To describe a case series of patients with anterior orbital invasion by medial canthal basal cell carcinoma (BCC) managed with non-exenterating surgery.
International, multicenter, retrospective, ...noncomparative, consecutive case series.
Twenty patients identified from the individual institutions' databases with histologically confirmed orbital invasion by periocular BCC.
Examination of charts, relevant imaging, and histopathologic data.
Demographics; clinical characteristics and radiologic features; histopathologic features; surgical techniques for excision, reconstruction, and subsequent procedures; complications; visual acuity; and recurrence.
Twenty patients were identified. Twelve of 20 patients (60%) had recurrent BCCs, with 1 patient having had prior radiotherapy for previously incomplete excision. Eighteen of 20 patients (90%) had a palpable mass, 16 of 20 patients (80%) had clinical involvement of the nasolacrimal system, and 1 of 20 patients (5%) had limited extraocular movements. Preoperative radiologic evidence of orbital invasion was found in 10 of 20 patients (50%). Histologic evidence of orbital invasion was present in every patient, the subtypes being infiltrative (9/20, 45%), nodular (4/20, 20%), micronodular (2/20, 10%), multifocal (1/20, 5%), and mixed (4/20, 20%); extratumoral perineural invasion was present in 1 patient (5%). Final margins were clear in 18 of 20 patients (90%), positive in 1 of 20 patients (5%), and unclear in 1 of 20 patients (5%). Reconstruction was by direct closure in 1 patient and by a variety of standard oculoplastic flaps and grafts in 19 of 20 patients (95%). Twelve of 20 patients (60%) had postoperative extraocular muscle movement restriction, and 15 of 20 patients (75%) had epiphora. Subsequent revision procedures were needed in 12 of 20 patients (60%), including insertion of a lacrimal bypass tube and revision of medial canthal position. At a mean follow-up of 38 months, 18 of 20 patients (90%) were still alive (2 deaths due to other causes) with 1 recurrence (exenterated). Postoperative visual acuity was within 2 Snellen lines of preoperative visual acuity in 17 of 20 patients (85%).
With careful planning and margin control, conservative surgery in this highly selected group proved possible with a low rate of disease recurrence, albeit with a relatively short follow-up. Postoperative complications, such as epiphora and ophthalmoplegia, were largely expected; most patients underwent subsequent revision procedures to address these and other complications.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Primary Tumors of the Orbital Bone Wen, Yun; Yan, Jianhua
The Journal of craniofacial surgery,
06/2016, Letnik:
27, Številka:
4
Journal Article
Recenzirano
Primary tumors of orbital bone are very rare, often appearing only as case reports in the literature. The purpose of this study was to describe some cases of bony tumors originating from the orbit ...along with their clinical manifestations and surgical outcomes.
A retrospective clinical, operative, and pathological review was performed on patients with primary orbital bone tumors, who were treated at the Zhongshan Ophthalmic Center, of Sun Yat-sen University, China between January 1, 2000 and December 31, 2012.
Among the 5 patients (3 men and 2 women) identified with primary orbital bone tumors, 4 cases were orbital osteoma and 1 case was a giant cell tumor (osteoclastoma). The right orbit was involved in 2 patients and the left in 3 patients. Their mean age was 27 years (range = 4-58 years). Mean follow-up was 4.4 years (range = 3-6 years). All patients underwent an anterior orbitotomy through a skin incision approach. Total resection was achieved in 2 patients and near-total resection in 3 patients. No surgical complications or recurrences occurred after a relatively long-term follow-up period. Reconstruction techniques to repair orbital wall defects were not required because of the minute size of the defects and patient's request.
Primary benign orbital bone tumors are quite rare. Based upon the findings of our review, both orbital osteoma and osteoclastoma can be successfully managed by anterior orbitotomy without any need for orbital wall reconstruction. The final prognosis for these cases was very favorable.
A Simple Quantitative Measure of Orbital Compliance Dunbar, Kristen E; Abascal, Cristina; Pandit, Saagar A ...
Ophthalmic plastic and reconstructive surgery,
2018 Nov/Dec, Letnik:
34, Številka:
6
Journal Article
Recenzirano
This study evaluates the reliability of a frequently used subjective measurement of orbital compliance (0-3 scale) and describes a simple, quantitative measure with excellent intra- and interrater ...reliability.
Two examiners performed both measurements on 100 orbits (50 consecutive patients) from the office of 1 oculoplastics surgeon. Each measurement was obtained at 2 different time points, 10 minutes apart. For the subjective measurement, the patient was asked to close their eyes, and the globe was displaced posteriorly with digital pressure until moderate resistance was felt. This was graded on a 0 to 3 scale. For the quantitative measurement (millimeter scale), the difference in axial displacement was measured using a Hertel exophthalmometer.
The subjective measurement (scale, 0-3) showed excellent test-retest reliability (average, 0.901) for both examiners at both time points and good interobserver reliability (average, 0.677). The quantitative measurement (millimeter scale) showed excellent test-retest reliability (average, 0.848) and very good interobserver reliability (average, 0.756).
This study shows that while both methods have both excellent test-retest reliability, the interobserver reliability is slightly higher with the quantitative measurement. This suggests that the described measurement of orbital compliance is both a reasonable alternative and possibly more accurate measurement without the steep learning curve.
Primary orbital squamous cell carcinoma is a rare entity. There is little published literature. We report a case of primary squamous cell carcinoma of the orbital soft tissues. Surgical resection ...offered the best treatment for the patient. Complete resection of the lesion was achieved. The patient received adjuvant radiotherapy due to the proximity of the lesion to the surgical margins. Surgical treatment is feasible and should be considered as part of the surgeon's arsenal. However, therapeutic decisions must be made on a case-by-case basis.
Objectives
To assess the value of the MR-based radiomics signature in differentiating ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI).
Methods
One hundred fifty-seven patients ...with pathology-proven OAL (84 patients) and IOI (73 patients) were divided into primary and validation cohorts. Eight hundred six radiomics features were extracted from morphological MR images. The least absolute shrinkage and selection operator (LASSO) procedure and linear combination were used to select features and build radiomics signature for discriminating OAL from IOI. Discriminating performance was assessed by the area under the receiver-operating characteristic curve (AUC). The predictive results were compared with the assessment of radiologists by chi-square test.
Results
Five radiomics features were included in the radiomics signature, which differentiated OAL from IOI with an AUC of 0.74 and 0.73 in the primary and validation cohorts respectively. There was a significant difference between the classification results of the radiomics signature and those of a radiology resident (
p
< 0.05), although there was no significant difference between the results of the radiomics signature and those of a more experienced radiologist (
p
> 0.05).
Conclusions
Radiomics features have the potential to differentiate OAL from IOI.
Key Points
• Clinical and imaging findings of OAL and IOI often overlap, which makes diagnosis difficult.
• Radiomics features can potentially differentiate OAL from IOI non invasively.
• The radiomics signature discriminates OAL from IOI at the same level as an experienced radiologist.
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