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   Table of Contents      
ARTICLES
Year : 1976  |  Volume : 24  |  Issue : 1  |  Page : 36-38

Orbital lymphangioma (regression with corticosteroids)


1 Postgraduate Institute of Medical Education & Research, Chandigarh-160011, India
2 Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh-160011, India

Correspondence Address:
S P Dhir
Postgraduate Institute of Medical Education & Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 1031384

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How to cite this article:
Dhir S P, Jain I S, Dutta B N. Orbital lymphangioma (regression with corticosteroids). Indian J Ophthalmol 1976;24:36-8

How to cite this URL:
Dhir S P, Jain I S, Dutta B N. Orbital lymphangioma (regression with corticosteroids). Indian J Ophthalmol [serial online] 1976 [cited 2019 Dec 12];24:36-8. Available from: http://www.ijo.in/text.asp?1976/24/1/36/31108

Orbital lymphangiomas constitute the largest group among the lymphangiomas involving the ocular adnexa. The tumour manifests primarily in young children. The treatment of lymphan­giomas has not been very satisfactory. Since these tumours grow slowly, repeated partial excision and plastic repair over a period of years may gradually get ahead of the tumour and lead to a satisfactory result.[3] These tumours are not amenable to radiation treatment[1].

We report a case of orbital lymphangioma who showed marked regression following syste­mic corticosteroid therapy.


  Case Report Top


MR. a 4 year old male was seen in paediatric surgi­cal unit with complaint of swelling of the right eye for the past three months, after trauma. The swelling has been gradually increasing in size. Patient was investigat­ed in surgical unit for nephroblastoma with secondaries in the orbit. On ophthalmic consultation, a diagnosis of haemangioma or lymphangioma was suggested and patient was transferred to ophthalmology service.

On examination visual acuity was found good. The right eyeball was pushed forwards, laterally and down­wards [Figure - 1]. The upper lid showed irregular swelling with bluish coloration. On palpation the swelling was irregular, cystic and non-tender. The skin over the swelling was freely mobile. The swelling could not be reduced. No bruit was heard over the swelling. Left eyeball was in its proper position.

Right cornea showed exposure keratitis in the lower one third. Both fundi were normal and no regional or other lymph glands were palpable.

A clinical diagnosis of haemangioma or lymphan­gioma was made. X-ray examination, haemogram and skin test for hydatid disease were non-contributory. Under general anaesthesia a needle was passed into the cystic medial swelling through the upper eye lid and ½ ml. of straw coloured fluid was obtained. The fluid did not clot. Fluid was examined for any evidence of parasites, but none were seen. Through a conjunctival incision in the upper fornix, a small cystic mass was obtained for histo-pathological examination.

Histo-pathological Examination

The tissue consists of dilated tortuous channels, some of which are of cystic proportions. The channels are made up of a fibro-muscular thin walls lined by endothelium and contain a few lymphocytes, but no red blood cells. The wall is somewhat myxomatous. In between the channels occasional focus of mono-nuclear cell clusters is seen [Figure - 3]. The above features are consistent with the diagnosis of cystic lymphangioma without any significant inflammatory reaction.

After the histo-pathological diagnosis of orbital lymphangioma, the patient was advised orbitotomy and surgical removal of the tumour. However, following the I report of regression of haemangioma of the orbit with corticosteroids in the literature[2],[4], patient was put on corticosteroids, (tab. Prednisolone 20 mg. daily) for one week. The proptosis started regressing by the end of the week and the corticosteroids were continued for another three weeks. By that time proptosis regressed remar­kably [Figure - 2]. Corticosteroids were gradually tapered over a period of three weeks and patient was followed for another 4 months.

The child has since maintained regressed proptosis for over nine months.


  Discussion Top


On histo-pathological review of the mass two points were specifically looked into i.e. the possibility of the lesion being a hemangiolymphangioma or the inflammatory lesion. Haemangioma of the eyelids as well as skin have been reported to regress with systemic steroids. No evidence of haemangioma could be found in this case. The inflammatory reac­tion was significantly absent which ruled out the possibility of resolution of the lesion due to anti-inflammatory effect of corticosteroids.

It seems that not only haemangiomas of the lid and orbit but lymphangiomas can also regress following systemic administration of corticosteroids and warrant a trial in such cases. The mechanism of action is not yet clearly understood. Neonatal haemangioma of the orbit and ocular adnexa have been suc­cessfully controlled with corticosteroid therapy.


  Summary Top


A histologically proved case of cystic lym­phangioma of the orbit is reported. The pro­ptosis regressed remarkably after systemic administration of corticosteroids. No evidence of haemangioma or inflammatory cells was found on histological review of the slide. Patient maintained regressed state of proptosis over nine months.

 
  References Top

1.
De Voe, A.G. 1966, "Symposium on Surgery of Ocular Adnexa" Published by C.V. Mosby Company Saint Louis, Page 166.  Back to cited text no. 1
    
2.
Hiles, D.A. and Pilchard, W.A. 1971, Amer. J. Ophthalmol, 71, 1003.  Back to cited text no. 2
    
3.
Reese, A.B. 1966, "Tumours of the Eye" Pub­lished by Harper and Row Publishers, New York, p. 423.  Back to cited text no. 3
    
4.
Venecia G. and Lobeck C.C. 1970 Arch. Ophthal 84, 98.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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