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Case Forty Nine - Orbital Lymphoma

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Clinical History: This is a 66 year old male with a history of proptosis and diminished visual acuity.

Findings: These axial CT images through the orbits demonstrate a relatively homogeneous, slightly dense mass within the intraconal region of the left orbit. There is no evidence for osseous destruction.

Diagnosis: Orbital lymphoma.

Discussion: Lymphoma is a solid tumor of the immune system. The majority are B-cell type non-Hodgkin's lymphoma. The orbital lymphoma is most often a sequelae of systemic disease, but primary orbital lymphoma is not uncommon. Actually, it is the third most common cause of unilateral proptosis after pseudotumor and orbital hemangioma. Orbital lymphoma has a predilection for the anterior and superior portions of the orbit, may occur anywhere intraconal or extraconal including a few case reports of intraoccular lymphoma. They are most commonly discovered in the region of the lacrimal gland, retrobulbar area, or within the superior orbital compartment. Orbital lymphoma characteristically molds itself to adjacent structures without eroding the bone. These lesions most often become clinically symptomatic in a slowly progressive manner, with patients presently with proptosis, pain, and soft tissue swelling, as well as with alterations in visual acuity. The CT appearance is generally nonspecific and may be quite difficult to distinguish from orbital pseudotumor. Lymphoma tends to be homogenously high density lesions without evidence for osseous erosions.

References:

  1. Flanders AE. Orbital Lymphoma Role of CT and MRI.
    Radiologic Clinics of North America. 1987;25:601-612.
  2. Harnsberger R. Head and Neck Imaging. Mosby,
    St. Louis; 1990:370-371.
  3. Valvassori G. Imaging of the Head and Neck. Thieme
    Medical Publishers, Inc. 1995.
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Submitted by:
Vince Keiser, M.D.
Charles F. Lanzieri, M.D.