Hind Alkatan
Orbital lesions vary in their classification, incidence and presentation depending on the age and the geographic distribution. Such lesions in the pediatric age group has been extensively studied because of the possibility of faster progression of orbital involvement and the higher risk of morbidity in this age group of patients where vision is still developing. In Saudi Arabia, this has been studied over a six-year period in the late 80’s when retinoblastoma cases used to present late with orbital involvement. In this current study, we revisited the same topic 20 years later aiming at finding out the most recent prevalence of orbital lesions in a similar population of patients over a longer period (14 years) in the same eye center and at comparing the current results to other reports worldwide. A total of 107 lesions from 106 patients were identified by tissue diagnosis, out of which more than half of the lesions were benign cystic (being the commonest), vasculogenic and inflammatory in 63% [95% CI (53.3-72.0)] of all biopsied lesions. Neoplasms accounted for 37% [95% CI (28.0 – 45.8)] with rhabdomyosarcoma being the commonest accounting for about one third of neoplasms and no orbital cases of retinoblastoma were found. A five-year-old male presenting with progressive right facial swelling underwent multiple biopsies before being diagnosed with a polyostotic frontal-zygomatic primary intraosseous hemangioma. Intraosseous hemangiomas are rare, more frequently afflict adult females, and very rarely involve the orbit. Our case with bony destruction and surrounding soft tissue mass measured 5.3 cm in a child mimicked a more ominous malignancy. This case is unique with its rapid progression and largest reported size, leading to additional challenges such as difficulty in achieving an adequate tissue sample and in the surgical management with respect to significant blood loss in a small child.
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