Antonio Leccisotti

Clinical and radiological presentation of 95 orbital lymphoid tumors.

Abstract• Background: Although most orbital lymphoid tumors are characterized by a slow, painless onset and a mass that molds to orbital structures, different presentations may occur. Intensity on T2-weighted MRI is a possible means for differentiating lymphoid tumors (hyperintense) from pseudotumors (hypointense). In addition, it is generally assumed that 75% of orbital lymphomas are at stage I on presentation.• Methods: The clinical, CT, and MRI presentation of 95 primary and secondary orbital lymphoid tumors (63 non-Hodgkin lymphomas and 32 lymphoid hyperplasias) and their histological grade and staging were reviewed. Immunohistochemistry and PCR were used to determine clonality.• Results: No significant differences were found between non-Hodgkin lymphomas and lymphoid hyperplasias, except for the mean age of the patients (6.3 years older in non-Hodgkin lymphomas). In both groups the most common presentation was a mass with an indolent course; visual impairment was seen in 13%, conjunctival redness in 25%, pain in 12%, and acute orbital inflammation in 15% of the patients. In most cases, the CT showed one or more lobulated or rounded masses, molding to adjacent structures, or a wedge-shaped enlargement of the lacrimal gland. Intramuscular lymphomas were rare and always associated with extramuscular masses. On T2-weighted MRI, only 35% of lymphoid tumors were hyperintense. Only 49% of lymphomas were at stage I on presentation.• Conclusion: An inflammatory presentation is not uncommon in orbital lymphoid tumors. Shape, molding and multiple masses can help radiological diagnosis, whereas MRI T2 intensity is unreliable. Accurate staging can disclose systemic disease in more than 50% of cases of non-Hodgkin lymphoma.

MRI in Graves Orbitopathy: Recognition of Enlarged Muscles and Prediction of Steroid Response

The purpose of this study is to compare MRI to CT in the recognition of Graves orbitopathy and to compare MRI to clinical examination in the prediction of steroid response. Sixteen patients with dysthyroid orbitopathy (21 orbits) were examined by CT and MRI; muscle enlargement was measured by ultrasonography. Sensitivity in recognizing enlarged muscles was 85.4% for CT and 61.2% for MRI; CT recognized all affected orbits but 1, while MRI failed in 4 cases. Clinical inflammatory signs (p = 0.17) were more reliable predictors of steroid response than muscular T2 hyperintensity on MRI (p = 0.64). In a patient where histological examination documented edematous changes, MRI failed to reveal edema. MRI adds no morphologic information to CT; moreover, T2 intensity is less specific than clinical examination in documenting active disease and forecasting therapeutic outcome.

PROGNOSIS OF ORBITAL LYMPHOID HYPERPLASIA

Abstract• BackgroundOrbital lymphoid hyperplasia can be associated with systemic non-Hodgkin lymphoma (NHL), even when polyclonal proliferation is found in the orbit. Although irradiation is recommended, some orbital lymphoid hyperplasias are treated by steroids (when inflammation is clinically presumed) or left untreated.• MethodsThe incidence of concurrent NHL and the incidence of future NHL after oral prednisone, radiotherapy, or no treatment were retrospectively evaluated in 33 cases of lymphoid hyperplasia (22 benign lymphoid hyperplasias, BLH, and 11 atypical lymphoid hyperplasias, ALH), after follow-up of 2–13 years.• ResultsNHL occurred in 12 of 33 cases (36.4%). In seven patients it was concurrent; in five patients it occurred 2–6 years later. In the actuarial curve, at 5 years 55% of patients were free of lymphoma, at 10 years, 46%. NHL was more commonly observed when the lacrimal gland was involved (57% vs 21%; P=0.03). Of the 13 patients treated with oral steroids, 46% had complete response, 39% partial response, and 15% future NHL. Of the seven irradiated patients, five (71%) had complete response, two (29%) partial response, and none future NHL. Of the eight untreated patients, five (63%) had partial response and three (37%) future NHL. Irradiated lacrimal gland BLHs only achieved partial response, one having radiation-induced orbital inflammation.• ConclusionBecause of a high risk of NHL, in all orbital lymphoid tumors systemic staging and follow-up are mandatory. The advised management is irradiation, except for Sjögren syndrome, an initially inflammatory lacrimal gland BLH, where a course of steroid is suggested before considering radiotherapy.

Painful ophthalmoplegia caused by superior ophthalmic vein thrombosis

Abstract A diabetic 69-year-old woman experienced a sudden painful ophthalmoplegia (third, fourth, and sixth cranial nerves) in the left eye, with visual loss and corneal hypesthesia, due to superior ophthalmic vein thrombosis. This was revealed by magnetic resonance imaging (MRI). Left eye fundus was characterized by an atrophic optic disc and by obliteration of all retinal vessels.The authors recommend early use of MRI in order to diagnose vascular affections, which may benefit by early appropriate therapy.

CT and MRI features of lacrimal fossa tumors: A retrospective study of 72 cases

ct and mri scans of 72 patients were examined, including eight pleomorphic adenomas, five recurrent pleomorphic adenomas, 13 carcinomas, two schwannomas, four dermoid cysts, two dacryops, two cholesterol granulomas, 18 pseudotumors, 18 lymphoid tumors. Features evaluated were shape, borders, calcifications, adjacent bone changes, palpebral lobe involvement, cystic appearance, T1 and T2-weighted intensity.Adenomas and schwannomas appeared rounded, with sharp margins and rarely associated with bony defects. Recurrent adenomas mainly had a lobulated shape and sharp borders, hyperostosis and bony defects. Carcinomas showed varied shapes, smooth margins, frequent bone erosion and calcifications. Pseudotumors and lymphoid tumors were mainly wedge-shaped, with a frequent palpebral lobe involvement and no bony changes. Margins were blurred in most pseudotumors, and sharp in most lymphoid proliferations. On mri, all diseases showed a low signal on T1 and a high signal on T2, except for pseudotumors (hypointense on...

Intraoperative autorefraction for combined phakic intraocular lens explantation and cataract surgery.

PURPOSE To evaluate intraoperative autorefraction during combined phakic intraocular lens (PIOL) explantation and cataract surgery. METHODS Phakic intraocular lens explantation was followed by crystalline lens emulsification and reformation of the anterior chamber with balanced salt solution. Autorefraction was performed intraoperatively with the Nikon Retinomax 2, and the IOL power was calculated using a formula for myopic eyes: IOL for emmetropia = 1.3 x aphakic spherical equivalent refraction + 1.45. RESULTS Nineteen myopic eyes of 15 patients with anterior or posterior chamber PIOL (including 6 eyes that had undergone photorefractive keratectomy) were treated. Two months postoperatively, mean spherical equivalent refraction was -0.56+/-0.40 diopters (D) (range: 0 to -1.50 D). CONCLUSIONS In myopic eyes, intraoperative auto-refraction provided a simple and reliable method to calculate IOL power in combined PIOL explantation and cataract surgery.

Optic nerve sheath meningiomas: Clinical features and functional prognosis

Seventeen cases of optic nerve sheath meningiomas were reviewed, in order to identify their clinical presentation, CT and MRI features, and to evaluate their visual prognosis in untreated cases and after surgery. The most common clinical features were represented by optic disk pallor and/or edema (16 cases), unilaterally reduced visual acuity (14 cases), afferent pupillary defect (12 cases), visual field alterations (nine cases out of 12), proptosis (12 cases), motility disturbances (eight cases), amaurosis fugax (five cases). On CT and MRI, eight tumors appeared fusiform, four excrescent, four tubular, one massive. The optic nerve could be recognized within the tumor in nine cases out of 16 on CT, and in eight out of nine on MRI. Contrast enhancement was observed in most cases. On T2-weighted MRI, meningiomas proved to be hyperintense in four cases and isointense to fat in the remaining five. A histological diagnosis was obtained in eight cases: seven belonged to the meningotheliomatous type; the remaini...

A case of orbital granular cell tumor (Abrikossof)

Granular cell tumor (Abrikossof tumor) is a rare orbital neoplasm. Its histogenesis is unclear: the cell origin has been proposed from skeletal muscle, histiocytes, fibroblasts, mesenchymal cells, Schwann cells. The authors observed a 58-year-old woman with monolateral exophthalmos and diplopia, caused by a supero-medial orbital granular cell tumor. Tho years after the complete excision, she had no recurrences or metastases. The immunohistochemical findings (negativity to muscular, epithelial, glial, histiocytic and neuronal markers; positivity to S-100 protein and vimentin) confirm the hypothesis of an origin from Schwann cells.

Bilateral optic nerve compression caused by lymphomatous infiltration of all extraocular - muscles

Orbital lymphoid tumors may arise within one or more extraocular muscles, although multiple and bilateral presentation is rare. Furthermore, bilateral optic nerve compression is an exceptional finding in orbital lymphoma. A 28-year-old man experienced bilateral proptosis and loss of vision. He had suffered from a stage IV non-Hodgkin lymphoma, not involving the orbit, which had been quiescent for 3 years. Ocular motility was impaired in all directions. Bilateral optic disc swelling was apparent. Orbital MRI revealed bilateral enlargement of all extraocular muscles and of lacrimal glands, causing apical optic nerve compression. Incisional biopsy confirmed the diagnosis of orbital small-cell lymphoma. Combination chemotherapy and oral prednisone administration resulted in a complete regression of orbital masses.Bilateral lymphomatous infiltration of all extraocular muscles with papilledema requires a differential diagnosis with other causes of bilateral papilledema and of extraocular muscle enlargement. A p...

Magnetic resonance imaging of orbital abscesses

The magnetic resonance imaging features of two orbital abscesses are reported, with correlation to clinical, computed tomographic and ultrasound findings.In the first case, a 16-year-old boy, after bilateral ethmoidal sinusitis, meningitis and right orbital cellulitis, developed an intraconal abscess. CT revealed a hypodense core, surrounded by a brighter pseudocapsule. On T1-weighted MRI, the center of the abscess appeared hypointense and the capsule isointense to muscle. On T2, the core was hyperintense, and the pseudocapsule was not evident. Ultrasonography showed a well-defined rounded lesion, with low-to-medium internal reflectivity. Follow-up was carried out by CT and ultrasound until complete healing.In the second case, after chemotherapy for a sytemic T-cell lymphoma, a 41-year-old man developed frontal and ethmoidal sinusitis and a left superior orbital mass originating from the frontal sinus. On T1-weighted MRI, the mass appeared hypointense, with a darker core, which appeared hyperintense on T2...