Orbital venous-lymphatic malformations (lymphangiomas) mimicking cavernous hemangiomas

PURPOSE: To illustrate that orbital venous-lymphatic malformations (lymphangiomas) may rarely simulate cavernous hemangiomas. METHODS: Retrospective case review. RESULTS: Five patients were identified from a series of 85 patients with venous-lymphatic malformations. The age range was 21 to 69 years,...

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Bibliographic Details
Published in:American journal of ophthalmology 2001-03, Vol.131 (3), p.364-370
Main Authors: Selva, Dinesh, Strianese, Diego, Bonavolonta, Giulio, Rootman, Jack
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Diagnosis, Differential
Female
Hemangioma, Cavernous - diagnosis
Hemangioma, Cavernous - surgery
Humans
Lymphangioma - diagnosis
Lymphangioma - surgery
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Ophthalmology
Orbit diseases
Orbital Neoplasms - diagnosis
Orbital Neoplasms - surgery
Retrospective Studies
Tomography, X-Ray Computed
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Summary:PURPOSE: To illustrate that orbital venous-lymphatic malformations (lymphangiomas) may rarely simulate cavernous hemangiomas. METHODS: Retrospective case review. RESULTS: Five patients were identified from a series of 85 patients with venous-lymphatic malformations. The age range was 21 to 69 years, and all cases presented with a history of slowly progressive or long-standing proptosis. Computerized tomography revealed relatively homogeneous intraconal masses that were well defined anteriorly. Two of the cases had expansion of the orbit, and one had focal calcification. The three who had magnetic resonance imaging showed heterogeneous contrast enhancement. The preoperative diagnosis in every case was cavernous hemangioma, and intraoperatively the lesions resembled cavernous hemangiomas. However, posterior dissection was difficult in all patients because of dense adhesions and, in one case, led to a central retinal artery occlusion. The histology was characteristic of orbital venous-lymphatic malformations in all five cases. CONCLUSIONS: Deep orbital venous-lymphatic malformations presenting in adulthood may be rarely confused with cavernous hemangiomas. In doubtful cases, significant intralesional heterogeneity, best seen on magnetic resonance imaging, and focal calcification may help distinguish the two entities. This differentiation is important, because dissection of venous-lymphatic malformations is fraught with more complications than surgical excision of a cavernous hemangioma.
ISSN:0002-9394
1879-1891
DOI:10.1016/S0002-9394(00)00826-6