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Orbital Pseudo-tumor: Clinical Aspects and Histological Results

Krommes G., Grehn F., Lieb W.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)

The clinical picture of orbital pseudotumor differs widely. It varies from mass effect to acute inflammation, asymptomatic occurrence and/or infiltration mainly of unknown origin. It affects the different anatomical structures, such as the muscles, lacrimal gland, periosteum, optic nerve etc. The histological features are similar to a adjacent sinusitis, thrombophlebitis, retained foreign body, trauma, dermoid cysts and lymphangioma. Systemic disorders such as dysthyroid ophthalmopathy, periarteritis nodosa, sarcoidosis, Wegner’s granulomatosis, dysproteinaemia, amyloidosis, lupus erythematosus etc can be associated.
Methods: 18 Patient suffering from orbital pseudotumor were treated in the Department of Ophthalmology, University Hospitals Wuerzburg between 1995 and 2002. The sex ratio was 12 male to 6 female, the average age calculated up to 46,2 ± 21,2 years. The operations taking a biopsie included 9 times frontal, 4 times lateral and one endonasal orbitotomia.
Results: The pathological examination differentiated four inflammatory pseudotumors with pseudolymphatic, mixed-inflammatory infiltrations and chronic non-specific inflammation with fibrosis respectively. The other histological results showed a chronic-sclerotic, inflammatory process, a lymphatic infiltration with a monoclonal component, a focal fibrosis a stromatumor, a cholesterol granuloma and a chronic granulating inflammation.
Conclusions: The wide range of orbital pseudotumor needs a concise differentiation in subgroups. It should be distinguished between inflammatory (acute, subacute, specific and non-specific), infiltrating, mass-effect, and vascular process. In most cases a biopsie is recommended.