Choristoma ; pathology ; surgery ; Dermoid Cyst ; diagnosis ; Diagnosis, Differential ; Dissection ; methods ; Eyelids ; pathology ; Hemangioma ; diagnosis ; Humans ; Infant, Newborn ; Male ; Neuroglia ; pathology ; Orbit ; diagnostic imaging ; Orbital Neoplasms ; diagnosis ; Treatment Outcome ; Ultrasonography ; methods

Orbital metastasis is a rare event, and metastatic disease affecting the extraocular muscles is an even less frequent complication of solid tumors. Herein, we report an unusual case of ptosis as the initial presentation of an invasive breast cancer. A 68-year-old woman presented with III and VI partial nerve paresis, secondary to a compressive retrobulbar mass. Magnetic resonance imaging revealed an infiltrative lesion involving the extraocular muscles. Tissue biopsy yielded a result compatible with metastasis to the orbit, with immunohistochemistry analysis suggesting breast as the primary organ. Mammography identified an area of architectural distortion; stereotactic wire-guided biopsy confirmed the result of the previous orbital biopsy. A positron emission tomography scan demonstrated disseminated disease. Palliative chemotherapy with bone-modulating agents and subsequent hormonal therapy was proposed. Unfortunately, the patient did not respond to therapy and died 38 months after diagnosis.
Aged ; Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Mammography ; Muscles* ; Neoplasm Metastasis ; Oculomotor Muscles ; Orbit ; Orbital Neoplasms ; Paresis ; Positron-Emission Tomography

Orbital metastases are rare and predominantly unilateral occurrences. Bilateral metastases affecting the extraocular muscles are extremely rare. A few case reports of bilateral metastases to extraocular muscles described binocular diplopia with conspicuous bilateral external ophthalmoplegia as an initial symptom. We report a case in which unilateral ptosis was an initial symptom and bilateral incomplete ophthalmoplegia was found on initial neurologic examination in invasive ductal carcinoma of the breast. The patient had hormone receptor-positive breast cancer, and so was treated by hormonal therapies and closely monitored. The presence of a secondary orbital lesion presents many difficulties of differential diagnosis and treatment. A thorough neurologic examination to detect ocular manifestations is most important for localization and broad differential diagnosis including mechanical orbital metastatic lesion.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Ductal, Breast ; Diagnosis, Differential ; Diplopia ; Humans ; Muscles ; Neoplasm Metastasis ; Neurologic Examination ; Ophthalmoplegia* ; Orbit ; Orbital Neoplasms ; Telescopes

BACKGROUND: A schwannoma is a benign, slow-growing peripheral nerve sheath tumor that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of all orbital neoplasms. In this study, we retrospectively review orbital schwannomas and characterize clinical, radiologic, and histologic features of this rare entity. METHODS: A retrospective review was performed to identify patients with histologically confirmed orbital schwannoma, among a list of 437 patients who had visited our hospital with soft tissue masses within the orbit as the primary presentation between 2010 and 2014. Patient charts and medical records were reviewed for demographic information, relevant medical and family history, physical examination findings relating to ocular and extraocular sensorimotor function, operative details, postoperative complications, pathologic report, and recurrence. RESULTS: Five patients (5/437, 1.1%) were identified as having histologically confirmed orbital schwannoma and underwent complete excision. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were not consistent in predicting histologic diagnosis. There were no complications, and none of the patients experienced significant scar formation. In two cases, patients exhibited a mild postoperative numbness of the forehead, but the patients demonstrated full recovery of sensation within 3 months after the operation. None of the five patients have experienced recurrence. CONCLUSION: Orbital schwannomas are relatively rare tumors. Preoperative diagnosis is difficult because of its variable presentation and location. Appropriate early assessment of orbital tumors by CT or MRI and prompt management is warranted to prevent the development of severe complications. Therefore, orbital schwannomas should be considered in the differential diagnosis of slow-growing orbital masses.
Cicatrix ; Diagnosis ; Diagnosis, Differential ; Forehead ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Medical Records ; Neurilemmoma* ; Orbit* ; Orbital Neoplasms ; Peripheral Nerves ; Physical Examination ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Schwann Cells ; Sensation

No abstract available.
Antibiotics, Antineoplastic/administration & dosage ; Bleomycin/*administration & dosage ; Child ; Dose-Response Relationship, Drug ; Humans ; Injections, Intralesional ; Lymphangioma/diagnosis/*therapy ; Magnetic Resonance Imaging ; Male ; Orbital Neoplasms/diagnosis/*therapy ; Pressure ; Tomography, X-Ray Computed

Schwannomas are well-differentiated solitary benign tumors that originate from the schwann cells of the nerve sheath. They can readily occur in the head and neck regions, but the schwannoma originating from the infraorbital nerve is extremely rare and usually painless, slow-growing, and without specific symptoms. The author experienced a rare case of infraorbital schwannoma, which was completely removed through the intraoral approach. A 20-year-old woman was admitted to our hospital for a painless, solid and circular mass located on the right infraorbital region. The eyeball movement and visual field were normal. There was no globe displacement or proptosis. Preoperative computed tomography demonstrated 13x10x5 mm-sized soft tissue mass. On March 2011, the mass was removed through an intraoral approach. On histopathological examination, the gross specimen consisted of a smooth, well-encapsulated and light yellowish solid mass, measuring 12x7x5 mm. Microscopically, it presented a typical manifestation of schwannoma with Antoni A area with Verocay body, and Antoni B area on H&E stain. The result of the immunohistochemical staining was positive for the S-100 protein. The patient had hypoesthesia of the nasal septum and vestibule in the postoperative period, and this finding confirmed that the internal nasal branch of infraorbital nerve was the nerve in which the schwannoma originated. Infraorbital schwannomas are very rare and must be included in the differential diagnosis of the orbital masses inferior to the eyeball. In the case of early diagnosis, the small-sized infraorbital schwannomas can be completely removed without any scar through an intraoral approach.
Cicatrix ; Diagnosis, Differential ; Displacement (Psychology) ; Early Diagnosis ; Exophthalmos ; Female ; Head ; Humans ; Hypesthesia ; Light ; Nasal Septum ; Neck ; Neurilemmoma ; Orbit ; Orbital Neoplasms ; Postoperative Period ; S100 Proteins ; Schwann Cells ; Visual Fields

Carcinoma, Squamous Cell ; diagnosis ; surgery ; Diagnosis, Differential ; Eye Evisceration ; Humans ; Male ; Middle Aged ; Orbital Neoplasms ; diagnosis ; surgery ; Ulcer ; diagnosis

A 79-year-old male presented with left ocular pain. Evisceration and silicone ball implantation were performed after a diagnosis of phthisis. He returned six weeks later because of left facial erythematous swelling, tenderness, mild fever, chills and cough. His condition was diagnosed as orbital cellulitis. Despite two weeks of empirical antibiotic therapy, the symptoms worsened. A subsequent orbital computed tomography scan revealed enhanced soft tissue infiltrations in his left orbit and eyelid. Biopsy showed a diffusely infiltrating tumor of signet ring cell cytology. A systemic evaluation revealed multiple bone metastases. Based on this evidence, the patient was diagnosed with a very rare case of histiocytoid variant eccrine sweat gland carcinoma with multiple bone metastases.
Aged ; Carcinoma/*diagnosis/pathology ; *Eccrine Glands ; Histiocytes/*pathology ; Humans ; Male ; Orbital Neoplasms/*diagnosis/pathology ; Positron-Emission Tomography ; Sweat Gland Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

PURPOSE: A Solitary fibrous tumor is a rare orbital neoplasm derived from mesenchymal cells. The neoplasm should be considered in differential diagnosis of any orbital tumor, and immunohistochemial analysis is important for correct diagnosis. The authors herein describe a case of a solitary fibrous tumor in addition to the findings of a literature review. Solitary fibrous tumors can develop from not only the lacrimal gland, but also orbital soft tissue. Until now, there has been no report of a solitary fibrous tumor arising from orbital soft tissue in Korea. CASE SUMMARY: A 50-year-old man visited our clinic due to a slow progressing mass on the lateral side of the left eye for 1 year. The patient did not suffer from any discomfort or discharge from the mass. Slit lamp and other ocular examinations were unremarkable. Orbital MRI revealed a solid extra-conal enhanced mass that measured 13x11 mm adhering to the lateral wall of the left orbit. Total surgical excision was Performed under local anesthesia and tumor cells showed a strong and diffuse positivity for CD34 by immunohistochemistry. The findings were consistent with the diagnosis of orbital solitary tumor. CONCLUSIONS: The orbital solitary tumor is rare, but it should be considered in the differential diagnosis of any orbital tumor.
Anesthesia, Local ; Diagnosis, Differential ; Eye ; Humans ; Immunohistochemistry ; Korea ; Lacrimal Apparatus ; Middle Aged ; Orbit ; Orbital Neoplasms ; Solitary Fibrous Tumors

A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.
Abscess/diagnosis ; Biopsy ; Carcinoma, Squamous Cell/*diagnosis/*secondary ; Diagnosis, Differential ; Esophageal Neoplasms/*pathology ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Orbital Diseases/diagnosis ; Orbital Neoplasms/*diagnosis/*secondary