A Rare Case of Left Orbital Extraconal Mass

Rare cases need expertise & experience to cure & manage. Learn the art of handling a rare case of Left Orbital Extraconal Mass through the rich experience of Dr. Yashesh Dalal Share your views on the case Follow us for more such updates!

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A Rare Case of left Orbital Extra- conal mass presented by Dr Yashesh Dalal in Experts Insights case is an informative demonstration of Neurosurgeons role in such tumours .He had impressed that it should be operated by a Neurosurgeon and should not be done by a ophthalmic surgeon .The intra - operative pictures were a treat to watch Orbital neoplasms in adults may be categorized on the basis of location and histologic type. Imaging features of these lesions often reflect their tissue composition. Cavernous malformations (also known as cavernous hemangiomas), although not true neoplasms, are the most common benign adult orbital tumor. They typically appear as a well-circumscribed, ovoid intraconal mass on cross-sectional images. Lymphoma, which may be primary or secondary to systemic disease, is the most prevalent orbital neoplasm in older adults (≥60 years of age). Choroidal melanoma is the most common primary adult ocular malignancy. Melanin has intrinsic T1 and T2 shortening effects, classically manifesting with hyperintense signal on T1-weighted magnetic resonance (MR) images and with hypointense signal on T2-weighted images. However, amelanotic or mildly pigmented lesions of melanoma do not demonstrate these characteristic MR imaging features. Breast cancer is the most common malignancy to metastasize to the orbit, followed by prostate cancer, melanoma, and lung cancer. In women with bilateral enophthalmos, metastatic scirrhous breast cancer should be considered in the differential diagnosis. Neoplasms that arise from the optic nerve or its sheath include glioma and meningioma. At imaging, gliomas often cause fusiform expansion of the optic nerve, in which the nerve itself cannot be delineated from the lesion. In contrast, meningiomas classically have a “tram-track” configuration, whereby the contrast-enhancing tumor is seen alongside the optic nerve. Neoplasms that derive from peripheral nerves include schwannoma and neurofibroma, the latter of which is associated with neurofibromatosis type 1. MR imaging is particularly valuable for evaluation of orbital neoplasms, as it provides critical anatomic information about ocular structures involved, perineural spread, and intracranial extension

very well narrated..m quite happy to see your active and avid involvement in each ane every case.
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Really a rare case of orbital extraconal mass and nicely diagnosed and manage by Dr Dalal speak volumes of his rich experience and commitment towards society and sharing with fraternity . Thanks for sharing.

Thanks Dr Praveen Yograj.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Primary lymphoma of the orbit is one of the commonest orbital tumours and accounts for as much as half of all orbital malignancies. It is a B-cell non-Hodgkin lymphoma, and in most cases arises from mucosa-associated lymphoid tissue (MALT). Clinical presentation is variable as any part of the orbit can be involved. In 25% of patients, the conjunctiva is involved, in which case patients demonstrate a 'salmon-red patch' of swollen conjunctiva. Patients who do not have conjunctival involvement (75% of cases) present with an orbital mass, usually in the superior lateral quadrant, in proximity to the lacrimal gland palpable mass exophthalmos ptosis diplopia and abnormal ocular movement Generally the mass is painless; however, a subset of patients demonstrates inflammatory-like changes, including pain, erythema, and swelling. Direct infiltration of the globe and/or optic nerve is rare, and vision is usually preserved.Orbital lymphoma usually appears as a soft tissue mass, either involving the conjunctiva (especially in the case of orbital adnexal MALT lymphoma (OAML)) or elsewhere in the orbit, frequently in the upper outer quadrant, closely associated with the lacrimal gland. Although the extraocular muscles may be surrounded or displaced by the mass, they can usually be identified as not being the origin of the tumour, helpful in distinguishing lymphomas from other orbital masses. Invasion of the globe or optic nerve is rare. Treatment and prognosis Orbital adnexal MALT lymphoma (OAML) have a better prognosis than other types of orbital lymphomas and are, not surprisingly, more often conjunctival. The recent identification of Chlamydia psittaci as a likely important causative factor in the increasing incidence of orbital lymphomas has lead to antibiotic therapy being used to reduce the size of the tumour and in some cases results in remission 1-3. Surgical biopsy/resection, radiotherapy, and chemotherapy have all been used. Currently, no OAML treatment guidelines exist 1. An overall 5-year relapse-free rate of 65% is reported, with less than 5% of patients with OAML eventually dying from the disease.Systemic dissemination is only seen in 5-10% of cases. Similarly, in cases of non-MALT-lymphoma, a combination of two or more of surgical biopsy/resection, radiotherapy, and chemotherapy is usually employed. Prognosis is less favourable. Differential diagnosis General imaging differential considerations include: other malignancies orbital rhabdomyosarcoma uveal melanoma lacrimal gland tumours orbital metastases (including disseminated lymphoma) idiopathic orbital inflammatory pseudotumour may be difficult to distinguish from lymphoma if associated with fibrosis, will be of lower T2 signal 5 thyroid-associated orbitopathy

well narrated
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Very interesting rare case to be presented here on this platform.

thank you
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Indeed useful case Congratulate respected sir

thanks.. my pleasure
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Perfect diagnosis in typical case is fantastic task .This is beauty of clinical research and treatment .. Thanks Dr Dalal

thank you doctor
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Well done .Congratulations Dr Dalal

thank you mam
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FIR ORBITAL MASS ONE HAS TO DO MRI ORBITS TO SEE ANY UNDERLYING ORBITAL INVOLEMENT B SCAN UKTRASOUND

thanks doctor..orbit MRI is standard .. B scan may not be necessary with MRI now..regards
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Illustrative and rare case Well done sir Congratulations

Thanx dr Ashok Leel
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