Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1

doi:10.1016/j.ophtha.2003.01.002

Ophthalmology

Volume 111, Issue 5, May 2004, Pages 997-1008

Presented at: Irish College of Ophthalmologists as the 2002 Montgomery Lecture, November, 2002; Dublin (JAS).

https://doi.org/10.1016/j.ophtha.2003.01.002 Get rights and content

Abstract

Objective

To determine the incidence of specific orbital tumors based on patients referred to an ocular oncology center.

Design

Retrospective, observational case series.

Participants

A total of 1264 consecutive patients referred to an ocular oncology service because of space-occupying orbital lesions.

Methods

A retrospective chart review was carried out for 1264 consecutive patients referred for a suspected orbital mass over a 30-year period. The lesions were grouped into general categories, as shown in “Results.” The specific diagnosis in each case was based on clinical findings, computed tomography scan results, magnetic resonance imaging results, and histopathologic analysis results, when available. The number and percentage of benign and malignant tumors per age group also was determined.

Main outcome measures

The incidence of orbital tumors and pseudotumors.

Results

Among 1264 consecutive patients, the number and percentage of lesions in each general category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13 (1%); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1%); lipocytic and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%); primary melanocytic lesions, 11 (<1%); metastatic tumors, 91 (7%); lymphoma and leukemia lesions, 130 (10%); secondary orbital tumors, 142 (11%); histiocytic lesions, 17 (1%); thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11%); and miscellaneous other lesions, 13 (1%). The most common diagnoses were: lymphoid tumor (139 cases;11%), idiopathic orbital inflammation (135 cases; 11%), cavernous hemangioma (77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35 cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst (26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The percentage of malignant lesions was 20% in children (age range, 0–18 years), 27% in young adults and middle-aged patients (age range, 19–59 years), and 58% in older patents (age range, 60–92 years). Rhabdomyosarcoma was the most common malignancy in children, representing 3% of all orbital masses, and lymphoma was the most common malignancy in older patients, representing 10% of cases.

Conclusions

A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions, 64% were benign and 36% were malignant. The percentage of malignant tumors increased with age, with malignancies being common in older patients because of the higher incidence of lymphoma and metastasis in the elderly.

Section snippets

Patients and methods

The computerized files of the Oncology Service at Wills Eye Hospital were reviewed, and all cases coded with a diagnosis of an orbital tumor or simulating condition were selected for a more detailed analysis. Using a modification of a previously published classification of orbital tumors and pseudotumors,18 the primary diagnosis in each case was categorized into 1 of several major groups of lesions (cystic, vasculogenic, peripheral nerve, optic nerve and meningeal, fibrocytic, osseous and

Results

During a 30-year period from December 1971 through April 2002, there were 1264 patients with the diagnosis of an orbital condition referred because of suspected orbital tumor. The general demographics are depicted in Table 1. The number and percentage of lesions in each major category are shown in Table 2.

The specific diagnoses in each category are depicted in Table 3, Table 4, Table 5, Table 6, Table 7, Table 8, Table 9, Table 10, Table 11, Table 12, Table 13, Table 14, Table 15, Table 16,

Discussion

Most reported series of the frequency of orbital tumors and pseudotumors are biased by factors such as a specialty interest of the reviewer, whether only histopathologically confirmed lesions were included, the age range of the patients, the geographic area of the patients, and other factors. For example, it is expected that cases derived from a neurosurgical practice would include more neural tumors such as meningioma and optic pathway glioma.7 Reports from an otolaryngology practice would

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Manuscript no. 220445.

Supported by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania; the Award of Merit in Retina Research, Houston, Texas (JAS); and the Macula Foundation, New York, New York (CLS).

View full text

Original articleSurvey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1☆

Abstract

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Surv Ophthalmol

Diagnosis and Management of Orbital Tumors

Atlas of Orbital Tumors

Intraorbital tumors

Arch Ophthalmol

Tumors of the Orbit

Trans Am Ophthalmol Soc

Orbital Tumors in children. A report on 214 cases

Int Ophthalmol Clin

Orbital tumors in children

Clin Neurosurg

Orbital tumors in childrenA clinical study of 62 cases

J Pediatr Ophthalmol

Tumors of the eye and adnexa in Africans of Uganda

Cancer

Expanding lesions of the orbit

Trans Ophthalmol Soc UK

Orbital tumors in African children

Br J Ophthalmol

Orbital space-occupying lesions. Four decades of Eye Hospital reports

Ann Ophthalmol

Original article
Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1☆