Greaves Giovanni H, Livingston Kym, Liu Grant T, Shindler Kenneth S, Volpe Nicholas J, Pistilli Maxwell, Mehta Sonul, Tamhankar Madhura A
a Department of Ophthalmology , Northwell Health , Great Neck , New York , USA.
b Department of Ophthalmology , Scheie Eye Institute , Philadelphia , Pennsylvania , USA.
Orbit. 2017 Oct;36(5):317-321. doi: 10.1080/01676830.2017.1337173. Epub 2017 Jul 13.
Neoplastic infiltration of the extraocular muscle (EOM) is a rare condition which can pose a diagnostic dilemma due to its rarity and overlapping ultrasonographic features with orbital myositis. The ultrasonographic features of neoplastic enlargement of EOM have not been systematically studied and previously have been described in only a few case reports. Orbital ultrasonography, in conjunction with the pattern of ocular misalignment, was assessed for its potential role in identifying patients with neoplastic EOM enlargement. Retrospective chart review of patients with neoplasm and myositis. The clinical features of 8 patients with neoplastic infiltration of the EOM were compared to 15 patients with myositis. In the neoplastic group the width of the EOM was (10.5 mm) almost twice the normal width of the muscle with myositis (p < 0.001). All the muscles in the neoplastic category were low to medium reflective. Paretic deviation was seen in 4/8(50%), purely restrictive in 2/8 (25%) and combined pattern in 2/8 (25%) were noted. In the myositis group the average EOM enlargement was 5.8 mm and all muscles showed low reflectivity. Although ultrasonographic features overlapped between the 2 groups paretic deviations were more common in the neoplastic group versus the myositis group (50% versus 7%). Neoplastic muscle enlargement tends to be larger with paretic deviations of ocular motility seen clinically. These findings in a patient with EOM enlargement should raise the suspicion of neoplasm as the etiology and further work up should be considered.
眼外肌(EOM)的肿瘤浸润是一种罕见的情况,由于其罕见性以及与眼眶肌炎超声特征重叠,可能会造成诊断困境。EOM肿瘤性增大的超声特征尚未得到系统研究,此前仅在少数病例报告中有描述。评估眼眶超声检查结合眼球运动偏斜模式在识别EOM肿瘤性增大患者中的潜在作用。对肿瘤患者和肌炎患者进行回顾性病历审查。将8例EOM肿瘤浸润患者的临床特征与15例肌炎患者进行比较。肿瘤组中EOM的宽度为(10.5毫米),几乎是肌炎患者肌肉正常宽度的两倍(p<0.001)。肿瘤组中的所有肌肉均为低至中等回声。在肿瘤组中,4/8(50%)出现麻痹性偏斜,2/8(25%)为单纯限制性偏斜,2/8(25%)为混合性偏斜。在肌炎组中,EOM平均增大5.8毫米,所有肌肉均表现为低回声。尽管两组之间超声特征有重叠,但肿瘤组的麻痹性偏斜比肌炎组更常见(50%对7%)。临床上可见肿瘤性肌肉增大往往更大,伴有眼球运动麻痹性偏斜。EOM增大患者的这些发现应引起对肿瘤病因的怀疑,并应考虑进一步检查。