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Differential Diagnosis and Therapy of Infiltrative Orbital Lesions in 43 Patients

1Holbach L., 2Kottler U. B., 1Müller E., 3Kirchner T.,
1Friedrich-Alexander-Universität, Augenklinik (Erlangen)
2Johannes-Gutenberg-Universität Mainz, Universitäts-Augenklinik (Erlangen)
3Friedrich-Alexander-Universität, Pathologisches Institut (Erlangen)

Purpose: Lymphoproliferative tumors and non-specific orbital inflammation (NSOI) represent the two most common types of infiltrative orbital lesions. A retrospective study was performed in 43 patients.
Patients and Methods: The clinical diagnosis was confirmed by biopsy in 25 patients with lymphoproliferative tumors and in 15 of 18 patients with NSOI. Incisional biopsy and surgical debulking were performed in 37 patients using anterior (transconjunctival or transseptal) orbitotomy, in two using lateral orbitotomy. One patient required eyelid-sparing exenteration.
Results: The lymphoproliferative tumors included extranodal marginal zone (MALT) lymphoma in 17 patients, diffuse large cell B-cell lymphoma in 4, reactive lymphoid hyperplasia in two, plasmocytoma in one, follicle center lymphoma in one patient. 15 patients with chronic NSOI showed the following types: 12x lymphoplasmacellular/sclerosing, 1x granulomatous, 1x eosinophilic, 1x necrotizing. The most common symptoms/signs were: 1. Nodule/swelling, 2. Irritation/proptosis, 3. Motility/vision impairment.
Conclusions: The histopathologic diagnosis was essential in all patients with lymphoproliferative lesions. Surgical debulking, often in combination with immunosuppressive therapy, was safe and efficient in many patients with NSOI and no evidence of optic nerve compression.

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