Application of

Imaging in Orbital
Tumors
Dr. Ajay Krishna Murthy
Consultant, Oculoplasty Services,
Narayana Nethralaya 2,
Bangalore
Orbital Mass

Figure A1 Figure B

1. Ajay K, Swathi Kaliki et al. (2017). ‘Concomitant orbital cavernous hemangioma and schwannoma in a patient: A rare
presentation’. International Society of Ocular Oncology Conference, Sydney, 24-28 March, 2017. Sydney: ISOO.
 Orbital Mass

Figure A Figure B
Hemangioma

Schwannomma Hemangioma
Orbital Hemangioma

A B
A. T2 flair heterogenous hyperintense lesion in retro B. Dynamic study – progressive enhancement and
orbital intraconal compartment- infero-medial aspect heterogenous complete enhancement on delayed images
 Schwannoma. A, Axial T1- isointense-signal tumor with hypointense area. B, Axial T2-
hyperintense with a very high-signal-intensity area. C, Postcontrast tumor enhances
heterogeneously with central no enhanced area. The time intensity curve for this
patient is characterized as A PERSISTENT CURVE

Zhang Z, Shi J, Guo J, Yan F, Fu L, Xian J. Value of MR

imaging in differentiation between solitary fibrous tumor
and schwannoma in the orbit. AJNR Am J Neuroradiol.
2013;34(5):1067-1071.

Solitary fibrous tumor. MRI , A, T1- isointense tumor with some hypointense
Areas . B, T2-tumor is isointense with some very high-signal-intensity areas . C, tumor
enhances heterogeneously. The time-intensity curve for this patient is characterized as A
WASHOUT CURVE.
Case of Right eye Proptosis
AA
A. Pre-contrast T2 axials without fat suppression
showing T2 hypointense lesion (Blue arrow) in the
intraconal compartment
B
B. Post-contrast T1 fat-sat coronals showing moderate
heterogenous enhancement. Lesion ( Blue arrow) is abutting the
inferior rectus (Green arrow) which is vertically oriented along the
lateral margin of the lesion
D/D: Solitary fibrous tumor
Lesion was abutting and displacing the
optic nerve and inferior rectus muscle,
surgical intervention was planned

Treatment
• Orbital excision biopsy through trans-
caruncular medial orbitotomy
• HPE Mesenchymal hamartoma
MRI 1 year post surgery

A B
(A) Precontrast T2 fat-sat coronals showing complete (B) T1 coronals with fat showing complete
resolution of the lesion with non-visualization of right resolution of the lesion with nonvisualization of
inferior rectus ( Green arrow) . Yellow arrow showing Right inferior rectus (Green arrow)
normal left inferior rectus.
Yellow arrow showing normal left inferior rectus.
 • The variant in question is Benign Mesenchymal hamartoma. It is a rare tumour of
the head and neck with only 3 cases of orbital occurrences ever reported.
• Rapidly progressive to slow-growing indolent mass lesions.
• Mavrikakis et al - 2 year old boy with progressive unilateral proptosis with loss of
vision - undergo exenteration at the end of 18 months
• Case series by Phan et al, the orbital incision biopsies were performed in two
infants. It showed a decrease in the size of the lesion in the first case and no
progression in the second by the end of 1 year and 6 months follow up
respectively

Gündüz, Kaan M.D.*; Kurt, Rengin Aslhan M.D.*ı; Kaygusuz, Gülsah M.D.†; Kankaya, Duygu M.D.†. Primary Chondromesenchymal Hamartoma of the Orbit. Ophthalmic Plastic & Reconstructive
Surgery: July 2009 - Volume 25 - Issue 4 - p 324-327
Mavrikakis I, White VA, Heran M, et al. Orbital mesenchymal hamartoma with rhabdomyomatous features. British Journal of Ophthalmology 2007;91:692-693.)
Phan IT, Courtney RJ, Marx DP, Wilson DJ, Mansoor A, Ng JD. Proptosis Caused by Rhabdomyomatous Mesenchymal Hamartomata Occurring in the Orbit. Ophthalmic Plast Reconstr Surg. 2016
May-Jun;32(3):e62-4
Mesenchymal Hamartoma
• Masquerade as benign or malignant tumor on imaging
• Any deviation in MRI should arise the suspicion for hamartoma
• Prevent over or under treating the disease
Thank you