Discussion Author: Paul M Michaud
Differential diagnosis for masses in the superolateral quadrant of the orbit include:
Lacrimal gland or duct tumor
Schannoma or Neurofibroma
Orbital lymphoma is the third most common cause of unilateral proptosis, following pseudotumor and orbital hemangioma. Non-Hodgkin B cell is the most common type.
Lymphoma tends to surround adjacent structures, without eroding bone, and most lie anterior and superior in the orbit, in close proximity to the lacrimal gland. However, any area of the orbit may be involved.
Presenting sympoms often include painless eyes swelling, proptosis, oculomotor/visual acuity defects.
If there is no systemic involvement, orbital lymphomas are typically treated with local radiation. Chemotherapy is used in cases of systemic invovement.
Classic cross-section image findings include:
Â» CT: hyperdense mass that is well demarcated as compared to the hypodense orbital fat and enhancement with contrast.
Â» MR: hypointense / isointense compared to hyperintense fat tissue on T1- and T2-weighted images respectively. Mild enhancement is usually demonstrated
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