Idiopathic orbital inflammation with bone destruction and extension into the paranasal sinuses.

Idiopathic orbital inflammation developed in the right orbit of a woman in her mid-thirties, causing tearing, photophobia, diplopia, altered depth perception, proptosis, and pain on eye movements. Computed tomography disclosed a mass involving the intraconal and extraconal nasal right orbit, extending to the orbital apex with anterior displacement of the globe, effacement of the medial rectus muscle, portions of the fat plane, and the superior oblique muscle, and bone destruction with extension of the mass through the orbital floor into the superior maxillary sinus and through the lamina papyracea into the ethmoid sinus. Orbital biopsy disclosed dense fibrous connective tissue with numerous lymphocytes and macrophages. Immunohistochemical stains supported a diagnosis of idiopathic inflammatory pseudotumor involving the orbit and sinus mucosa. Treatment with a prednisone taper and a retrobulbar injection of triamcinolone acetonide have relieved her symptoms and diminished her proptosis. This patient highlights the rare potential of idiopathic orbital inflammation to erode though bone into adjacent cranial structures.

Efficacy and safety of carbon-ion radiotherapy for lacrimal gland carcinomas with extraorbital extension: a retrospective cohort study.

PURPOSE: To evaluate the efficacy and safety of carbon-ion radiotherapy (CIRT) for patients with lacrimal gland carcinomas (LGCs) with extraorbital extension. RESULTS: The median follow-up period was 53.7 months. The 5-year local control and overall survival rates were 62% and 65%, respectively. Regarding late toxicities, 12 patients (36.4%) developed Grade 4 optic nerve disorders, including visual losses of the diseased side (N = 8; 66.7%), and 1 patient (3.0%) developed a Grade 3 optic nerve disorder. Three patients (9.0%) developed Grade 3 cataracts, 3 (9.0%) developed glaucoma, and 1 (3.0%) developed retinopathy. Two patients (6.1%) had Grade 4 central nervous system necrosis. No Grade 5 late toxicities were observed. The 5-year preservation rate of the ipsilateral eyeball was 86%. CONCLUSION: Definitive CIRT is effective for LGCs with extraorbital extension with acceptable toxicity. METHODS: Thirty-three patients treated with CIRT at our institution were analyzed. Sixteen patients (48.5%) had adenoid cystic carcinoma, 8 (24.2%) had adenocarcinoma not otherwise specified, and 9 (27.3%) had other types of the disease. Thirty patients (90.9%) had T4c tumors. The prescribed doses were 57.6 Gy (relative biological effectiveness [RBE]) (N = 18; 54.5%) and 64.0 Gy (RBE) (N = 15; 45.5%) in 16 fractions.

Giant Orbital Melanoma in a Heroin Abuser.

PURPOSE: The aim of this report was to report a heroin abuser with nondiagnosed giant uveal melanoma infiltrating the orbit and prolapsing through the face. METHODS: We conducted a case report of the patient with giant melanoma. RESULTS: In March 2013, a 39-year-old male with bleeding from the right side of his face was taken to the Emergency Center of the University Hospital Bratislava by ambulance. The heroin abusing, homeless male who had never been treated before reported a 2-year history of a prolapsed, dark colored mass from his eye. Acute computed tomography confirmed a solid mass 20 × 20 cm prolapsing from the orbit. The patient rejected primary care, accepted only 1 transfusion and left the hospital. Two months later, he was admitted to the hospital due to anemia after many collapses. Liver metastasis was present. Surgical palliative therapy was not possible due to his general status. The patient started fractionated external radiotherapy with 8.0 Gy Co60. Histopathological examination of the biopsy specimen showed malignant melanoma of the epitheloid type G2-3. The patient died in December 2013. CONCLUSION: Extraorbital formation of a melanoma mass may progress to a giant volume, and without treatment, led to metastases in the liver and to death after 9 months in our patient with anemia.