Pseudotumor : Distribution, Clinical Features, Treatment Outcomes

Sung Joon Park; Sin So Jung; Dea Gyu Lee; Jea Woo Jang

doi:10.3341/jkos.2008.49.9.1379

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Park, Jung, Lee, and Jang: Pseudotumor : Distribution, Clinical Features, Treatment Outcomes

Original Article

J Korean Ophthalmol Soc 2008;49(9):1379-1386.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1379

Pseudotumor : Distribution, Clinical Features, Treatment Outcomes

Sung Joon Park, M.D.¹, Sin So Jung, M.D.¹, Dea Gyu Lee, M.D.², Jea Woo Jang, M.D.^1,

¹Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University, Kim’s Eye Hospital, Seoul, Korea

²Department of Ophthalmology, Cheju National University, College of Medicine, Jeju, Korea

Address reprint requests to Jea Woo Jang, M.D.Department of Ophthalmology, Konyang University, Kim’s Eye Hospital #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7777, Fax: 82-2-2633-3976, E-mail: greatj@unitel.co.kr

Received 26 August 2008 Accepted 17 June 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical characteristics and results of outcomes in different types of orbital pseudotumor.

Methods

This study included 62 patients diagnosed with orbital pseudotumor between 2002 and 2007, who were followed-up for more than 6 months. The pseudotumor was classified into anterior, diffuse, apical, myositic, or lacrimal types according to computed tomography (CT) findings. All patients were initially treated with corticosteroids and checked for symptom improvement and response to the corticosteroids.

Results

Lacrimal type pseudotumor (61%, 39/62) showed the highest incidence, and lid swelling (97%, 60/62) was the most common symptom. Response rate to corticosteroid treatment was 84%, and the recurrence rate was 29%.

Conclusions

The orbital pseudotumors were localized by computed tomography and classified to compare the symptoms, treatment efficacy and recurrence rates between the different types. The orbital pseudotumor is most commonly diagnosed based on clinical symptomsand radiologic features without biopsy. The orbital pseudotumor showed a good treatment response but also a high recurrence rate. Therefore, when starting treatment, it is important to consider differential diagnosis. It is recommended to carefully examine patients who have lid swelling for a few weeks with computed tomography before using corticosteroid treatment.

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Keywords: Corticosteroid, Distribution, Pseudotumor

References

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Figure 1.

Anterior type, CT image shows a ragged infiltration involvingthe anterior soft tissue of the right orbit and surrounding the right globe.

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Figure 2.

Diffuse type, CT scan shows soft tissue infiltration involving the entire orbit, extending from the apex to the posterior margin of the right globe.

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Figure 3.

Apical type, CT scan shows a mass of the apex of the right orbit with extension along the posterior portion of the extraocular muscles and the optic nerve.

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Figure 4.

Myositic type, CT scan shows enlargement of the right medial rectus muscle with involvement of the tendon sheath..

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Figure 5.

Lacrimaltype, CT scan shows right lacrimal gland enlargement.

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Table 1.

Demographics of 62 patients

Age (M:F) (years)	45.5±1.1 (47.1±0.9:42.1±1.1)*
Gender (M:F) (%)	23 (37.1):39 (62.9)
No. of Unilateral : Bilateral involvement (%)	53 (85.5):9 (14.5)
Follow-up time (months)	7.2±0.7*
Duration for recurrence (months)	6.1±2.7*

Mean±standard deviation.

Table 2.

Frequency and mean age of different subtypes

	Subtype	No. of patients
Lacrimal	39 (61%)	44±15.3
Myositic	8 (13%)	43±10.0
Anterior	8 (13%)	48±13.7
Diffuse	6 (11%)	52±14.3
Apical	1 (2%)	67
Total	62 (100%)	45.5±13.2

^∗ Mean±standard deviation.

Table 3.

The chief complaints in 62 patients with orbital pseudotumor

Subtype	No.	Lid swelling	Ocular pain	chemosis	diplopia
Lacrimal	39	39 (100%)	12 (31%)	15 (39%)	4 (10%)
Myositic	8	6 (75%)	4 (50%)	1 (12%)	7 (88%)
Anterior	8	8 (100%)	2 (25%)	2 (28%)	0 (0%)
Diffuse	6	6 (100%)	4 (50%)	2 (33%)	2 (33%)
Apical	1	1 (100%)	1 (100%)	1 (100%)	1 (100%)
Total	62	60 (97%)	23 (37%)	21 (34%)	14 (22%)

Table 4.

The characteristics of steroid effectiveness

Subtype	Onset and treatment interval∗ (days)	Effectiveness	Recurrence	Duration for recurrence (months)
Lacrimal	49.2±47.1	32/39 (82%)	8/32 (25%)	Duration for recurrence (months)	9.3±20.5
Myositic	2.6±3.6	8/8 (100%)	2/8 (25%)	2.5±0.7
Anterior	63.3±2.1	6/8 (75%)	5/6 (83%)	3.2±2.3
Diffuse	27.6±63.3	5/6 (83%)	2/5 (40%)	2.8±3.2
Apical	37.5±0.0	1/1 (100%)	1/1 (100%)	2.5±0.7
Total	45.6±33.6	52/62 (84%)	18/62(29%)	6.1±2.7

^∗ Mean±standard deviation.

Table 5.

The characteristics of orbital myositis patients

Age (years)	Sex	Onset &treatment interval	Involved muscle*	Steroid effectiveness	recurrence
31	F	1 day	IR∗	yes	no
44	M	0 day	LR^†	yes	no
33	F	0 day	LR	yes	no
57	F	0 day	SR^‡, MR^§, IR	yes	recurrence
40	M	0 day	MR	yes	recurrence
53	F	0 day	SR	yes	no
60	M	10 days	SR	yes	no
40	M	10 days	SR	yes	no

^∗ IR=inferior rectus muscle

^† LR=lateral rectus muscle

^‡ SR=superior rectus muscle

^§ MR=medial rectus muscle.

Table 6.

Frequency of steroid pulse therapy

Subtype	No. steroid pulse therapy
Lacriamal	7/12 (58.3%)
Myositic	1/12 (8.3%)
Anterior	1/12 (8.3%)
Diffuse	2/12 (16.6%)
Apical	1/12 (8.3%)

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