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      Orbital lymphoma: imaging features and differential diagnosis

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          Abstract

          Purpose

          Patterns of orbital lymphoma at diagnosis and follow-up are described. We also discuss differential diagnosis of orbital masses.

          Materials and methods

          This pictorial review contains 19 cases of orbital lymphoma before and after treatment. Superior-lateral quadrant and extra-conal location were observed predominantly. Effective response after treatment was presented on follow-up imaging, although few local relapses were found. Further follow-up showed no changes of residual images.

          Discussion

          Location of orbital masses can help in the differential diagnosis. Moreover, imaging features of lymphoma at diagnosis can be useful in planning surgical biopsy. Pattern of follow-up described may be relevant on monitoring imaging.

          Teaching points

          Orbital lymphoma involves mainly superior-lateral quadrant and the orbital structures inside .

          Location of retrobulbar mass-like lesions are useful information in the differential diagnosis .

          Satisfactory response is detected after treatment, however relapse is noted, so follow-up is needed .

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          Most cited references26

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          Inflammatory pseudotumor.

          Inflammatory pseudotumor is a quasineoplastic lesion that most commonly involves the lung and the orbit, but it has been reported to occur in nearly every site in the body. The pathogenesis, natural history, clinical presentation, imaging findings, and treatment options for inflammatory pseudotumor in the lung, heart, gastrointestinal tract, adrenal gland, iliopsoas muscle, orbit, and central nervous system are discussed. Because inflammatory pseudotumors mimic malignant tumors both clinically and radiologically, the radiologist should be familiar with this entity and help avoid unnecessary radical surgery when possible.
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            Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome.

            Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is a distinct lymphoma with unique clinicopathologic features. We report the clinical outcome of stage I and II MALT lymphoma treated with involved field radiation therapy (RT). From 1989 to 2000, 103 patients with stage IE and IIE disease were referred. Their median age was 60 years, with a 2:1 female predominance. Presenting sites were stomach (17 patients), orbital adnexa (31 patients), salivary glands (24 patients), thyroid gland (13 patients), and other sites (18 patients). Ninety-three patients received RT--85 received RT alone, and eight received chemotherapy and RT--with a median dose of 30 Gy. The median follow-up time was 5.1 years. A complete response (CR) to RT alone was achieved in 84 of 85 patients. Among CR patients, 14 experienced relapse. Relapse sites were mostly contralateral paired-organ or distant MALT locations and, infrequently, lymph nodes. The crude local control rate with RT was 95.3% (81 of 85 patients). No relapses were observed in patients with stomach or thyroid lymphoma, whereas 14 of 63 patients (22%) experienced relapse in the other sites. The overall 5-year survival rate was 98%, and the disease-free survival rate was 77%. Transformed lymphoma was observed in 14% of patients (two of 14) experiencing relapse. Moderate-dose RT achieved excellent local control in localized MALT lymphomas and had curative potential for three fourths of the patients. Gastric and thyroid MALT lymphomas had better outcome, whereas distant failures were common for other sites. Despite relapse, the disease often maintained an indolent course.
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              Orbital metastases: diagnosis and course.

              Three issues were investigated in adult outpatients with orbital metastases. One, how accurate are current diagnostic methods? Two, what is the survival associated with orbital metastases? Three, did any clinical factors correlate with prognosis in this patient cohort? Retrospective analysis of patients with orbital metastases managed in an ocular oncology unit. 11 of 31 (35%) patients had no known primary malignancy at the time of orbital diagnosis. In eight of 31 (26%) computed tomography and/or magnetic resonance imaging data did not yield the diagnosis of metastases. In 15 of 17 (88%) cases a fine needle aspiration biopsy was diagnostic. Several types of therapy were used. The median survival was 1.3 years. Orbital metastases, even with newer diagnostic techniques can be difficult to diagnose. Management was based on location and extent of both orbital and systemic disease as well as vision. In most cases, orbital symptoms were palliated; however, survival was dismal. No clinical factor correlated with prognosis.
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                Author and article information

                Contributors
                gemika@gmail.com
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1869-4101
                18 April 2012
                18 April 2012
                August 2012
                : 3
                : 4
                : 337-344
                Affiliations
                Department of Radiology, Hospital Universitari de Bellvitge, Feixa Llarga, s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain
                Article
                156
                10.1007/s13244-012-0156-1
                3481074
                22695946
                d87406e7-bf86-4d25-8ac1-5a54ce8b1c41
                © European Society of Radiology 2012
                History
                : 22 November 2011
                : 7 February 2012
                : 21 February 2012
                Categories
                Pictorial Review
                Custom metadata
                © European Society of Radiology 2012

                Radiology & Imaging
                orbit,magnetic resonance imaging,orbital adnexa,lymphoma,computed tomography
                Radiology & Imaging
                orbit, magnetic resonance imaging, orbital adnexa, lymphoma, computed tomography

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