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Uveal melanoma. MRI of an 84-year-old male patient with uveal melanoma showing a well-defined tumor of the left nasal vitreous body. The tumor shows a hyperintense signal on unenhanced T1-weighted images (A), a diffuse enhancement on contrast-enhanced T1-weighted images (B), and a marked hypointense signal on T2-weighted images (C). Retinal detachment with subretinal fluid (arrows) is shown in the coronal view (fat saturated T2-weighted sequence) (D).
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Orbital masses include a broad spectrum of benign and malignant entities. Often these masses are asymptomatic or show a slow growth rate, so that emergence of clinical symptoms is prolonged. In this context, cross-sectional imaging plays an elementary role in the characterization of these lesions. Aside from the characterization of the underlying e...
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... moderate contrast enhancement can be detected; nevertheless, it is hardly visible due to the intrinsic T1 hyperintensity. In addition, uveal melanoma often causes retinal detachment and subretinal hemorrhage (Figure 2). ...
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... vast majority of B-cell lymphomas (90%) present as a unilateral tumor, e.g., mucosa-associated lymphoid tissue (MALT) lymphomas ( Figure 10). However, especially in mantle cell lymphoma, a bilateral tumor can be registered [53] ( Figure 12). On CT and MRI, lymphoma appears as a well-circumscribed, homogenous, typically lobulated mass. ...
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... imaging findings can help to predict the diagnosis of a schwannoma. On MRI, orbital schwannoma presents as a lobular, heterogeneously enhancing mass on T1-weighted imaging after contrast administration, with isointense or hypointense signal on non-contrast T1-weighted and marked hyperintense signal on T2-weighted sequences ( Figure 20). Contrast enhancement can either be distributed homogenously or heterogeneously [75,76,80]. ...
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... may show characteristic expansion into bone, without bony erosion [75]. Typical histopathology of a schwannoma of the optic nerve shows Figure 21. ...
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... enhancement is variable, either on CT and MRI [87]. An example is illustrated in Figure 22 with the corresponding histopathology in Figure 23. No nuclear atypia and no mitosis are present. ...
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... enhancement is variable, either on CT and MRI [87]. An example is illustrated in Figure 22 with the corresponding histopathology in Figure 23. No nuclear atypia and no mitosis are present. ...
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... orbital metastases show enhancement on T1-weighted imaging after contrast administration, a low signal on non-contrast T1-weighted images and intermediate to high signal intensity on T2-weighted images are common. An example of a patient with orbital metastasis is shown in Figures 24 and 25. ...
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... three subtypes can be divided: embryonal, alveolar, and mixed. Figure 26 shows an example of an embryonal rhabdomyosarcoma of the orbit. For the diagnosis and grading of RMS, a biopsy is the reference standard [96]. ...
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... of hemorrhage are rare but possible, especially in alveolar and pleomorphic subtypes. An example of a patient with RMS is shown in Figure 27. Figure 27. ...
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Background
Epidermoid cyst is a developmental lesion with 1.6–6.9% cases found in the head and neck region. Intraoral epidermoid cyst is a rare finding and intratonsillar epidermoid cyst is even rarer, with less than 0.01% incidence.
Case presentation
We are reporting a case of 16 year old with complain of unilateral tonsillar enlargement since 5...
Citations
... Metastatic lesions are more often found in the anterior part of the orbit than in the posterior [84]. The most common metastases are breast, lung, and prostate cancer, melanoma, carcinoma, renal cell carcinoma, neuroblastoma, and rhabdomyosarcoma [85,86,87]. Among the rapidly progressive ocular symptoms are exophthalmos, diplopia, impaired vision acuity, pain, blepharoptosis, and palpable tumour [88]. ...
Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.
... Pleomorphic adenoma is pseudoencapsulated benign neoplasm primarily consisting of bland, lumen-forming and spindled myoepitheliomatous cells, each with a nucleus that is often oval, uniform, finely stippled, and either lacks a nucleolus entirely or has a tiny, punctate nucleus (Vogele et al., 2022). In pleomorphic adenoma, lumens have been demonstrated to have double-layered cellular walls and to show splaying-off or feathering of the outer myoepithelial cells into the stroma, where they experienced diverse alterations and transformed into hyaline, myxoid, or chondroid foci. ...
Background: Lacrimal gland adenoma is a benign tumour of the lacrimal gland mostly involving the orbital part of the gland and composed of epithelial and myoepithelial components. It involves the third and fourth decade of life as a gradual painless enlargement of the lacrimal gland. Case: This is a case report of a 30-year-old female presenting with the forward bulging of the right eye causing the eye to be displaced medio-inferiorly over the course of one year. After careful clinical examination and MRI, a clinical diagnosis of lacrimal gland adenoma was established and was planned for right lateral orbitotomy (without marginotomy) via eyelid crease incision and transcutaneous-transseptal approach with complete excision of the tumour under general anaesthesia. Observations: This case was presented to the out patient department with mild painful non-axial proptosis of the right eye. After clinical examination, her MRI report showed a well-defined altered signal intensity enhancing lesion on the extraconal compartment of the right orbit in the antero-supero-lateral aspect. After complete surgical removal of the mass, it was sent for histopathological analysis and it confirmed it as a pleomorphic adenoma. The patient has been following up every 6 months for 2 years and is asymptomatic. Conclusion: Being the most prevalent lacrimal gland tumour, pleomorphic adenoma affects the unilateral lacrimal gland causing non-axial proptosis. Complete removal of mass has an excellent prognosis with complete resolution of symptoms.
... The morphology and the size of the orbit can be affected by various conditions, such as Crouzon syndrome and Graves' disease and these morphological changes can provide valuable diagnostic clues [2,3]. Early detection and effective management of these conditions can be achieved by utilizing advanced diagnostic tools which are essentially guided by comprehensive anatomical knowledge of the orbital morphology [4]. ...
... The information regarding the relationship between the lateral wall and the floor lengths could assist in diagnosing the potential orbital floor fractures, often observed in facial trauma. Similarly, the highly correlated dimensions of the roof and the medial and lateral walls might be practical in identifying congenital defects, traumatic injuries, or neoplastic formations affecting the orbits or eyeball [4,20]. Additionally, the correlations between orbital circumference and transverse and vertical diameters could be utilized to evaluate overall orbital anatomy, which is critical in surgical planning for procedures such as orbital decompression [21]. ...
Background and objective
The complex structural integrity of the orbit is crucial for visual functions. Three-dimensional (3D) reconstructions from radiological images have revolutionized anatomical understanding, eliminating the limitations of two-dimensional (2D) imaging and offering intricate spatial details for complex structures. The aim of this study was to analyze the detailed morphometry of the orbit in healthy Anatolian adults, considering sex, side discrepancies, and clinical relevance using 3D models reconstructed from multidetector computed tomography (MDCT) images.
Materials and methods
Fifty-six (44.44%) males and 70 (55.56%) females (total: 126, mean age: 48.62) MDCT images were randomly selected and 3D skull models were reconstructed using 3D Slicer software. Measurements were conducted in millimeters (mm) for transverse and vertical diameters, circumference of the orbital opening, orbital wall lengths, as well as intraorbital and extraorbital distances.
Results
The method of measurements showed high reproducibility of results. The mean values for transverse and vertical diameters, circumference of the orbital opening, medial and lateral wall lengths, roof and floor lengths, and intraorbital and extraorbital distances were 40.23±2.12 mm (p<0.001), 34.94±2.16 mm (p=0.365), 44.74 ±3.02 mm (p<0.001), 46.30±2.69 mm (p<0.001), 51.26±2.91 mm (p<0.001), 49.01±3.22 mm (p<0.001), 126.10±5.71 mm (p<0.001), 19.63±2.35 mm (p=0.026), and 94.09±4.84 mm (p<0.001), respectively.
Conclusion
The study's high measurement reproducibility contributes significantly to the existing literature and clinical practice. These findings offer specific insights into Anatolian orbital morphometry, aiding in surgical planning, implant placement, and diagnostic assessments. The precise measurement values serve as a reliable reference for clinicians, facilitating the identification of normal and abnormal orbital anatomy and enhancing patient care. We believe this study provides valuable data for craniofacial and ophthalmological research, benefiting both clinical practice and future research endeavors in these fields.
... Lymphoma's characteristics on T1W images are similar to those of RMS, with the degree of enhancement varying from moderate to strong and restricted diffusion on DWI. However, lymphoma commonly presents as a homogeneously enhancing mass and typically envelops anatomic orbital structures without invasion or depressing the eyeball [17] . ...
Rhabdomyosarcoma (RMS) is the most common mesenchymal tumor in children and adolescents, with 10% of cases occurring in the orbits. RMS should be suspected whenever children present with rapidly progressing unilateral exophthalmos. Its symptoms depend on the lesion's origin and location. We report the clinical case of a 19-year-old male patient admitted to the hospital because of blurred vision and bulging eyes that gradually increased over several months. Magnetic resonance imaging showed a mass located mainly in the left orbit, pushing and deforming but not invading the eyeball. The lesion had grown into the left ethmoid sinus wall. The histopathological incisional biopsy results were with alveolar RMS.
... Patients often present with proptosis due to a slowly growing orbital mass, which accounts for ~70 % of cases [4,11,12]. Exophthalmos is typically progressive, depending on the anatomical location, and may or may not be axile, painless, and non-pulsatile until a complication occurs (e.g., thrombosis, hemorrhage, or inflammation). Discovery is sometimes accidental. ...
... Small calcifications or bone remodeling can occur. Mild contrast enhancement is a common proptosis feature because of its low vascular flow [11]. Magnetic resonance imaging should be used to evaluate the potential compressive impact, particularly on the optic nerve. ...
Introduction: Orbital tumors are heterogeneous lesions originating from various structures in the eyeball, including the extraconal, conal, and intraconal spaces. One orbital tumor type is a vascular tumor, such as a hemangioma. Hemangiomas are most common in women aged 20–64 years. They are painless and slow-growing, leading to proptosis. The diagnosis can generally be established by clinical examination and computed tomography (CT) or magnetic resonance imaging scans. Orbital hemangioma management can involve regular observation of small and asymptomatic tumors or surgery for large symptomatic tumors.
Presentation of Case: We report a 20-year-old Asian woman who presented with swelling on the medial side of her right eyelid that had increased over the last three months. A non-contrast head CT scan showed a mass in the right eye’s medial wall. The patient underwent a joint operation with an ophthalmologist to remove the median orbital tumor by transnasal endoscopic orbital surgery. Anatomical pathology examination of the tumor tissue identified hemangiomas.
Conclusion: An endoscopic transnasal approach is a safe and effective way to access and manage an orbital tumor medial to the optic nerve. It is essential to have a multidisciplinary team with experience in endoscopic procedures. This patient had satisfactory results at their three-month postoperative follow-up. They reported no symptoms, and their CT scan did not show a relapsed mass in the right oculi region.
Many pathologies affect different orbital spaces. Being confined, any pathology leads to eyeball displacement, mostly a forward protrusion. Distinct orbital and adnexal signs may indicate an underlying serious or life-threatening systemic disorder to the physician. Orbital pathologies at the orbital apex are sight sight-threatening. Nearly one-third of all orbital pathologies are malignant. Although major advances have occurred in orbital imaging, a tissue biopsy is often required. Lid retraction and lag are classical signs of thyroid-associated orbitopathy (TAO). Orbital fibroblasts carry thyrotropin receptors and play a crucial role in the pathogenesis of extraocular muscle enlargement. Treatment of TAO depends on the severity of the soft tissue inflammation but primarily rests on intravenous corticosteroids. Other causes of extraocular muscle enlargement include IgG4 myositis and lymphomas. Orbit gets involved in metastatic disease, and lung cancer may first present in orbit. While tuberculosis of the orbit is rare, a high index of suspicion should be kept for fungal infections, especially in immunocompromized individuals and organ transplant patients.
Key Clinical Message
Schwannomas are rare tumors in the orbit, typically originating from various nerves and presenting diagnostic challenges. We present a unique case of a unilateral orbital schwannoma arising from the supraorbital nerve. A 55‐year‐old female presented with a painless, slowly growing mass in the right superior orbit, causing proptosis. Visual acuity remained unimpaired, and clinical examination revealed a well‐defined mass in the superior orbit. A provisional diagnosis of an orbital dermoid or cyst was made, leading to excision biopsy. The histopathological examination confirmed a diagnosis of benign schwannoma. Schwannomas in the orbit, particularly those arising from the supraorbital nerve, are uncommon and often challenging to diagnose. Early surgical intervention is crucial to prevent complications associated with tumor growth. This case underscores the need to consider schwannomas as a differential diagnosis for slow‐growing orbital masses in adults and emphasizes the importance of timely management to prevent vision‐threatening complications.
