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Friday, February 15, 2013

Orbital Neoplasm: Classificaion, Signs and Symptoms, Investigations and Treatment of Orbital Neoplasm

Orbital Neoplasm

Classification of Orbital Neoplasm:

A) Orbital Neoplasm In children:

1.      Hamartoma and choristoma

2.      Vascular:

a.       Capillary Haemangioma (most common vascular tumor in children)
b.      Lymphangioma

3.      Neural:

a.       Optic nerve glioma
b.      Neurofibroma

4.      Mesenchymal:

a.       Rhabdomyosarcoma ( most common primary orbital malignant tumor of children)

5.      Metastatic:

a.       Retinoblastoma
b.      Leukemia
c.       Neuroblastoma

What is Hamartoma?

Hamartoma means excessive growth of normal tissue in normal site.
Eg: Capillary haemangioma and lymphangioma

What is choristoma?

Choristoma means excessive growth of normal tissue in abnormal site.
·         Dermoid cyst: Lined by keratinized epithelium and contains dermal appendages ( sweat glands and hair follicles)
·         Epidermoid cyst: Lined by epithelium and filled up by keratin. No dermal appendages.
·         Lipodermoid cyst.

B) Orbital Neoplasm In Adults:

1.      Vascular:

a.       Cavernous haemangioma
b.      Lymphangioma

2.      Neural:

a.       Meningioma
b.      Neurofibroma

3.      Lacrimal gland tumour

4.      Hamartoma and choristoma

5.      Metastatic:

a.       Leukemia
b.      Hodgkin’s Lymphoma

Clinical features of Orbital Neoplasm:

A) Symptoms of orbital neoplasm:

1.      Protrusion of eyeball
2.      Blurring of vision due to
a.       Exposure keratopathy
b.      Optic nerve compression
3.      Dull, aching pain
4.      Double vision due to restriction of ocular movement

Signs of Orbital Neoplasm:

1.      Proptosis
2.      Displacement of eyeball:
a.       Axial proptosis: cavernous haemangioma and optic nerve glioma
b.      Infero-medially: lacrimal gland tumour
c.       Upwards: Carcinoma antrum
d.      Downward: Neurofibroma of upper orbital tissue
3.      Periorbital oedema and hyperaemia
4.      Restriction of ocular movement which give rise to:
a.       Squint
b.      Diplopia
5.      Visual impairment due to:
a.       Exposure keratopathy
b.      Optic nerve compression
c.       Displacement of eyeball
d.      Restriction of ocular movement.

Investigations done in a suspected case of Orbital Neoplasm:

1.      Complete blood count:

a.       Anaemia
b.      Abnormal white blood cell count: Leukaemia, Hodgkin’s lymphoma

2.      Chest X-Ray, Posterior-Anterior view:

a.       Primary carcinoma of lung
b.      Enlarged hilar lymph nodes
c.       Reticulosis

3.      Orbital and Skull X ray:

a.       Optic nerve glioma and enlarged optical foreman
b.      Meningioma: Direct visualization

4.      Ultrasonography of orbit:

a.       Outline of orbital neoplasm
b.      Site

5.      CT scan and MRI:

a.       Site and Size
b.      Origin

Treatment of orbital neoplasm:

1.      If slow growing and localized:

a.       Surgical removal, retaining of eye wherever possible

2.      If rapidly growing primary or secondary malignant tumor:

a.       Chemotherapy and radiotherapy

That's all for today!
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