Orbital pseudotumor. Fine-needle aspiration biopsy and response to therapy

To determine the diagnostic accuracy of fine-needle aspiration biopsy and study the natural history and therapeutic response of a group of patients with orbital pseudotumor.

Retrospective review of patients seen by one ocular oncologist for diagnosis and management of presumed orbital pseudotumor.

Thirty-eight patients had fine-needle aspiration biopsy under computed tomographic (CT) guidance. No false-positive results were observed. In 10% of fine-needle aspiration biopsies, negative results were observed. In all patients in this series, lymphomas could be differentiated from pseudotumors. Flow cytometry or Southern blot analysis could be performed on these cytopathologic specimens and was useful in selected cases. Eighty-one patients were followed after various forms of treatment. Essentially complete remissions were observed in 49 of 81 patients. High-dose oral corticosteroids were effective in approximately 31% of patients. A poor steroid response was observed in patients with mass lesions and those with fibrotic disease. Surgical resection was effective in 76% of patients; most of these had relatively discrete mass lesions. Radiation was effective in approximately 64% of patients. Radiation was more effective in nonfibrotic lesions and in patients with erythema. This type of treatment was less effective in fibrotic lesions and in patients who had a longer interval between diagnosis and therapy.

Fine-needle aspiration biopsy is useful in evaluating patients with presumed orbital pseudotumor. There is a high success rate in many patients with orbital pseudotumor, although patients with diffuse fibrotic disease have a poor prognosis.