement and decreased visual acuity on the involved side. There was no specific symptom when compared with the other intraorbital tumors. Total resection of the tumor was performed through transcranial frontozygomatic approach. Histopathologic examination revealed evidence of organized hematoma without definite sources of bleeding such as microangioma, microaneurysm or arteriovenous malformation. Retrospective review of history failed to uncover episodes of hemorrhagic tendency or direct trauma to the head or the orbit. Subsequently a diagnosis of spontaneous organized hematoma was made. Great emphasis was laid on the fact that CT-scan was one of the most useful diagnostic tools. Our surgical approach was introduced and discussed.     

Vagal paraganglioma. Report of a case surgically treated and review of the literature

The authors report the observation of one case of vagal paraganglioma occurred in a young woman. The tumor manifested itself as a left sub-mandibular tumescence; the very first diagnostic approach was achieved through echography, which showed a mass behind the internal carotid artery and compressing the internal jugular vein. The following examinations, represented by neck CT, NMR, angiography and fine needle aspiration initially directed towards the suspicion of chemodectoma. Only at operation, the anatomical situation of the tumor, which encapsulated the vagus nerve and the subsequent results of the hystological examination revealed the correct diagnosis of vagal paraganglioma.