Orbital diseases

1.1. Aim: This study aims to determine whether ADC measure- ments allow discrimination of indolent (group A) from aggressive orbital lymphoma (group B) and how much ADC value can predict lymphoma subtype.
1.2. Methods: A retrospective two-armed cohort study inclu- ding 32 Orbital Adnexal Lymphoma (OAL) lesions evaluated by conventional magnetic resonance image (MRI) and Diffusion Weighted Image (DWI) examination preceding histopathological lesion confirmation. DWI using single-shot echo-planar imaging with b factors of 0,400 and 800 sec/mm2 were performed on 3 Tesla MRI unit. Lymphomas were grouped into indolent or ag- gressive histopathological subtypes according to the Revised Eu- ropean-American Classification of Lymphoid Neoplasms (REAL). The groups minimum, maximum and percentiles of ADC values of indolent were compared to those of aggressive lymphoma subtype. Multiple receiver operating characteristic curve (ROC) analysis was performed for predicting aggressive OAL.
1.3. Results: Of the 32 (OAL) cases, 23 (71.9%) were indolent and 9 (28.1%) were aggressive OAL subtypes. In general, ADC values were significantly higher in the indolent compared to the ag- gressive OL subtypes. (P<0.001). Extra-ocular muscles (P = 0.69) and globe involvement (P = 0.9) were not significant confounders for association of ADC to histological type. The area under curve (AUC) for ADC minimum was 94.4% and for ADC maximum was 81.6%. ADC minimum showed higher sensitivity and specificitythan ADC maximum in revealing (OAL) subtypes.
1.4. Conclusions: ADC measurements are higher in indolent than in aggressive (OAL). ADC minimum has higher sensitivity and specificity than ADC maximum in (OAL) lesions. These concepts confirm and expand the knowledge on (OAL), revealing the im- portance of ADC minimum in discriminate indolent from aggres- sive OAL. DWI can be used to characterize (OAL) based on ADC values, having higher sensitivity and specificity to point the (OAL) subtypes.

A patient with an 18-year history of chronic lymphocytic leukaemia developed zygomycosis of the orbit, sinuses and nasal bones together with pulmonary fungal nodes due to Absidia corymbifera while on high dose steroids and four months after successful treatment of pulmonary aspergilloma with liposomal amphotericin B followed by oral voriconazole. He was treated successfully with extensive surgical debridement, intravenous liposomal amphotericin B and intravenous itraconazole.