Ekstraoküler Kistik Tümörlerinde Klinik Tanı ve Tedavi Sonuçları

Yıl 2023, Cilt: 45 Sayı: 3, 373 - 381, 23.05.2023

Nilgün Yıldırım Tülay Şimşek Emine Dündar

https://doi.org/10.20515/otd.1218941

Öz

Ekstraoküler kistik tümörü olan olguların patoloji ve klinik bulgularla konulan tanıları, klinik özellikleri ile tedavi sonuçlarının değerlendirilmesi. Ekstraoküler kistik tümörü tanısı alan 85 olgu çalışmaya alındı. Olgular yaş, cinsiyet, klinik bulgular, tümörün yerleşimi, klinik ön tanı, tedavi, patolojik tanı ve prognoz açısından değerlendirildi. Seksen beş olguya ait 92 tümör retrospektif olarak değerlendirildi. Olguların 47’si (%55,3) kadın, 38’i (%44,7) erkek olup yaş ortalaması 26,8±5,2 yıl idi. 7 olguda tümörün iki taraflı olduğu saptandı. Olgularda, en sık başvurma nedeni gözde ağrısız şişlik olmasıydı. Diplopi ve egzoftalmus en sık mukosel olgularında saptandı. Kistler en sık alt iç kadranda (%35) yerleşmiş olup bunu sırası ile üst dış kadran (%27), üst iç kadran (%25) ve alt dış kadran (%13,5) izliyordu. Cerrahi tedavide bir olgunun 1 gözündeki tümör total olarak çıkartıldı. Dört olgu ise cerrahi tedavi uygulanmadan izleme alındı. Kitlelerin patolojik tanıları; 31’i epidermal dermoid kist, 7’si konjonktival dermoid kist, 37’si epidermal kist (18 primer kutaneöz, 15 primer konjonktival, 4 sekonder konjonktival) , 7’si sudoriferous kist, 5’İ kolobomatöz kist, 3’ü mukosel, 2’si lipodermoid idi. Alt iç kadranda en sık epidermal kistler, üst iç ve dış kadranda ise en sık dermoid kistler görüldü. Kistik tümörlerin %13’ünde klinik ve patolojik tanı arasında uyuşmazlık saptandı. Cerrahi yapılan konjonktiva dermoid kistli bir göz dışında diğerlerinde nüks görülmedi. Çalışmamızda, epidermal kistler ve dermoid kistler en sık görülen ekstraoküler kistik tümörü olup, klinik ön tanı ile patolojik tanı uyumu %87 olarak saptandı. Kistin tamamının çıkartılması ile kür sağlandığı görüldü.

Anahtar Kelimeler

epidermoid kist orbita kistleri, dermoid, teratom

Destekleyen Kurum

YOK

Clinical diagnosis and treatment results of extraocular cystic tumours

Öz

Evaluation of the diagnosis, clinical features and treatment results of cases diagnosed with extraocular cystic tumors based on pathological and clinical findings. Eighty-five patients diagnosed with extraocular cystic tumours were included in the study. Patients were evaluated in terms of age, sex, clinical findings, localization of the tumor, clinical diagnosis, pathological diagnosis, and treatment outcomes. Ninety-two eyes of 85 patients were evaluated retrospectively. There were 47 (%55.3) female and 38 (%44.7) male patients with a mean age of 26.8±5.2 years. Tumors were bilateral in 7 patients. The most common presenting sign was a painless swelling in the eye. Diplopia and proptosis were mostly observed in patients with mucocele. Cystic lesions were localized in inferomedial (%35) superolateral (%27), superomedial (%25), and inferolateral (%13.5) aspects of the orbit respectively. Tumoral mass completely excised by surgical treatment except in one patient. Four patients were followed without surgical treatment. Pathologic diagnoses were; epidermal dermoid cyst (31), conjunctival dermoid cyst (7), epidermal cyst (37; primary cutaneous (18), primary conjunctival (15), secondary conjunctival (4), sudoriferous cyst (7), colobomatous cyst (5), mucocele (3), an lipodermoid (2). The epidermal cyst was the most frequently seen cystic lesion in the lower inner quadrant. The dermoid cyst was the most frequently seen lesion in the upper inner and outer quadrants. A mismatch between clinical and pathological diagnosis was 13%. Recurrence was not observed except in one eye with a conjunctival dermoid cyst. Dermoid cysts and epidermal cysts were the most common cystic tumors of the extraocular tissues. Concordance between pathological and clinical diagnosis was found to be 87%. The cure was maintained by removing the cyst completely.

Anahtar Kelimeler

epidermoid kist orbita kistleri, dermoid, teratom

Kaynakça

• 1. Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions The 2002 Montgomery Lecture, Part 1. Ophthalmology 2004;111:997-1008.
• 2. Giulio B, Diego S, Piergiacomo G, et al. An Analysis of 2,480 Space-Occupying Lesions of the Orbit From 1976 to 2011. Ophthal Plast & Recons Surg 2013;29: 79-86.
• 3. Bullock JD, Goldberg SH, Rakes SM. Orbital tumors in children. Ophthal Plast Reconstr Surg 1989; 5:13-6.
• 4. Gunalp I, Gunduz K. Cystic lesions of the orbit. Int Ophthalmol 1996; 20:273-7.
• 5. Kodsi SR, Shetlar DJ, Campbell RJ, et al. Am J Ophthalmol 1994; 117:177-82.
• 6. Shields JA, Bakewell B, Augsburger JJ et al. Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies. Arch Ophthalmol 1984; 102:1606-11.
• 7. Shields JA, Bakewell B, Augsburger JJ, et al. Space-occupying orbital masses in children. A review of 250 consecutive biopsies. Ophthalmology 1986; 93:379-84.
• 8. Ohtsuka K, Hashimoto M, Suzuki Y. A review 244 orbital tumors in Japanese patients during a 21 year period:Origin and location. Jpn J Ophthalmol 2005; 49:49-55
• 9. Pushker N, Meel R, Kumar A, et al. Orbital and periorbital/epidermoid cyst:a series of 280 cases and a brief review. Can J Ophthalmol 2020; 55:176-81.
• 10. Vashisht S, Ghai S, Hatimota P et al. Cystic lesion of the orbit: A CT spectrum. Indian J Radiol Imaging 2003; 13:139-44.
• 11. Tunç M. Orbita tümörlerinin tanı ve tedavisinde güncel yaklaşımlar.Turk J Ophthalmol 2014;44 (Özel sayı):1-7.
• 12. Sathanantan N, Moseley IF, Rose GE. The frequency and clinical significance of bone involvement in outer canthus dermoid cysts. Br J Ophthalmol 1993; 77: 789-94.
• 13. Colombo F, Holbach LM, Naumann GO. Chronic inflammation in dermoid cysts: a clinicopathologic study of 115 patients. Orbit 2000; 19:97–107
• 14. Foo MI, Braswell LE, Lubeley LJ, et al. Minimally invasive treatment of pediatric head and neck dermoids:percutaneous drainage and radiofrequency coblation. Pediatr Radiol 2019; 49:1222-8.
• 15. Chieh-Chih T, Yen-Ching L, Shu-Ching K, et al. Preoperative methylene blue injection as a surgical adjuvant in treatment of orbital dermoid cyst. Acta Ophthalmol Scand 2007;85:909–10.
• 16. Pant AR, Suwal R, Joshi P. et al. Microphthalmos with Orbital Cyst: Case Series with a Review of Literature. Birat J Health Sci. 2022; 6: 1665-8.
• 17. Kim UR, Arora V, Shah AD, et al. Case report: Ocular malformation with a 'double globe' appearance. Indian J Radiol Imaging 2009; 19:298-300.
• 18. Foxman S, Cameron JD. The clinical implications of bilateral microphthalmos with cyst. Am J Ophthalmol 1984; 97:632–8.
• 19. Chaudhry IA, Arat YO, Shamsi FA et al. Congenital microphthalmos with orbital cysts: distinct diagnostic features and management. Ophthal Plast & Recons Surg. 2004;20:452-7
• 20. Mehta A, Rao A, Khanna A. Sudoriferous cyst of the orbit of adult origin after trauma. Indian J Ophthalmol 2008; 56:235-7.
• 21. Burnham JM, Lewis K. Intracranial extension of an orbital epidermoid cyst. Ophthal Plast Reconstr Surg 2016; 32:135-6.
• 22. Shields JA, Shields CL. Orbital cysts of childhood classification, clinical features, and management. Surv Ophthalmol 2004:49:281-99.
• 23. Goto H, Yamakawa N, Komatsu H, et al. Clinico-epidemiological analysis of 1000 cases of orbital tumors. Jpn J Ophthalmol. 2021; 65:704-723.
• 24. Giulio B, Diego S, Piergiacomo G, et al. An Analysis of 2,480 Space-Occupying Lesions of the Orbit From 1976 to 2011. Ophthal Plast & Recons Surg 2013;29: 79-86
• 25. Cohen LM, Yoon MK. Update on Current Aspects of Orbital Imaging: CT, MRI, and Ultrasonography. Int Ophthalmol Clin 2019;59:69-79.
• 26. Koukkoulli A, Pilling JD, Patatas K, et al. How accurate is the clinical and radiological evaluation of orbital lesions in comparison to surgical orbital biopsy? Eye 2018;32:1329-33.