Augenheilkunde up2date 2019; 9(02): 119-137
DOI: 10.1055/a-0650-5426
Tränenwege, Augenlider, Orbita
Georg Thieme Verlag KG Stuttgart · New York

Benigne Neoplasien der Orbita

Benign Neoplasms of the Orbit
Christoph von Sonnleithner
,
Malte Zorn
,
Eckart Bertelmann
Further Information

Publication History

Publication Date:
17 April 2019 (online)

Zusammenfassung

Die Vielfalt orbitaler Raumforderungen ist außerordentlich groß. Manche Entitäten sind sehr selten. Das häufigste Symptom ist der Exophthalmus, daneben können Bulbusdislokation, Strabismus, Schmerzen, Sehverschlechterung und Gesichtsfeldausfälle auftreten. Die Therapie der Wahl bei den meisten symptomatischen benignen Neoplasien der Orbita ist die chirurgische Resektion.

Abstract

Benign orbital neoplasms comprise a wide spectrum of different entities. The origin of the tumours can be epithelial or mesenchymal. Epithelial neoplasms of the orbit originate from the lacrimal gland. The most important tumour is the pleomorphic adenoma, which should not be biopsied but resected in toto. The most common intraconal neoplasm in adults is the cavernous hemangioma. Symptomatic cavernous hemangiomas should be treated. The treatment of choice for most symptomatic benign neoplasms of the orbit is surgical resection. Suitable surgical approaches are anterior transconjunctival and lateral orbitotomy. Cryoextraction is a minimally invasive technique that is particularly suitable for cavernous hemangiomas.

Kernaussagen
  • Gutartige Neoplasien der Orbita umfassen ein großes Spektrum unterschiedlichster Entitäten. Der Ursprung der Geschwülste kann epithelialer oder mesenchymaler Art sein.

  • Epitheliale Neubildungen der Orbita gehen von der Tränendrüse aus.

  • Die wesentliche Raumforderung ist das pleomorphe Adenom, das nicht biopsiert werden sollte, sondern in toto reseziert werden muss.

  • Die häufigste intrakonale Raumforderung bei Erwachsenen ist das kavernöse Hämangiom. Symptomatische kavernöse Hämangiome sollten behandelt werden.

  • Die Therapie der Wahl bei den meisten symptomatischen benignen Neoplasien der Orbita ist die chirurgische Resektion. Geeignete Zugänge sind die anteriore, transkonjunktivale und laterale Orbitotomie. Einen minimalinvasiven Zugang, der besonders bei kavernösen Hämangiomen geeignet ist, liefert die Kryoextraktion.

 
  • Literatur

  • 1 Riede UN, Schaefer HE, Wehner H. Allgemeine und spezielle Pathologie. 2. Aufl.. Stuttgart: Thieme; 1989
  • 2 Ro SR, Asbach P, Siebert E. et al. Characterization of orbital masses by multiparametric MRI. Eur J Radiol 2016; 85: 324-336
  • 3 Erb-Eigner K, Asbach P, Ro SR. et al. DCE-MR imaging of orbital lesions: diagnostic performance of the tumor flow residence time τ calculated by a multi-compartmental pharmacokinetic tumor model based on individual factors. Acta Radiol 2018; DOI: 10.1177/0284185118795324.
  • 4 Sahlmüller M, Schroeter J. Idiopathic inflammatory orbitopathy. Klin Monbl Augenheilkd 2011; 228: 827-840 quiz 841–842 doi:10.1055/s-0031-1280222
  • 5 Léauté-Labrèze C, Dumas de la Roque E, Hubiche T. et al. Propranolol for severe haemangiomas of infancy. N Engl J Med 2008; 358: 2649-2651
  • 6 Avigitidou G, Koch RK, Cursiefen C. et al. Current aspects of eyelid, lacrimal and orbital surgery in childhood. Ophthalmologe 2015; 112: 102-109
  • 7 Sherman RP, Rootman J, Lapointe JS. Orbital dermoids: clinical presentation and management. Br J Ophthalmol 1984; 68: 642-652
  • 8 Cavazza S, Laffi GL, Lodi L. et al. Orbital Dermoid Cyst of Childhood: Clinical Pathologic Findings, Classification and Management. Int Ophthalmol 2011; 31: 93-97
  • 9 Shields CL, Shields JA. Lacrimal gland tumors. Int Ophthalmol Clin 1993; 33: 181-188
  • 10 Rose GE, Wright JE. Pleomorphic adenoma of the lacrimal gland. Br J Ophthalmol 1992; 76: 395-400
  • 11 Lai T, Prabhakaran VC, Malhotra R. et al. Pleomorphic adenoma of the lacrimal gland: is there a role for biopsy?. Eye (Lond) 2009; 23: 2-6
  • 12 Bertelmann E, Minko N. Safety of the preoperative evaluation of pleomorphic adenoma: a retrospective analysis. Klin Monatsbl Augenheilkd 2012; 229: 231-235
  • 13 Fletcher CDM. Diagnostic Histopathology of Tumors. London: Churchill Livingston Elsevier; 2007
  • 14 Shields JA, Shields CL, Scartozzi R. . Survey of 1264 patients with orbital tumors and simulating lesions. Ophthalmology 2004; 111: 997-1008
  • 15 Chandrasekhar J, Farr DR, Whear NM. Pleomorphic adenoma of the lacrimal gland: case report. Br J Oral Maxillofac Surg 2001; 39: 390-393
  • 16 Iyeyasu J, Reis F, Altemani A. et al. An unusual presentation of lacrimal gland pleomorphic adenoma. Rev Bras Oftalmol 2013; 72: 338-340
  • 17 Aghaghazvini L, Salahshour F, Yazdani N. et al. Dynamic contrast-enhanced MRI for differentiation of major salivary glands neoplasms, a 3-T MRI study. Dentomaxillofac Radiol 2015; 44: 20140166
  • 18 Zheng N, Li R, Liu W. et al. The diagnostic value of combining conventional, diffusion-weighted imaging and dynamic contrast-enhanced MRI for salivary gland tumours. Br J Radiol 2018; 91: 20170707
  • 19 Eida S, Sumi M, Sakihama N. et al. Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 2007; 28: 116-121
  • 20 Assili S, Fathi Kazerooni A, Aghaghazvini L. et al. Dynamic contrast magnetic resonance imaging (DCE-MRI) and diffusion weighted MR imaging (DWI) for differentiation between benign and malignant salivary gland tumors. J Biomed Phys Eng 2015; 5: 157-168
  • 21 Font RL, Gamel JW. Epithelial Tumors of the lacrimal Gland: an Analysis of 265 Cases. In: Jakobiec FA. ed. Ocular and adnexal Tumors. Birmingham, AL: Aesclulapius Publishers Inc; 1978: 787-805
  • 22 Wright JE, Steward WB, Krohel GB. Clinical presentation and management of lacrimal gland tumors. Br J Ophthalmol 1979; 63: 600-606
  • 23 Wright JE. Factors affecting the survival of patients with lacrimal gland tumors. Can J Ophthalmol 1982; 17: 3-9
  • 24 Mensink HW, Mooy CM, Paridaens D. In situ adenocarcinoma ex pleomorphic adenoma of the lacrimal gland. Clin Experiment Ophthalmol 2005; 33: 669-671
  • 25 Currie ZI, Rose GE. Long-term risk of recurrence after intact excision of pleomorphic adenomas of the lacrimal gland. Arch Ophthalmol 2007; 125: 1643-1646
  • 26 Leatherbarrow B. Oculoplastic Surgery. 2nd ed.. ed. London: Informa Healthcare; 2011
  • 27 Tunç M, Sadri E, Char DH. Orbital lymphangioma: an analysis of 26 cases. Br J Ophthalmol 1999; 83: 76-80
  • 28 Graeb DA, Rootman J, Robertson WD. et al. Orbital lymphangiomas: clinical, radiologic and pathologic characteristics. Radiology 1990; 175: 417-421
  • 29 Bond JB, Haik BG, Taveras JL. et al. Magnetic resonance imaging of orbital lymphangioma with and without gadolinium contrast enhancement. Ophthalmology 1992; 99: 1318-1324
  • 30 Suzuki Y, Obana A, Lohto Y. et al. Management of orbital lymphangioma using intralesional injection of OK-432. Br J Ophthalmol 2000; 84: 614-617
  • 31 Poonyathalang A, Preechawat P, Jiarakongmun P. et al. Sclerosing therapy for orbital lymphangioma using sodium tetradecyl sulfate. Jpn J Ophthalmol 2008; 52: 298-304
  • 32 Wojno TH. Sotradecol (sodium tetradecyl sulfate) injection of orbital lymphangioma. Ophthal Plast Reconstr Surg 1999; 15: 432-437
  • 33 Boulos PR, Harissi-Dagher M, Kavalec C. et al. Intralesional injection of Tisseel fibrin glue for resection of lymphangioma and other thin walled orbital cysts. Ophthalmic Plast Reconstr Surg 2005; 21: 171-176
  • 34 Deparis SW, Goldberg AN, Indaram M. et al. Paranasal sinus mucocele as a late complication of dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2017; 33 (3S Suppl 1): S23-S24
  • 35 Sheyn A, Naylor T, Lenes-voit F. et al. Maxillary sinus mucoceles and other side effects ofexternal-beam radiation in the pediatric patient: A cautionary tale. Ear Nose Throat J 2017; 96: E27-E28
  • 36 Scangas GA, Gudis DA, Kennedy DW. The natural history and clinical characteristics of paranasal sinus mucoceles: a clinical review. Int Forum Allergy Rhinol 2013; 3: 712-717
  • 37 Prendes MA, Perszyk I, Horkey D. et al. Isolated orbital mucoceles in the absence of obstructive sinus disease. Orbit 2017; 36 (06) 388-391
  • 38 Devars du Mayne M, Moya-Plana A, Malinvaud D. et al. Sinus mucocele: natural history and long-term recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129: 125-130
  • 39 Tailor R, Obi E, Burns J. et al. Fronto-orbital mucocele and orbital involvement in occult obstructive frontal sinus disease. Br J Ophthalmol 2016; 100: 525-530
  • 40 Carroll GS, Haik BG, Fleming JC. et al. Peripheral nerve tumors of the orbit. Radiol Clin North Am 1999; 37: 195-202 xi–xii
  • 41 Rootman J, Goldberg C, Robertson W. Primary orbital schwannomas. Br J Ophthalmol 1982; 66: 194-204
  • 42 Zhang ML, Suarez MJ, Bosley TM. et al. Clinicopathologic features of peripheral nerve sheath tumors involving the eye and ocular adnexa. Hum Pathol 2017; 63: 70-78
  • 43 Wang Y, Xiao LH. Orbital schwannomas: findings from magnetic resonance imaging in 62 cases. Eye (Lond) 2008; 22: 1034-1039
  • 44 Lee LR, Gigantelli JW, Kincaid MC. Localized neurofibroma of the orbit: a radiographic and histopathologic study. Ophthal Plast Reconstr Surg 2000; 16: 241-246
  • 45 Karcioglu Z. Clinicopathologic Correlates in orbital Disease. Duaneʼs Foundations of clinical Ophthalmology, Vol. 3, Chapter 17. Philadelphia: Lippincott Williams & Wilkins; 2006
  • 46 Misra S, Gogri P, Misra N. et al. Recurrent neurofibroma of the orbit. Australas Med J 2013; 6: 189-191
  • 47 Van Zuuren EJ, Posma AN. Diffuse neurofibroma on the lower back. J Am Acad Dermatol 2003; 48: 938-940
  • 48 Kumar BS, Gopal M, Talwar A. et al. Diffuse neurofibroma of the scalp presenting as circumscribed alopecic patch. Int J Trichology 2010; 2: 60-62
  • 49 Falzon K, Drimitzas E, Picton S. et al. Visual outcomes after chemotherapy for optic pathway glioma in children with and without neurofibromatosis type 1: results of the International Society of Paediatric Oncology (SIOP) Low-Grade Glioma 2004 trial UK cohort. Br J Ophthalmol 2018; 102: 1367-1371 doi:10.1136/bjophthalmol-2017-311305
  • 50 Wilhelm H. Meningeome im Bereich der vorderen Sehbahn. Ophthalmologe 2013; 110 (05) 403-407
  • 51 Haroche J, Cohen-Aubart F, Emile JF. et al. Reproducible and sustained efficacy of targeted therapy with vemurafenib in patients with BRAF(V600E)-mutated Erdheim-Chester disease. J Clin Oncol 2015; 33: 411-418
  • 52 Heisig A, Sörensen J, Zimmermann SY. et al. Vemurafenib in Langerhans cell histiocytosis: report of a pediatric patient and review of the literature. Oncotarget 2018; 9: 22236-22240
  • 53 Faber W, Kock E, Landau I. et al. Trochleanahes Chondrom der Orbita. Klin Monatsbl Augenheilkd 1992; 200: 138-139 doi:10.1055/s-2008-1045727