True Pseudotumors and “Pseudo” – Pseudotumors: A Case Series
Maria Donna Damo Santiago, MD, MBA1,2,3 and Andrei Paolo S. Angbue-Te, MD1,4
1Department of Ophthalmology, Far Eastern University-Nicanor Reyes Memorial Foundation (FEU-NRMF), Quezon City, Philippines
2Department of Ophthalmology, Makati Medical Center, Makati City, Philippines
3Department of Ophthalmology, St. Luke’s Medical Center, Quezon City, Philippines
4Department of Ophthalmology, Metropolitan Medical Center, Manila, Philippines
Correspondence: Maria Donna Damo Santiago, MD, MBA
Department of Ophthalmology, Far Eastern University-Nicanor Reyes Memorial Foundation (FEU-NRMF)
Regalado Avenue, North Fairview, Quezon City, Philippines 1123.
Disclosure: The authors have no conflicts of interest or proprietary interest in any of the topics or products presented in this manuscript.
Objective: To characterize the clinical and pathological features of 4 patients with histopathology-confirmed idiopathic orbital inflammatory disease (OID) initially diagnosed as an orbital neoplasm and 9 patients with histopathology-confirmed orbital neoplasm that presented as idiopathic OID.
Methods: The medical records of 13 patients with orbital mass were reviewed. All biopsies were performed by one orbit surgeon.
Results: There were 4 patients in the histopathology-confirmed idiopathic OID group with preoperative diagnosis of orbital neoplasm. Mean age at presentation was 27 years. Follow-up period ranged from 6 to 41 months. The left orbit was predominantly involved (3/4). The presenting symptoms and signs included proptosis (2/4), diplopia (1/4), and inflammation (1/4). The preoperative best-corrected decimal acuity mean was 0.92. Three of 4 patients retained their preoperative visual acuity postoperatively. There was recurrence of inflammatory signs in only 1 patient, which responded well to oral corticosteroids. In the histopathology-confirmed orbital neoplasm with preoperative diagnosis of idiopathic OID group, there were 9 patients with mean age at presentation of 52 years. Follow-up period averaged 7.5 months (range: 0.5 – 83 months). The presenting symptoms and signs included proptosis (4/9), inflammation (3/9), orbital pain (1/9), and epiphora (1/9). The preoperative best-corrected decimal acuity mean was 0.78. Histopathology and immunohistochemistry of the orbital masses revealed malignancy in 80% (7/9) of these cases.
Conclusions: Idiopathic OID remains a diagnostic dilemma for many physicians. A detailed history, comprehensive physical examination, and appropriate radiological evaluation are essential to differentiate OID and non-inflammatory orbital conditions such as neoplasms. Biopsy is recommended when there is poor or equivocal response to steroids or suspicion of orbital malignancy.
Keywords: Pseudotumor, orbital inflammatory disease, neoplasm, biopsy, histopathology