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   Table of Contents      
ARTICLES
Year : 1978  |  Volume : 26  |  Issue : 4  |  Page : 53-55

Leukaemic deposits in the orbit


Deptt. of Ophthal., G.R. Medical College, Gwalior, India

Correspondence Address:
G C Baijal
Deptt. of Ophthal., G.R. Medical College, Gwalior
India
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Source of Support: None, Conflict of Interest: None


PMID: 285923

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How to cite this article:
Baijal G C, Agarwal M L, Gawande C, Gupta D C. Leukaemic deposits in the orbit. Indian J Ophthalmol 1978;26:53-5

How to cite this URL:
Baijal G C, Agarwal M L, Gawande C, Gupta D C. Leukaemic deposits in the orbit. Indian J Ophthalmol [serial online] 1978 [cited 2020 Sep 19];26:53-5. Available from: http://www.ijo.in/text.asp?1978/26/4/53/31507

Table 1

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Table 1

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Leukaemic deposits in orbit are known to occur in acute or chronic lymphatic leukaemia but it is rarely seen in myeloid leukaemia. There are several reports of leukaemic deposits in the orbital region in cases of acute myeloid leukaemia [1],[6],[8],[13],[15] . Some of these have been called as chloroma, a variant of myeloid leukae­mia which is characterised by greenish yellow tumour mass in the skull specially in the orbits. A further instance of leukaemia deposits of acute myeloid leukaemia in the orbital region is being reported.


  Case Report Top


Gajaraj, a six years old Hindu male child, son of a rural farmer was admitted in the Eye Ward of J.A. Group of Hospitals, Gwalior on 20.7.75 for gradual protrusion of both the eyes and swelling in the region of eye brows.

About four months back the child had low grade fever for a fortnight which subsided with treatment. Two months later he developed swelling below the eyebrows on both sides. Gradually the size of the swel­lings increased resulting in protrusion of both eye balls. It was associated with headache and pain in eyes. There was general weakness, loss of appetite and loss of weight. One weak earlier to admission he had severe bleeding per nose which was treated by a general practi­tioner who advised him to consult Ophthalmologist. Nothing significant was found in the past History and family history.

External Examination

The child was poorly nourished with marked pallor of the skin, conjunctiva and mucous membrane of the oral cavity. No bleeding was seen through nose, There was no fever. Cervical lymph glands were palpable but not tender. Liver was palpable about 2 cms. below the right costal margin which was firm and non-tender. Spleen was not palpable.

Ocular Examination

Symmetrical swellings were seen on both sides below the eye brows involving the whole supraorbital margin leading to downward displacement of the eyeballs and proptosis [Figure - 1]. The swellings were hard and tender, oval in shape, measuring about 8 cms. horizon­tally and 4 cms. vertically. There was marked stretching of the skin of the upper lid over the swelling having a smooth surface, shiny appearance and prominent veins.

The supra orbital margin could not be palpated. Rest of the orbital margins were smooth The ocular movements were restricted in all directions particularly in upper direction, Conjunctival chemosis were present. Fundi showed slight fullness of veins.

Investigation[Table - 1]

The biopsy was taken on 30.7.75 under general anaesthesia. The mass was pale white in colour and there was practically no bleeding during removal of the biopsy mass. It was cartilaginous in consistency. Histologically the biopsy tissue showed diffusely arranged immature white blood cells in a delicate loose fibrous stroma. The predominating cells being undifferentiated reticulum and the blast cells. [Figure - 2]..


  Discussion Top


Wide spread leukaemic deposits are-quite common in lymphatic and myeloid leukaemia. However a localised leukaernia deposit in the orbit is extremely rare. Reese and Guy[11] repor­ted an incidence of leukaemic deposits in the orbit with bilateral proptosis in 2% cases of lymphatic leukaemia. Similarly leukaemic deposits in myeloid leukaemia in orbits have been described[3],[4],[5],[6],[8].

Sorsby[14] reported involvement of orbit tumour mass in about 50% of all instances of chloroma which is regarded as a variant of an acute myeloid leukaemia. The lesion manifests as localised mass, the site of predilection being skull but the involvement of the viscera is not uncommon. These simple tumour masses should be differentiated from chloroma. Chlor­oma. is characterised by greenish discolouration of the tumour due to presence of choleglobin. Some of the tumours which have been reported as chloroma were white in colour. Humble[7] and Ross[12] reserved the term chloroma, to only those tumours which showed green pigment.

Mathur[9] reported four cases of chloroma in which only two patients showed green pigment­ation while in the remaining two the colour was not mentioned. Hameed, Das and Agrawal[6] described[2] cases of chloroma but they did not study the histological appearance and the colour of the tumour could not be ascertained. Dacie, Dresner, Mollin and White[2] described a child with massive periorbital infiltration of both eye lids leading to intense swelling in association with acute myeloid leukaemia. But it was not regarded as a case of chloroma as the green pigment was absent. A rare case of monocyte chloroma has been described by Gump, Hester and Lohr[5] in a male aged 55 years. The disease is commonly found in children and young adults with peak evidence in third and fourth years. Morrison, Sarnwick and Rubinstein[10] have also reported a congenital case.

The present case also did not show green pigmentation of the tumour but otherwise the cells were definitely premature blast cells. The peripheral blood picture also revealed acute myeloid leukaemia. Since the green pigmenta­tion was absent we cannot call it as a case of chloroma.


  Summary Top


A case of acute myeloid leukaemia with bilateral leukaemic deposits in the orbits simulating chloroma is reported. The differen­tiating features from chloroma of the orbit are discussed.

 
  References Top

1.
Chatterjee, B.M. and Sen, N.N. ,1960. Brit. Jour. Ophthal., 44, 440.  Back to cited text no. 1
    
2.
Dacie, J., Dresner, E., Mollin, D.L., and White, J.C., 1950, Brit. Med. J., 1, 1417.  Back to cited text no. 2
    
3.
Duc, C., 1937, Rass, Ital. Ottal, 6, 719. (Quoted by Duke Elder 1952).  Back to cited text no. 3
    
4.
Duke Elder, S., 1952, Text Book of Ophthal­mology 5, 5552, Henry Kimpton London.  Back to cited text no. 4
    
5.
Gump, M.E., Hester, E.G. and Lohr, O.W., 1936 Arch. Ophthal. (Chicago), 16, 931.  Back to cited text no. 5
    
6.
Hammed, S., Das, T. and Agarwal, K.C., 1959 Brit. Jour. Ophthal., 43, 107.  Back to cited text no. 6
    
7.
Humble, J.G. 1946 Quart. J. Med., 15, 299.  Back to cited text no. 7
    
8.
Jain, N.S., Sethi, D.V. and Om Prakash 1955, J. All India Ophthal. Soc., 3, 13.  Back to cited text no. 8
    
9.
Mathvr, S.P., 1959, Amer. J. Ophthal., 47, 91.  Back to cited text no. 9
    
10.
Morrison, M., Samwick, A.A. and Rubinstein, R.I., 1.939, Amer. Jour. Dis. Child, 58, 332. (Quoted by Whitby & Britton, 1953)  Back to cited text no. 10
    
11.
Reese, A.B. and Guy, L., 1933, Amer. J. Ophthal., 16, 671.  Back to cited text no. 11
    
12.
Ross, R.R., 1955, Amer. Jour. Med., 18, 671.  Back to cited text no. 12
    
13.
Seal, G.N. and Gupta, A.K., 1973, Indian J. of Ophthal. 21, 73.  Back to cited text no. 13
    
14.
Sorsby, A., 1951, Systemic Ophthalmology, 574 Butterworth, London.  Back to cited text no. 14
    
15.
Wright, 1938, Extra-ocular Affections, Madras (Quoted by Duke Elder 1952).  Back to cited text no. 15
    


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

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