Pathology of the Head and Neck

Eye and Ocular Adnexa Chapter 10 307The orbit is the most common location for metastasesto the eye and adjacent structures in children (neuroblastoma),whereas the choroid is the predominant sitein adults. Approximately 5% of all orbital tumour-likelesions are metastatic lesions. However, because malignanciesare far more frequent in adults, most orbitalmetastatic lesions are found in elderly patients. Themean period of time between the onset of the primarydisease and orbital manifestation is 5 years. The mainprimary symptoms are lid swelling, red eye, diplopia andproptosis. The most frequent primary tumour is a breastcarcinoma, but many other carcinomas can metastasiseto the orbit (Figs. 10.31, 10.32). Metastatic melanomas tothe eye and orbit are rare and generally occur in patientswith disseminated metastases during the terminal stagesof the disease, with a short life expectancy.Fig. 10.31. Carcinoid metastatic to the orbit: this haemorrhagicorbital mass contained small nests of monomorphous epithelialcells. Immunohistochemistry was consistent with a carcinoidFig. 10.32. Renal cell adenocarcinoma metastatic to the orbit:nests of clear epithelioid cells were found; immunohistochemistryshowed positivity for both vimentin and cytokeratin10.8.2.2 Optic Nerveand Meningeal TumoursOptic nerve and meningeal tumours can spread intothe orbit. Together they represent 8% of all orbital tumours.10.8.2.3 Metastatic TumoursReferences1. Akpek EK, Polcharoen W, Chan R, Foster CS (1999) Ocularsurface neoplasia masquerading as chronic blepharoconjunctivitis.Cornea 18:282–2882. Akpek EK, Polcharoen W, Ferry JA, Foster CS (1999) Conjunctivallymphoma masquerading as chronic conjunctivitis.Ophthalmology 106:757–7603. Armstrong NT (1992) The ocular manifestations of congenitalrubella syndrome. Insight 17:14–164. Aultbrinker EA, Starr MB, Donnenfeld ED (1988) Linear IgAdisease. The ocular manifestations. Ophthalmology 95:340–3435. Balayre S, Gomez K, Tribut A, Dore P, Gobert F (2003) Toxoplasmagondii and necrotizing retinitis: a case report. J FrOphtalmol 26:837–8416. Bastiaensen LA, Verpalen MC, Pijpers PM, Sprong AC (1985)Conjunctival sarcoidosis. Doc Ophthalmol 59:5–97. Biggs SL, Font RL (1977) Oncocytic lesions of the caruncleand other ocular adnexa. Arch Ophthalmol 95:474–4788. Bost M, Mouillon M, Romanet JP, Deiber M, Navoni F (1985)Congenital glaucoma and Von Recklinghausen’s disease. Pediatrie40:207–2129. Bourcier T, Monin C, Baudrimont M, Larricart P, Borderie V,Laroche L (2003) Conjunctival inclusion cyst following parsplana vitrectomy. Arch Ophthalmol 121:106710. Breslow NE, Norris R, Norkool PA, Kang T, Beckwith JB,Perlman EJ, Ritchey ML, Green DM, Nichols KE (2003)Characteristics and outcomes of children with the Wilms tumor-Aniridiasyndrome: a report from the National WilmsTumor Study Group. J Clin Oncol 21:4579–458511. Bruna F (1954) Association of keratoconus with retinitis pigmentosa.Boll Ocul 33:145–15712. Busbee BG (2004) Advances in knowledge and treatment: anupdate on endophthalmitis. Curr Opin Ophthalmol 15:232–23713. Cervantes G, Rodriguez AA Jr, Leal AG (2002) Squamouscell carcinoma of the conjunctiva: clinicopathological featuresin 287 cases. Can J Ophthalmol 37:14–19; discussion19–2014. Ceuterick C, Martin JJ (1984) Diagnostic role of skin or conjunctivalbiopsies in neurological disorders. An update. JNeurol Sci 65:179–19115. Chai F, Coates H (2003) Otolaryngological manifestationsof ligneous conjunctivitis. Int J Pediatr Otorhinolaryngol67:189–19416. Chan CC, BenEzra D, Hsu SM, Palestine AG, NussenblattRB (1985) Granulomas in sympathetic ophthalmia and sarcoidosis.Immunohistochemical study. Arch Ophthalmol103:198–202