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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 26 |
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Characterization of orbital tumors and simulating lesions diagnosed in a referral hospital in Colombia during 2010–2020: 84 cases
Luis Alberto Ruiz Robles, Christian Esteban Paba Rojas, Sara Margarita Pérez Pérez, Stephanie Noriega
Department of Ophthalmology, San Ignacio Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| Date of Submission | 13-May-2023 |
| Date of Decision | 31-May-2023 |
| Date of Acceptance | 05-Jun-2023 |
| Date of Web Publication | 27-Jul-2023 |
Correspondence Address:
Sara Margarita Pérez Pérez
Seventh Street #40-62, Bogota 111121
Colombia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/pajo.pajo_31_23
Design: Observational, descriptive, and retrospective. Participants: A total of 84 patients diagnosed with tumor and simulating lesions in the ophthalmology unit ot the Hospital Universitario San Ignacio between 2010 – 2020. Methods: All patients with a ICD10 code according to tumoral or inflammatory disease of the orbit at Hospital Universitario San Ignacio between January 2010 and December 2020 were included, and the diagnosis was confirmed with the clinical history. Pathology was classified according to the histopathological report or definitive diagnosis made with diagnostic tests/imaging. Additionally, the following data were obtained: age, sex, history, evolution time, lesion origin (primary, invasion, or metastasis), laterality, location in relation to the muscular cone, lesion size, symptoms, signs, presence of adenomegaly, extension, diagnostic approaches, histopathological diagnosis, intra/extrahospital treatment, and outcome. A virtual data collection format was developed for data collection, with subsequent descriptive analysis reporting percentages. Results: In adult patients (over 18 years old), 60 lesions were diagnosed. The most frequent tumor pathologies in this group correspond to squamous cell carcinoma of the eyelid with invasion into the orbit, 6 cases (18.75%), cavernous hemangioma, 4 (12.5%), lymphoid tumors, 4 (12.5%), schwannoma, 2 (6.25%), and pleomorphic adenocarcinoma, 2 (6.25%). The main simulating lesion in the adult population corresponds to thyroid orbitopathy, which is attributed to 33.3% of all tumor or non-tumor lesions. In patients under 18 years of age, 24 lesions were diagnosed. The most frequent pathologies in this group corresponded to retinoblastoma, 11 cases (45.8%), rhabdomyosarcoma, 5 (20.8%), and cavernous hemangioma, 2 (8.3%). In patients under 18 years of age, 54.1% of cases resulted in loss of the eyeball. Conclusion: During the period from January 2010 to December 2020, 84 orbital tumors and simulating lesions were diagnosed. The most frequent tumor lesion in adults corresponds to squamous cell carcinoma of the eyelid with invasion into the orbit, and in patients under 18 years of age, it corresponds to retinoblastoma. Greater secondary loss of the eyeball is documented in this latter population group, requiring enucleation or evisceration in 54.1% of cases.
Keywords: Inflammatory orbital diseases, orbital tumors, retinoblastoma, thyroid orbitopathy
How to cite this article:
Ruiz Robles LA, Paba Rojas CE, Pérez Pérez SM, Noriega S. Characterization of orbital tumors and simulating lesions diagnosed in a referral hospital in Colombia during 2010–2020: 84 cases. Pan Am J Ophthalmol 2023;5:26 |
How to cite this URL:
Ruiz Robles LA, Paba Rojas CE, Pérez Pérez SM, Noriega S. Characterization of orbital tumors and simulating lesions diagnosed in a referral hospital in Colombia during 2010–2020: 84 cases. Pan Am J Ophthalmol [serial online] 2023 [cited 2023 Sep 27];5:26. Available from: https://www.thepajo.org/text.asp?2023/5/1/26/382403 |
| Introduction | |  |
In ophthalmology, multiple diseases impact the quality of life of patients. However, a spectrum of orbit conditions, tumors, and simulating lesions is described, which requires timely diagnosis and accurate treatment to preserve the individual's life. Unfortunately, these lesions have not been characterized in the Colombian population, limiting their proper diagnosis and treatment.
Orbital tumors encompass a wide spectrum of lesions that can be classified according to age group, tissue of origin, histopathological characteristics, anatomical location in the orbit, and demographic characteristics of the patient. In addition, tumors can be classified as primary when they are originated from orbital structures, secondary when originating from tissues adjacent to the orbit, and metastatic when the lesion is the result of hematogenous dissemination.[1]
These lesions can represent high economic burdens for patients, their families, and health-care systems. In 2020, Zhou et al. reported costs associated with caring for patients with retinoblastoma (the most common orbital tumor in the pediatric population) in China. On average, nonmedical costs corresponded to $12,252.93 ± 9872.64 ($728.86–48,104.95) US dollars (USD), and medical costs were around $15,034.48 ± 8224.19 $3963.99–36,826.53) USD. In addition, the family members of these patients lost an average of $13,512.23 ± 11,545.83 USD, with a reduction in work time of 11.50 ± 8.06 months.[2]
In the Hispanic American population, Ramirez-Ortiz et al. published in 2005 that the average cost of medical treatment in patients with intraocular retinoblastoma during the 1st year after diagnosis was, on average, 20,200 USD compared to 34,100 USD in patients with extraocular disease.[2] In addition to their economic impact, orbital tumors are associated with high mortality, tumors such as adenoid cystic carcinoma in its basaloid variant report 5-year survival rates of 21%.[3]
In addition, Gündüz and Yanık[4] indicated that the low incidence of these lesions limits their study, causing the lack of clinical trials and limiting diagnostic/therapeutic recommendations to those of case reports and small retrospective studies. In Colombia, descriptive epidemiological studies regarding orbital tumors are scarce, and this document aims to establish a better understanding of these lesions and their behavior in our population.
| Materials and Methods | | |
All patients with the International Classification of Disease-10 code according to tumoral or inflammatory disease of the orbit at Hospital Universitario San Ignacio between January 2010 and December 2020 were included in the study, and the diagnosis was confirmed with the clinical history. Pathology was classified according to the histopathological report or definitive diagnosis made with diagnostic tests/imaging. In addition, the following data were obtained: age, sex, history, evolution time, lesion origin (primary, invasion, or metastasis), laterality, location in relation to the muscular cone, lesion size, symptoms, signs, presence of adenomegaly, extension, diagnostic approaches, histopathological diagnosis, intra/extrahospital treatment, and outcome. A virtual data collection format was developed for data collection, with subsequent descriptive analysis reporting percentages.
| Results | | |
During the period from January 2010 to December 2020, 84 tumor lesions or simulators of tumor lesions of the orbit were diagnosed; of these, 60 lesions were diagnosed in patients older than 18 years, and in this population group, 75% of the patients were younger than 60 years, 58% were male, 97% had no history predisposing to tumor pathology, and bilateral involvement included 37% of cases. The main sign documented was proptosis in 72% of cases. Exenteration was required in 8.3% of cases and 16% presented extraorbital tumor involvement at the time of initial diagnosis or during follow-up. The most frequent tumor pathologies were: squamous cell carcinoma of the eyelid with invasion to the orbit (18.75% – 6/32 cases), cavernous hemangioma (12.5% – 4/32 cases), lymphoid tumors (12.5% – 4/32 cases), and schwannoma and pleomorphic adenocarcinoma (each 6.25% – 2/32 cases). The main simulating lesion corresponds to thyroid orbitopathy, which is attributed to 33.3% of the total lesions in those older than 18 years (20/60 cases) [Figure 1] and [Table 1].
In patients under 18 years of age, 24 lesions were diagnosed, 62% of these were diagnosed in males, 88% had no pathologic history before diagnosis, 91.6% of the lesions were of orbital origin, and 50% were present in the muscular cone. Bilateral involvement was described in 22% of patients and 42% were limited to the right orbit. No extraorbital extension was documented in 54% of cases and the main primary tumors in case of metastasis originated in the central nervous system (three cases), lung (three cases), and bone system (two cases). Loss of the eyeball was recorded in 54.1% of patients under 18 years of age; of these, exenteration was required in 23.07% and enucleation in 76.9% of cases. Two deaths were documented, corresponding to 8.33% of cases; however, follow-up after the initial diagnosis was lost ineight cases.
The most frequent pathologies in children under 18 years of age correspond to: retinoblastoma (11 cases – 45.8%), rhabdomyosarcoma (5 cases – 20.8%), and cavernous hemangioma (2 cases – 8.3%). During the documented period, neuroblastoma, myofibrosarcoma, pleomorphic adenoma, Galeano's vein malformation, lymphangioma, and orbital pseudotumor (one case per pathology – 4.1%) were reported [Figure 2] and [Table 2]. | Figure 2: Distribution of orbital tumors in a patient under 18 years of age
Click here to view |
| Discussion | | |
In Colombia and Latin America, information regarding orbital tumors and simulating lesions is limited; most publications consist of case reports or studies with small samples.
In 2012, Moscote-Salazar et al. published their experience in the Neurosurgery Department of the National Cancer Institute, Bogotá D.C., during the years 2002–2008; they reported a total of 35 cases, documenting meningothelial meningioma (24% of cases), metastasis (15%), inverted papilloma (6%), and optic nerve glioma (6%) as the most frequent pathologies throughout 6 years that comprised the study.[5]
According to our research, the largest Latin American study focused on orbital tumors corresponds to one published by Sirianni et al. documenting their experience over 12 years in a Referral Hospital in Brazil, with 269 patients. Similar to the present study, the main lesion documented corresponds to eyelid skin tumors with invasion to the orbit; however, they report a predominance of basal cell carcinoma, contrary to the squamous cell carcinoma reported in our institution. The most frequent lesions reported by Sirianni et al. were basal cell carcinoma with invasion to the orbit (57.9%), retinoblastoma (17.1%), squamous cell carcinoma of the conjunctiva (7.4%), and melanoma (6.7%).[6]
In 2004, Shields et al. described 1264 cases of orbital tumors and simulating lesions diagnosed over 30 years at an Ophthalmology Oncology Referral Center in the United States. The authors report as the most frequent tumor lesions: lymphoid tumors (11%), cavernous hemangioma (6%), lymphangioma (4%), meningioma (4%), optic nerve glioma (4%), and metastasis secondary to breast cancer (4%).[7]
Regarding simulating lesions in our study, the main one corresponds to thyroid orbitopathy, and this contrasts with the report by Shields et al.,[7] who describe nonspecific orbital inflammation (NOI) as the main simulator in 11% of cases. In 2012, Gonzalez-Gomar also reported NOI as the main simulator in a study conducted at the Conde de Valenciana Institute in Mexico City over 5 years and collected information on 73 cases.[8]
When comparing studies, discrepancies are found. Shields et al.[7] explained these findings in biases secondary to the specialty of interest of the authors, the implementation or not of histological confirmation, and the geographic area of the patients, among other factors.[8] This, together with the low incidence of these lesions and the lack of studies, limits the diagnostic and therapeutic recommendations. More studies are required to achieve an adequate identification of the most frequent orbital lesions in the Colombian population.
| Conclusions | | |
This is an approximation of orbital tumors in a country such as Colombia, yet not been done before, so it provides an inside to the most prevalent tumors in Latin American countries.
Acknowledgments
The author would like to thank San Ignacio Hospital for permitting access to the clinical history of the patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Gündüz A, Yeşiltaş Y, Shields C. Orbital tumors: A systematic review: Part I. Expert Rev Ophthalmol 2015;10:465-83.  |
| 2. | Ramírez-Ortiz MA, Ponce-Castañeda MV, Cabrera-Muñoz ML, Medina-Sansón A, Liu X, Orjuela MA. Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma. Cancer Epidemiol Biomarkers Prev 2014;23:784-92. doi: 10.1158/1055-9965.EPI-13-1069. |
| 3. | Gamel JW, Font RL. Adenoid cystic carcinoma of the lacrimal gland: The clinical significance of a basaloid histologic pattern. Hum Pathol 1982;13:219-25. |
| 4. | Gündüz K, Yanık Ö. Myths in the diagnosis and management of orbital tumors. Middle East Afr J Ophthalmol 2015;22:415-20. |
| 5. | Moscote-Salazar LR, Alcalá-Cerra G, Penagos-González P, Zubieta-Vega C, Alberto Meneses C, Castellar-Leones SM. Orbital tumors: Experience with 35 cases. Bol Asoc Med P R 2012;104:32-4. |
| 6. | Sirianni D, Leles CR, Mendonça EF. A 12-year retrospective survey of management of patients with malignant neoplasms in the orbital cavity in a Brazilian cancer hospital. Open Dent J 2013;7:140-5. |
| 7. | Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery lecture, part 1. Ophthalmology 2004;111:997-1008. |
| 8. | Gonzalez-Gomar A, Tovilla-Canales J, Villalvazo-Cordero L, Hernandez-Robledo F. Orbital tumors: Frequency, distribution by age and clinical-histopathologic correlation over a five-year period at a referral center. Years in a referral center. Rev Mex Ophthalmol 2012;86:171-6. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
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