|Year : 1961 | Volume
| Issue : 4 | Page : 94-96
Reticulum cell sarcoma of orbit- a case report
MS Nirankari, Om Parkash, Daljit Singh
Department of Ophthalmology, Medical College, Amritsar, India
|Date of Web Publication||7-Apr-2008|
M S Nirankari
Department of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nirankari M S, Parkash O, Singh D. Reticulum cell sarcoma of orbit- a case report. Indian J Ophthalmol 1961;9:94-6
Reticulum cell sarcoma of orbit, a tumour of high malignancy is relatively rare. The literature records its occurrence at all ages, the oldest case recorded being 83 years (Burki 1943) and the youngest being 4 years (Morteda, 1961). This tumour is so rare in infants that not many surgeons have a personal experience of this type of tumour in tender age.
| Case Report|| |
P., 3½ years old, male child was admitted to Ram Lal Eye Hospital, Amritsar, on February 15, 1957 with the history of a rapidly increasing painless swelling under the left upper lid for the last one month. Fifteen days before admission the lid was incised by a general practitioner with the hope of draining the suspected pus, without success. The patient was not running any temperature at that time.
Local Examination of the Left Eye.
The left upper lid showed a horizontal scar about one cm long, just below the lateral extremity of the eyebrow. There was complete drooping of the upper lid with diffuse fullness in the upper part. The lid could not be lifted voluntarily. The closed left eye appeared more prominent than the right eye. On lifting the tense upper lid, the eyeball was seen proptosed and directed downwards. The proptosis was irreducible and non-pulsatile. The upward movement of the left eyeball was found limited. The upper lid was smooth on both surfaces and had normal thickness. Through the lid, however, a swelling could be felt just under the middle of the supra-orbital margin. The size of the swelling was about 2 cm, shape roundish and the consistency firm. Slight side to side movements could be elicited through the lid.
Vision in both eyes was equal.
General examination did not reveal any abnormality.
Blood, urine, X-ray chest and orbit were all normal.
Under general anaesthesia, a liberal incision 4 cm long was made just under the supra-orbital margin, the centre of the incision being at the most prominent part of the tumour. The incision was deepened through the orbicularis and the septum orbitale was identified and incised. The tumour felt with the finger was found arising deep in the orbit, its upper surface almost hugging the under surface of the superior orbital wall. The posterior surface of the mass was reached by the index finger and the entire tumour was brought out with little difficulty.
The tumour was about 35 mm in diameter, round in shape and of firm consistency. The cut surface revealed a pale-pink colour. A part of the tumour was sent for histopathology. Meanwhile the patient was discharged after an uneventful recovery in the post-operative period. At the time of discharge slight ptosis was still present.
Shows a malignant neoplasm composed of well dispersed pleomorphic reticulum cells enmeshed in a dense net-work of fine reticulum fibres. The growth is traversed by fibro-vascular trabeculae of unusual appearances which are, I believe, more organised and better differentiated but integral part of the tumour. [Figure - 2].
Diagnosis-Reticulum cell sarcoma of the orbit.
As soon as the histological report was received, the patient was called back. A mass about half the original size could be palpated in the orbit. This time the growth did not seem to be circumscribed. Exentration was done and deep X-ray therapy started. Inspite of rigorous treatment, the growth filled the orbit in a month's time. Exentration was repeated and X-ray therapy continued. After 6 months the orbit was again half full with the growth. A biopsy of the tissue was sent again. The report confirmed the original diagnosis of reticulum cell sarcoma.
The patient was taken away from the hospital by the parents as the child was not getting any relief. He subsequently died in July, 1958. At the time of death the growth had assumed the size of a cricket ball and had grown over the forehead, the cheek and the root of the nose. No autopsy was done.
| Comments|| |
Stout (1942) divides lymphomatous tumours into three varities depending upon the histological characteristics.
1. Lymphocytic cell type.
2. Reticulum cell type.
3. Giant follicle lymphosarcoma.
Giant follicle lymphosarcoma is the least malignant, whereas reticulum cell sarcoma is the most malignant. The histological picture of the lymphomatous tumours is not always constant. Early histopathological examination may suggest chronic lymphogranuloma. Afterwards it may take up the characteristics of one of the three types mentioned above. The least malignant Giant follicle lymphosarcoma can change into the most malignant reticulum cell type, but the reverse is not true. Our case also showed constancy of the structure as proved by histological study on two different occasions, one early in the disease and the other in the near-end stage.
Around the lacrymal gland and in the sub-conjunctival regions where lymphoid tissue is normally present, lymphocytic cell type of tumour is most likely. A tumour starting at a site normally devoid of lymphoid tissue is more likely to be of reticulum cell type, arising from the omnipresent reticuloendothelial cells.
Reticulum cell tumour may sometimes show a rapidly advancing and fatal course. The symptoms are of an acute inflammatory process. Even the blood examination may point to an inflammatory process by showing leucocytosis. But the incision never brings out pus. Our patient was also given an incision in the hope of draining out pus.
Reticulum cell sarcoma spreads locally or by blood stream. The course is chronic and unpredictable. But there is no doubt, as pointed out by Stout that treated patients (by surgery and Radio-therapy) show a much longer survival rate than the untreated ones. All the factors that determine the course of a malignant disease in general are applicable here too. From the point of view of a surgeon, however, the site of this tumour in the orbit is definitely worse than a tumour, say arising in the leg. Complete removal of the tumour from the orbit is less likely, whereas in the case of a limb an amputation is very effective if done early enough. Dennison (1955) reports one case of reticulum cell sarcoma of leg in an infant of one year that was still living, whose leg was amputated 11 years back.
| Summary|| |
Reticulum cell sarcoma of orbit is described in an infant of 3 years. The youngest case previously recorded in literature was 4 years (Morteda, 1961).
We are thankful to Dr. Greer of Melbourne, who sent us the histopathological report of the case.
| References|| |
Dennison (1955). Arch. Die. Childhood., 30 :472.
Duke-Elder, S. (1952). Text Book of Ophthalmology. Vol. 5 P. 5553 Kimpton, London.
Morteda, A. (1961) . Brit. J I. Ophth., 45 :365.
Reese, A. B. (1961) . Tumours of the Eye. Hoeber, New York.
Stout, A. P. (1942) . A. M. A.. 118 :968.
[Figure - 1], [Figure - 2]