Clinical and Imaging Characteristics of Orbital Leukemic... : Ophthalmic Plastic & Reconstructive Surgery (original) (raw)

Article

Bidar, Maziar M.D.*§∥; Wilson, Matthew W. M.D., F.A.C.S.*†§; Laquis, Steven J. M.D.*§∥; Wilson, Terry D. R.N.*; Fleming, James C. M.D., F.A.C.S.*§; Wesley, Ralph E. M.D.§∥; Ribeiro, Raul C. M.D.‡; Haik, Barrett G. M.D.*§

*Department of Surgery, Division of Ophthalmology, †Department of Pathology, ‡Department of Hematology/Oncology and International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee; §Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health Sciences Center, Memphis, Tennessee; and ∥Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee

Accepted for publication October 23, 2006.

This work was supported by grants CA 57629 and CA21765 CA20180 from the National Cancer Institute, by a Center of Excellence grant from the State of Tennessee, by the American Lebanese Syrian Associated Charities (ALSAC), and by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.

Portions of this manuscript were presented as a poster at the ASOPRS annual meeting, October 2001, New Orleans, Louisiana.

Any animal research in this thesis was performed according to the affiliated institution standards for animal research. Any human studies were performed under approval of the Institutional Review Board.

Address correspondence and reprint requests to Matthew W. Wilson, MD, FACS, Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health Sciences Center, 930 Madison Avenue, Suite 100, Memphis, TN 38163. E-mail: [email protected]

Ophthalmic Plastic & Reconstructive Surgery 23(2):p 87-93, March 2007. | DOI: 10.1097/IOP.0b013e3180333a85

Purpose:

To characterize the clinical and imaging features of orbital leukemic tumors in 27 patients seen and treated at St. Jude Children's Research Hospital.

Methods:

A retrospective review was performed on the clinical and imaging records of 27 consecutive patients with a diagnosis of orbital leukemic tumors. The following data were extracted from the patients' records: age at diagnosis of orbital leukemic tumors, sex, race, national origin, type of leukemia, temporal relationship of orbital disease to diagnosis of leukemia, survival from diagnosis of orbital leukemic tumor, laterality of the orbital disease, location of the mass within the orbit, imaging features of the mass, chemotherapeutic protocol, treatment with bone marrow transplant, and orbital radiation.

Results:

The median age at diagnosis of orbital leukemic tumor was 8 years (range, 1–18 years). Nineteen of the 27 patients were male, and 21 patients were born and lived in the United States. Twenty-one patients had acute myeloid leukemia, five had acute lymphoblastic leukemia, and one had chronic myelogenous leukemia. In 85% of patients (n = 23), the diagnosis of leukemia was based on the bone marrow examination findings. Orbital imaging revealed homogenous masses that molded to one or more orbital walls without bony destruction. Nine patients had bilateral orbital involvement. All patients received multiagent systemic chemotherapy, and 14 underwent bone marrow transplantation. Five patients received external beam radiation for the treatment of orbital disease. Fifteen (55.6%) of the 27 patients were alive at the time of the study. The median survival for all patients was 4.75 years (range, 0.1–24 years) after the diagnosis of orbital disease.

Conclusions:

Orbital leukemic tumors occur most commonly in the first decade of life, in association with acute myeloid leukemia. They appear as homogenous masses along the orbital walls. Although the overall survival rate for patients with leukemia has improved over the past 3 decades, the mortality of patients who develop orbital leukemic tumors remains high.