Orbital solitary fibrous tumor: radiographic and histopathologic correlations.

OBJECTIVE: To correlate the clinicopathologic and radiographic features characteristic of orbital solitary fibrous tumor (SFT). METHODS: The diagnostic features and clinical outcome of seven adults with orbital SFT are retrospectively outlined. Orbital imaging was performed by ultrasonography, computed tomography, or magnetic resonance imaging. Some cases were imaged by multiple modalities. Histopathologic examination of each tumor specimen included standard light and immunohistochemical stains. RESULTS: Heterogeneous internal composition was better appreciated on magnetic resonance imaging than on computed tomography. All cases undergoing magnetic resonance imaging showed T1 isointensity and T2 hypointensity relative to gray matter. Strong, generalized immunohistochemical reactivity to vimentin and CD34 validated the diagnosis of SFT and differentiated the specimens from other spindle cell neoplasms. After complete tumor resection, our patients remain tumor free with postoperative intervals of 15 to 45 months. CONCLUSIONS: Solitary fibrous tumor has now been reported in 26 orbits. No physical finding is pathognomonic, but several imaging traits are highly characteristic. Intralesional image heterogeneity and a predominantly low T2 signal intensity are distinctive of SFT. Complete tumor resection and immunohistologic specimen evaluation are emphasized. Clinicians should consider the diagnosis of SFT when confronted with an adult patient having an orbital soft tissue mass demonstrating the distinctive magnetic resonance imaging findings.

Intracranial abscess as a complication of subperiosteal abscess of the orbit.

PURPOSE: To describe the potential complication of intracranial abscess in the setting of orbital abscess. METHODS: We retrospectively reviewed case reports and the literature. Three patients were found to have pansinusitis progressing to subperiosteal abscess of the orbit and subsequent intracranial abscess. RESULTS: Three patients, ages 14, 26, and 57 years, with concurrent pansinusitis, subperiosteal abscess of the orbit, and intracranial abscess were treated with intravenous antibiotics and surgical drainage of the orbital abscess and sinuses. Two of the three patients required drainage of the intracranial abscess. CONCLUSIONS: Although rare, intracranial abscess is a life-threatening complication of orbital abscess. It requires aggressive intervention by a multidisciplinary team.

Update on orbital floor fractures: indications and timing for repair.

There has been much discussion and controversy over the management of blowout fractures of the orbit. At various times, recommendations have included operating on all orbital floor fractures and operating on none of them. As our understanding of blowout fractures and their sequelae has evolved over time, so too has understanding of when and whom would benefit from surgery. In the past, the focus has often been on early versus late repair. The focus should really be on understanding the mechanisms of diplopia and enophthalmos in orbital floor fractures, the best way to evaluate a patient, and, finally, the best method of restoring maximal function and appearance. We present herein a historical perspective on the management of orbital floor fractures and our current recommendations for the indications and timing of surgical repair.

Cutaneous malignant melanoma metastatic to the eyelid.

Cutaneous malignant melanoma metastatic to the choroid, orbit, or vitreous is rare. Metastatic lesions to the eyelid are rare as well. The authors report a case of malignant melanoma metastatic to the eyelid. This was the first sign of tumor recurrence in a patient who was thought to have been successfully treated for a melanoma of the back 3 years previously. The patient died 6 weeks after diagnosis of the eyelid lesion. In the presence of known malignancy, metastasis must be suspected in new eyelid lesions.

Paranasal sinus endoscopy and orbital fracture repair.

Although excellent results may be achieved in the management of many orbital floor injuries with standard transconjunctival or transcutaneous approaches, visualization of the posterior edge of the orbital floor or medial wall defect may be challenging at times. We describe our experience using endoscopic examination of the orbital floor through maxillary sinus approaches during the repair of selected orbital floor fractures. Owing to the posterosuperior angulation of the orbital floor, these approaches allow better visualization of the posterior edge of fractures involving the posterior portion of the orbital floor than do the standard transconjunctival approaches, and they facilitate confirmation that all orbital soft tissues have been elevated from the fracture site. We have used these techniques successfully in 9 patients with fractures involving either the posterior portion of the orbital floor or the medial wall or both.

The multidisciplinary management of psammomatoid ossifying fibroma of the orbit.

OBJECTIVE: To discuss the multidisciplinary management of psammomatoid ossifying fibroma (POF) of the orbit and to clarify the clinicopathologic terminology. DESIGN: The authors present a cohort of cases of POF involving the frontal and ethmoid sinuses and the orbit and discuss the nomenclature and literature. PARTICIPANTS: Three patients with POF and their treatment are discussed. INTERVENTION: Patients were worked up and treated by a multidisciplinary team using imaging studies and histopathologic analysis. Reconstruction, if necessary, was carried out at the time of excision or in a second-stage procedure. MAIN OUTCOME MEASURES: In each case, the lesion was completely excised and has not recurred. RESULTS: The diagnosis of POF was made in each case, and the patient underwent successful resection of the tumor. CONCLUSION: The authors' experience suggests that a multidisciplinary approach, including a radiologist, pathologist, neurosurgeon, otolaryngologist, craniofacial surgeon, and orbital specialist, may be useful in the evaluation and management of these lesions.

The role of the integrin family of adhesion molecules in the development of tumors metastatic to the orbit.

Tumors metastatic to the orbit frequently originate from certain primary tumors such as breast, lung, prostate, and melanoma. The site-specific nature of orbital metastases, as well as that of other metastatic lesions, cannot be the result of random seeding. We present evidence from a review of the literature demonstrating that tumor cells express adhesion molecules of the integrin family, and that these receptors play a pivotal role in the development of a metastatic colony. We investigated orbital metastatic lesions from prostate carcinoma, malignant melanoma, and lobular breast carcinoma to determine the level of integrin expression by immunohistochemistry. Several integrin subunits (alpha2, alpha4, beta3) were found to have increased expression in the metastasis when compared to normal prostate tissue and normal melanocytes. The increased expression of these integrins may be responsible for the tendency of these tumors to metastasize to the orbit, as well as for the tendency of prostate tumors to metastasize to bone. The results from the staining of the breast metastasis were inconclusive.

Adjustable suture technique for levator recession.

OBJECTIVE: To determine whether an adjustable suture technique is clinically useful in levator recession surgery. DESIGN: Consecutive clinical series. SETTING: Inpatient hospital and ambulatory surgical center. PARTICIPANTS: Ten patients who were undergoing levator recession surgical procedures for correction of eyelid retraction constituted the group of subjects of this study. OUTCOME MEASURES: Outcome measures included margin-reflex distance and palpebral fissure measurements. RESULTS: Postoperative margin-reflex distance and palpebral fissure measurements were within 0.5 mm of the desired eyelid position in 10 or 14 procedures and within 1 mm of the desired position in 12 of 14 procedures. CONCLUSION: Adjustable sutures may be a useful adjunct in levator recession surgery.