Abstract

SO.08.05

Current and new clinicopathologic concepts in orbital diseases – a retrospective study of 270 patients with orbitotomy

Leonard Holbach1, Ludwig M. Heindl1, Mansour Tarif1, Friedrich E. Kruse1, Arndt Hartmann2
1Universitäts-Augenklinik Erlangen, 2Pathologisches Institut der Universität Erlangen-Nürnberg, Erlangen

Purpose
To evaluate the spectrum and frequency of biopsy results obtained by anterior or lateral transosseous orbitotomy in 270 patients.
Patients and Methods
270 consecutive patients who underwent anterior or lateral orbitotomy were enrolled in this clinical retrospective single-center study. Clinical symptoms and signs were correlated with differential diagnosis, surgical approach and histopathologic findings. Diagnoses were elaborated according to recent guidelines of the WHO classification for tumors. The new TNM-classification (2009) was applied for the staging of orbital malignancies.
Results
The mean age of the patients (153 females and 117 males) at the time of surgery was 47.2 years (range 1-88 years). The diagnosis was obtained by incisional or excisional biopsy. Lymphoid tumors (lymphoid hyperplasia, Non-Hodgkin B-or T-cell lymphoma) with 22% were the most common lesion, followed by vascular tumors (capillary/cavernous hemangioma, lymphangioma, hemangiopericytoma) 17%, dermoid cysts 10%, inflammatory lesions (idiopathic orbital inflammation, sarcoidosis, Wegener’s granulomatosis, nodular fasciitis) 8%, metastases 7%, lacrimal gland tumors (pleomorphic adenoma, dacryops, adenoid-cystic carcinoma, ductal adenocarcinoma, myoepithelial carcinoma) 7%, peripheral nerve tumors (schwannoma, neurofibroma, meningeoma) 5%, mesenchymal tumors (solitary fibrous tumors) 1%, myogenic tumors (rhabdomyosarcoma) 1%, histiocytic tumors (fibrous histocytoma, xanthogranuloma, Langerhans’ cell histiocytosis) 1%, bony tumors (osteoma, fibrous dysplasia, chondromyxoid fibroma) 1% and others (foreign-body granuloma etc.) 10%.
Conclusions
Recent WHO-guidelines are helpful for a standardized classification of orbital diseases. This is useful for the diagnosis of new entities such as described in the present study (e.g. bony orbital chondromyxoidfibroma, myoepithelial carcinoma of the lacrimal gland or T-cell lymphoma). The application of the new TNM-system (2009) is important for a uniform staging of patients with orbital malignancies. Both are important regarding the comparison of study results and multicenter trials.

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