Survey of 1264 patients with orbital tumors and simulating lesions - The 2002 Montgomery Lecture, Part 1

Objective: To determine the incidence of specific orbital tumors based on patients referred to an ocular oncology center. Design: Retrospective, observational case series. Participants: A total of 1264 consecutive patients referred to an ocular oncology service because of space-occupying orbital lesions. Methods: A retrospective chart review was carried out for 1264 consecutive patients referred for a suspected orbital mass over a 30-year period. The lesions were grouped into general categories, as shown in Results. The specific diagnosis in each case was based on clinical findings, computed tomography scan results, magnetic resonance imaging results, and histopathologic analysis results, when available. The number and percentage of benign and malignant tumors per age group also was determined. Main Outcome Measures: The incidence of orbital tumors and pseudotumors. Results: Among 1264 consecutive patients, the number and percentage of lesions in each general category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13 (1 %); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1 %); lipocytic and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%); primary melanocytic lesions, 11 (<1 %); metastatic tumors, 91 (7%); lymphoma and leukemia lesions, 130 (10%); secondary orbital tumors, 142 (11 %); histiocytic lesions, 17 (1 %); thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11 %); and miscellaneous other lesions, 13 (1 %). The most common diagnoses were: lymphoid tumor (139 cases;11 %), idiopathic orbital inflammation (135 cases; 11 %), cavernous hemangioma (77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35 cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst (26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The percentage of malignant lesions was 20% in children (age range, 0-18 years), 27% in young adults and middle-aged patients (age range, 19-59 years), and 58% in older patents (age range, 60-92 years). Rhabdomyosarcoma was the most common malignancy in children, representing 3% of all orbital masses, and lymphoma was the most common malignancy in older patients, representing 10% of cases. Conclusions: A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions, 64% were benign and 36% were malignant. The percentage of malignant tumors increased with age, with malignancies being common in older patients because of the higher incidence of lymphoma and metastasis in the elderly. (C) 2004 by the American Academy of Ophthalmology.