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| ARTICLES |
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| Year : 1978 | Volume
: 26
| Issue : 4 | Page : 53-55 |
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Leukaemic deposits in the orbit
GC Baijal, ML Agarwal, Charu Gawande, DC Gupta
Deptt. of Ophthal., G.R. Medical College, Gwalior, India
Correspondence Address:
G C Baijal
Deptt. of Ophthal., G.R. Medical College, Gwalior
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 285923 
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 |
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 | |  |
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 | | |
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 | | |
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 | | |
| 1. | Chatterjee, B.M. and Sen, N.N. ,1960. Brit. Jour. Ophthal., 44, 440.  |
| 2. | Dacie, J., Dresner, E., Mollin, D.L., and White, J.C., 1950, Brit. Med. J., 1, 1417. |
| 3. | Duc, C., 1937, Rass, Ital. Ottal, 6, 719. (Quoted by Duke Elder 1952). |
| 4. | Duke Elder, S., 1952, Text Book of Ophthalmology 5, 5552, Henry Kimpton London. |
| 5. | Gump, M.E., Hester, E.G. and Lohr, O.W., 1936 Arch. Ophthal. (Chicago), 16, 931. |
| 6. | Hammed, S., Das, T. and Agarwal, K.C., 1959 Brit. Jour. Ophthal., 43, 107. |
| 7. | Humble, J.G. 1946 Quart. J. Med., 15, 299. |
| 8. | Jain, N.S., Sethi, D.V. and Om Prakash 1955, J. All India Ophthal. Soc., 3, 13.
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| 9. | Mathvr, S.P., 1959, Amer. J. Ophthal., 47, 91. |
| 10. | Morrison, M., Samwick, A.A. and Rubinstein, R.I., 1.939, Amer. Jour. Dis. Child, 58, 332. (Quoted by Whitby & Britton, 1953) |
| 11. | Reese, A.B. and Guy, L., 1933, Amer. J. Ophthal., 16, 671. |
| 12. | Ross, R.R., 1955, Amer. Jour. Med., 18, 671. |
| 13. | Seal, G.N. and Gupta, A.K., 1973, Indian J. of Ophthal. 21, 73.
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| 14. | Sorsby, A., 1951, Systemic Ophthalmology, 574 Butterworth, London. |
| 15. | Wright, 1938, Extra-ocular Affections, Madras (Quoted by Duke Elder 1952). |
[Figure - 1], [Figure - 2]
[Table - 1]
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