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Hans Barron Heymann, Michael Mbagwu, Paul Bryar; Clinical and radiographic characteristics of biopsy-proven adult orbital lesions at an urban academic center. Invest. Ophthalmol. Vis. Sci. 2016;57(12):713.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical and radiographic characteristics of biopsy-proven adult orbital lesions at a single academic center
A retrospective chart review was conducted using the Northwestern Enterprise Data Warehouse for all adult patients having undergone orbital biopsies from January 2000 to October 2014. The database was queried using CPT codes for all orbital biopsies. Patients under age 18 years were excluded. 495 adults were identified using the CPT coding for orbital biopsies. Of the 495, 381 patients were excluded from study following chart review that did not demonstrate biopsies of orbital lesions and 10 patients were excluded because of incomplete records. 103 patients and 104 total cases fit inclusion criteria into the study.
Clinical: Of 104 cases, 31.7% (n=33) were considered lymphoma or lymphoid lesions (LLL) and 68.3% (n=71) were non-lymphoid lesions (NLL). Of LLL, the most frequent were extranodal marginal zone lymphoma (ENML) 48.5%, lymphoid hyperplasia 21.2%, diffuse large B cell lymphoma 9.1% and IgG-4 disease 9.1%. Of NLL, the most frequent were categorized as non-neoplastic benign conditions 32.4% (n=23). Of these, amyloidosis and sarcoidosis (n=5 each) were most frequent. Of the remaining neoplastic NLL, the most frequent were infiltrating basal cell carcinoma (BCC) (8.5%), metastasis (8.5%), infiltrating squamous cell carcinoma (SCC) (7.0%), pleomorphic adenoma (5.6%) and solitary fibrous tumor (5.6%). Radiographic: Of 104 patients, 94.2% (n=98) of the patients had imaging studies documented, 5.8% (n=6) had no imaging recoded. Of the 98 patients with documented imaging 63 (64.3%) had CT scans and 34 (34.7%) had MRI scans initially ordered. One patient (1.0%) had an ultrasound performed. A radiologist listed a clinical differential diagnosis in 80 of the 98 CT/MRI reports (81.6%.) The ultimate histopathologic diagnosis was in the radiologist’s differential diagnosis in 58 of the 80 reports (72.5%).
The majority of orbital biopsy diagnoses were NLL (68%), with 32% being LLL. Of the NLL, the most common diagnoses were non-neoplastic disorders, BCC, metastases, and SCC. Of the primary orbital tumors, pleomorphic adenoma and solitary fibrous tumor were the most common. For the lymphoid lesions, approximately 70% were malignant lymphoma, with ENML being most common. Radiologists predicted the histopathologic diagnosis 73% of the time.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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