Uncommon primary tumors of the orbit diagnosed by computed
               tomography-guided core needle biopsy: report of two cases

Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.

Orbital neoplasms; Needle biopsy; Computed tomography; Diagnosis

Authorship

Chiang Jeng Tyng

Master, Titular Physician and Responsible for the Unit of Percutaneous Intervention, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilMaster, Titular Physician and Responsible for the Unit of Percutaneous Intervention, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

João Paulo Kawaoka Matushita Jr.

Master, Fellow, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilMaster, Fellow, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Almir Galvão Vieira Bitencourt Mailing Address: Dr. Almir Galvão Vieira Bitencourt. Rua Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 01509-010. E-mail: almirgvb@yahoo.com.br.

PhD, Titular Physician at Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilPhD, Titular Physician at Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Flávia Branco Cerqueira Serra Neves

MD, Fellow, Division of Ophthalmology, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.Hospital do Servidor Público EstadualBrazilSão Paulo, SP, BrazilMD, Fellow, Division of Ophthalmology, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.

Maurício Kauark Amoedo

MD, Fellow, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilMD, Fellow, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Paula Nicole Vieira Barbosa

Master, Titular Physician and Responsible for the Unit of Computed Tomography, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilMaster, Titular Physician and Responsible for the Unit of Computed Tomography, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Rubens Chojniak

PhD, Titular Physician and Director, Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.A.C.Camargo Cancer CenterBrazilSão Paulo, SP, BrazilPhD, Titular Physician and Director, Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.

Mailing Address: Dr. Almir Galvão Vieira Bitencourt. Rua Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 01509-010. E-mail: almirgvb@yahoo.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (3)

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Figure 1
Case 1 – Imaging findings in a 56-year-old patient with an orbital lesion at right. A: Non-contrast-enhanced computed tomography demonstrating isointense retrobulbar, ovoid lesion with regular contours at right, in close contact with the apex of the orbit. B,C: Magnetic resonance imaging demonstrating the same lesion medially displacing the extraocular muscles, with heterogeneous high signal intensity on T2-weighted sequence (B), and enhancement after paramagnetic contrast injection in the areas with lower signal intensity on T2-weighted sequences (C).

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Figure 2
Case 2 – A 32-year-old patient with an orbital lesion at right. A: Magnetic resonance imaging demonstrating extraconal lesion at right, with regular contours. Anterior displacement of the ocular globe and medial displacement of the extraocular muscles and optic nerve, with intense enhancement after paramagnetic contrast injection. B: Noncontrast enhanced computed tomography demonstrating the same lesion. C,D: Positioning of the coaxial needle by inferior transpalpebral approach (C) and tomographic section confirming the location of the needle end adjacent to the lesion (D).

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Figure 3
Case 1 – Computed tomography-guided core biopsy of orbital lesion at right. A: Local anesthesia with 2% lidocaine in the subcutaneous tissue (A1) and tomographic section demonstrating the location and angulation of the needle (A2) for procedure planning. B: Positioning of coaxial needle by lateral transpalpebral approach (B1) and tomographic section confirming the location of the needle end adjacent to the lesion (B2). C: Insertion of the biopsy needle through the coaxial needle for samples collection (C1) and tomographic section demonstrating the presence of foci of gas within the lesion (C2), confirming that the samples were collected from this area.

Figure 1 Case 1 – Imaging findings in a 56-year-old patient with an orbital lesion at right. A: Non-contrast-enhanced computed tomography demonstrating isointense retrobulbar, ovoid lesion with regular contours at right, in close contact with the apex of the orbit. B,C: Magnetic resonance imaging demonstrating the same lesion medially displacing the extraocular muscles, with heterogeneous high signal intensity on T2-weighted sequence (B), and enhancement after paramagnetic contrast injection in the areas with lower signal intensity on T2-weighted sequences (C).

Figure 2 Case 2 – A 32-year-old patient with an orbital lesion at right. A: Magnetic resonance imaging demonstrating extraconal lesion at right, with regular contours. Anterior displacement of the ocular globe and medial displacement of the extraocular muscles and optic nerve, with intense enhancement after paramagnetic contrast injection. B: Noncontrast enhanced computed tomography demonstrating the same lesion. C,D: Positioning of the coaxial needle by inferior transpalpebral approach (C) and tomographic section confirming the location of the needle end adjacent to the lesion (D).

Figure 3 Case 1 – Computed tomography-guided core biopsy of orbital lesion at right. A: Local anesthesia with 2% lidocaine in the subcutaneous tissue (A1) and tomographic section demonstrating the location and angulation of the needle (A2) for procedure planning. B: Positioning of coaxial needle by lateral transpalpebral approach (B1) and tomographic section confirming the location of the needle end adjacent to the lesion (B2). C: Insertion of the biopsy needle through the coaxial needle for samples collection (C1) and tomographic section demonstrating the presence of foci of gas within the lesion (C2), confirming that the samples were collected from this area.

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Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

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