Orbit: Benign and Malignant Lesions Flashcards
orbital cavernous hemangioma
- a collection of small blood vessels surrounded by a fibrous pseudocapsule
- large vascular spaces are within the mass, thus the term cavernous
orbital cavernous hemangioma etiology/associations
thought to be a congenital venous malformation
orbital cavernous hemangioma demographics
- typically diagnosed between the ages of 30-50 years
- women > men
orbital cavernous hemangioma laterality
unilateral
orbital cavernous hemangioma symptoms
- bulging eye/displaced eye
- double vision
orbital cavernous hemangioma signs
- proptosis
- globe displacement
- restricted EOM
orbital cavernous hemangioma complications
- compression on the globe and/or optic nerve
- thrombosis
orbital cavernous hemangioma management
- orbital CT or MRI
- if symptomatic or complications, refer out
- complete surgical excision
orbital cavernous hemangioma pearls:
- most common ____
- most common location is ____
- growth may accelerate during _____
benign orbital tumor in adults;
within the muscle cone of the orbit;
pregnancy
orbital venous varix (orbital varices)
abnormally enlarged vein that becomes dilated with increased venous pressure (e.g., during Valsalva maneuvers, bending forward, or breath holding)
orbital venous varix (orbital varices) etiology/associations
thought to be a congenital venous malformation
orbital venous varix (orbital varices) demographics
typically diagnosed between the ages of 10-20 years (but can occur later)
orbital venous varix (orbital varices) laterality
unilateral
orbital venous varix (orbital varices) symptoms
- intermittent bulging eye/displaced eye
- intermittent double vision
orbital venous varix (orbital varices) signs
- intermittent proptosis
- intermittent globe displacement
- intermittent restricted EOM
orbital venous varix (orbital varices) complications
- compression on the globe and/or optic nerve
- orbital hemorrhage; rapid and painful proptosis
- thrombosis; rapid and painful proptosis
orbital venous varix (orbital varices) management
- orbital CT or MRI
- if complications refer out
- surgery or embolization
orbital venous varix (orbital varices) pearls:
-may also have ____
eyelid and conjunctival varices
lacrimal gland pleomorphic adenoma (benign mixed cell tumor)
benign tumor of the lacrimal gland
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) etiology
proliferation of epithelial cells
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) demographics
typically occurs between the ages of 30-40 years
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) symptoms
- displaced eye
- double vision
- eyelid swelling and redness
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) signs
- globe displacement inferiorly and medially
- restricted EOM
- eyelid edema and erythema
- palpable lacrimal gland mass
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) complications
malignant transformation
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) management
- orbital CT or MRI
- refer out
- complete surgical excision
lacrimal gland pleomorphic adenoma (benign mixed cell tumor) pearls:
- _____ progression occurs over the course of 12 months
- _____ progression and pain may indicate malignancy
slow, painless;
rapid
lacrimal gland carcinoma
malignant tumor of the lacrimal gland
lacrimal gland carcinoma etiology
- adenoid cystic carcinoma: nest of basaloid cells
- pleomorphic adenocarcinoma: proliferation of epithelial cells; usually develops within a long-standing benign mixed epithelial tumor or as a recurrence of a previously resected benign mixed tumor
lacrimal gland carcinoma demographics
- adenoid cystic carcinoma: typically occurs between the ages of 30-40
- pleomorphic adenocarcinoma: typically occurs in the elderly
lacrimal gland carcinoma laterality
unilateral
lacrimal gland carcinoma symptoms
- displaced eye
- double vision
- eye pain
lacrimal gland carcinoma signs
- globe displacement inferiorly and medially
- restricted EOM
- eyelid edema and erythema
- palpable lacrimal gland mass
lacrimal gland carcinoma complications
intracranial extension
lacrimal gland carcinoma management
- orbital CT or MRI
- refer out
- complete surgical excision
- exenteration if extensive
- radiotherapy and chemotherapy
lacrimal gland carcinoma pearls:
- onset of pain is ____
- five-year survival rate is ____, and at 15 years is _____
- major cause of death is ____
rapid (over 1-3 months);
47%;
only 22%;
intracranial extension
orbital lymphoma
malignant tumor of the orbit; any part of the orbit may be affected with ~50% of cases affecting the lacrimal gland
orbital lymphoma etiology/associations
proliferation of lymphocytes
orbital lymphoma demographics
typically occurs between the ages of 50-70 years
orbital lymphoma laterality
unilateral > bilateral
orbital lymphoma symptoms
- bulging/displaced eye
- double vision
- droopy eyelid
- eyelid swelling
- eye pain in a minority of cases
orbital lymphoma signs
- proptosis
- globe displacement
- restricted EOM with possible pain on eye movement
- ptosis
- palpable mass if anterior
- may have pink salmon-patch area of subconjunctival extension
orbital lymphoma complications
- compression on the globe and/or optic nerve
- metastasis
orbital lymphoma management
- orbital CT or MRI
- refer out
- biopsy
- radiotherapy (external beam) with or without chemotherapy (chemotherapy is considered if there is metastasis)
orbital lymphoma pearls:
- ____% chance of developing systemic lymphoma within 5 years
- lymphoma represents one end of the spectrum of ____; at the other end of the spectrum is benign reactive lymphoid hyperplasia (demographics, laterality, signs and symptoms are similar, transformation to malignancy can occur)
60;
lymphoproliferative lesions;
orbital rhabdomyosarcoma
malignant tumor of the orbit
orbital rhabdomyosarcoma etiology/associations
proliferation of primitive mesenchymal stem cells that normally develop into skeletal muscle
orbital rhabdomyosarcoma demographics
- infancy to adulthood
- 70% occur between ages of 8-10 years
orbital rhabdomyosarcoma laterality
unilateral
orbital rhabdomyosarcoma symptoms
- bulging/displaced eye
- double vision
- droopy eyelid
- eyelid swelling and redness in a minority of cases
- ocular pain and redness in a minority of cases
orbital rhabdomyosarcoma signs
- proptosis
- globe displacement
- restricted EOM with possible pain on eye movement
- ptosis
- eyelid edema and erythema
- conjunctival injection and chemosis
orbital rhabdomyosarcoma complications
- compression on the globe and/or optic nerve
- erosion of orbital bones
- metastasis
orbital rhabdomyosarcoma management
- refer to ED
- orbital CT or MRI
- biopsy
- radiotherapy (external beam) and chemotherapy
orbital rhabdomyosarcoma pearls:
- most common _____
- ____ new cases per year
- most common location is the _____
- can also present, less commonly, in _____
- hallmarks are _____
- _____ 5-year survival rate
malignant orbital tumor in children; ~35; superior nasal orbit; conjunctiva, eyelid, iris, or ciliary body; rapid onset and progression; 75-95%
orbital rhabdomyosarcoma:
- ____ has a similar presentation to rhabdomyosarcoma
- 2nd most common orbital malignancy after rhabdomyosarcoma
- most common _____
- usually arises from ____
- patients typically have sudden _____
- may develop ____
- prognosis is _____
metastatic neuroblastoma;
pediatric orbital metastatic tumor;
a primary tumor in the abdomen, mediastinum, or neck;
proptosis with eyelid ecchymosis that may be bilateral;
ipsilateral Horner’s syndrome;
poor