Orbital Tumors in Adults – a Decennary Study
Authors:
J. Krásný 1,2; J. Šach 3; R. Brunnerová 1; J. Konvička 1; M. Jankovská 4; A. Srp 5; J. Kozák 6
Authors‘ workplace:
Oční klinika FN Královské Vinohrady, Praha, přednosta prof. MUDr. Pavel Kuchynka, CSc.
1; Institut pro vzdělávání zdravotníků, Praha, vedoucí prof. MUDr. Pavel Kuchynka, CSc.
2; Ústav patologie FN Královské Vinohrady, Praha, vedoucí prof. MUDr. V. Mandys, CSc.
3; Hematologické oddělení FN Královské Vinohrady, Praha, přednosta doc. MUDr. T. Kozák, Ph. D., MBA.
4; Radiodiagnostická klinika FN Královské Vinohrady, Praha, přednosta doc. MUDr. V. Janík, CSc.
5; Stomatochirurgická klinika FN Motol, Praha, přednosta doc. MUDr. J. Kozák, CSc.
6
Published in:
Čes. a slov. Oftal., 64, 2008, No. 6, p. 219-227
Overview
The authors refer about diagnostic procedures, treatment and follow-up of 87 adult patients with orbital tumors during the period 1998 – 2007 in the Department of Ophthalmology, Faculty Hospital Královské Vinohrady, Charles University, Prague, Czech Republic, E. U. The group consists of 42 men and 45 women, age range 18–89 years. In 49 patients, the tumors were of benign origin (age 18–80 years, median, 48 years), and 38 patients suffered from malign tumors (age 38–89 years, median, 61 years). Among basic examinations methods ranked the magnetic resonance imaging and the histological verification of the tumor. Sixty-four tumors were treated by means of 70 surgical procedures. The anterior diagnostic or therapeutic orbitotomy was used in 72.5 % of the cases, lateral osteoplastic orbitotomy (Kronlein) in 14.5 %, and exenteration of the orbit in 13 % of the cases. Altogether 23 patients were treated without surgery by means of corticosteroids, or are followed-up due to a benign tumor only. As the most common, the inflammatory pseudotumors of the orbit were diagnosed in 40 %. Clinically they were of the anterior nodular, or posterior diffuse form, dacryoadenitis or orbital myositis. All patients were treated by means of prednisolon for at least three months; due to the relapse of the immunopathologic process, in 16 % of the cases the therapy was supplemented with azathioprime. The surgical procedure was the choice of treatment in 66 % of inflammatory processes in the lacrimal gland region. In four cases the sarcoidosis was established. The second tumor in the final ranking was lymphoma in 19.5 %; the MALT-lymphoma was diagnosed in 59 % of these cases. The chemotherapy was chosen for the treatment in 2/3 of the cases, and in all cases the remission was reached. The actinotherapy was chosen especially in other types of lymphoma; the follicular form and “molding” lymphoma were the causes of the death in two patients. Among malignant tumors, the most serious clinical courses were histological different primary carcinomas of the orbitopalpebral region in 14 % of the cases, and secondary melanoma spreading from the conjunctiva in 5.5 %. Both these tumors, counting the same number as lymphomas, were the only indications to the exenteration of the orbit, and causes of the death in four patients.
Conclusion:
Among orbital tumors in adults, the most common were inflammatory pseudotumor and lymphoma. The decisive procedure was always the histological verification, which directed the following therapy.
Key words:
orbital tumor, pseudotumor of the orbit, MALT-lymphoma, orbitotomy, exenteration of the orbit, magnetic resonance imaging
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Czech and Slovak Ophthalmology
2008 Issue 6
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