A Case of Adenoid Cystic Carcinoma Mimicking Orbital Pseudotumor

Abstract

Introduction: Clinical approach to the case of dacryoadenitis. Case Report: A 41-year-old male patient was admitted to our clinic with complaints of decreased vision in the left eye, periorbital and headache for 2 days. On examination, his visual acuity was full on the right and counting fingers at 2 meters on the left. There was a slight swelling and dimness in the margins of the optic disc on the left, other eye examination findings were normal. The patient was treated with intravenous methylprednisolone at a dose of 1gr/day for three days with the prediagnosis of orbital pseudotumor. However, it was observed that the patient's complaints recurred after methylprednisolone was discontinued. In repeated orbital MRI, at the level of the orbital apex on the left, infiltrating the dural structures, indenting the cavernous sinus, affecting the soft tissue structures adjacent to the nasopharyngeal lumen on the left, are seen. The left optic nerve was found to be slightly thicker than normal, especially at the apex level. For histopathological diagnosis, endoscopic biopsy was performed from the tumor and surrounding tissue from the left maxillary sinus. The biopsy result was reported as adenoid cystic carcinoma. Discussion: The diagnosis of orbital pseudotumor is made in accordance with clinical, radiological and pathological data. Orbital pseudotumor is histopathologically characterized by polymorphous inflammatory cell infiltration accompanied by varying degrees of fibrosis. It is difficult to distinguish an orbital pseudotumor from a true neoplasm. Lymphomas constitute 20% of orbital mass lesions. Our case was initially treated with a preliminary diagnosis of orbital pseudotumor localized in the posterior orbit and responded to steroids. However, lack of complete recovery and recurrence after steroid discontinuation brought to mind other underlying pathologies and directed to further examination and biopsy. As a matter of fact, the patient, who was diagnosed with adenoid cystic carcinoma as a result of biopsy, was included in the oncological follow-up and treatment program. It is necessary to be vigilant in terms of malignancy in orbital pseudotumors and not to avoid biopsies in suspected cases.