O.RBITAL TUMOUR.

By ARTHUR BENSON, F.R.C.S.,Junior Surgeon to St. Mark's Ophthalmic Hospital;

AND

w. R. GRAVES, L.R.C.P., L.R.C.S.Pathologist to St. Mark's Ophthalmic Hospital.

[Read in the Section of Pathology, April 5, 1895J.

M. G., aged fifty-five, from Killucan, was sent to me by Dr.

Lyons, of Mullingar. He stated that the left eye for the

last twelve months had had redness of the eyelid and swelling

at the nasal corner; that he had gone to a general hospital

in J nne last, and had lachrymal probes passed, and was then

sent home, after a stay of eight or nine days in hospital;

that the swelling in the side of the nose was getting worse

all the time, till ~1e came to me in September last. I then

found that there was a hard, lobulated tumour protruding

from the side of the orbit, and pushing the left eye outwards

and for\vard to a considerable extent. Over this tumour theskin was stretched very tightly, but did not seem to be actually

involved by the gro,vth, but it was very adherent to it on

the apex of the tumour, though free elsewhere. The vision

of the eye was 168; there was slight commencing senile

cataract, but the fundus was perfectly normal, and free from

optic neuritis. The bone did not seem to be implicated and

the motions of the eye were very little interfered with.

The tumour was removed (Dr. Bennett kindly assisting)

by two incisions, including an elliptical piece of skin covering

the most prominent nodule. The remainder of the skin was

fairly easily stripped off, and the tumour was separated from

its attachments. It was covered by an ill-defined capsule.

It was about the size of a small hen~s-egg, and extended as

Bv MR. BENSON and DR. GRAVES. 373&'

far back as the optic foramen. -The bone was bare and

eroded, apparently by pressure, at the apex of the orbit, at

the superior wall of the orbit opening into the frontal sinus,and at the nasal side opening into the nasal duct. Throughthis opening the air escaped freely when he blew his nose.

The tumour was soft and friable, and owing to the con­siderable adhesions to the surrounding structures, I canhardly feel sure that the growth was totally removed, butthe wound healed up, and the eye returned to almost itsnormal position, leaving only very slight deformity. Dr.

Graves' Report on the mieroscopic characters of the tumour,

which he kindly cut and examined for me, is as follows :-

The tumour is very irregular in shape. At one end there is apiece of skin firmly adherent; the growth near this is pigmented,elsewhere it is free from pigment. On one side, not far from theskin end, there are several small pieces of bone adherent, and closeto this a few fibres of striped muscle-probably the tensor tarsi­are entangled in the growth, which appears to have originated inthe region of the lachrymal sac. On section it proved to be alarge, round-celled alveolar sarcoma, pigmented in places.

He finds the follo,ving cases of orbital sarcoma have beenrecently recorded :-A case of sarcoma of the orbit extendinginto the cranial cavity has been recorded by Ayres, ofCincinnatti,a in a man of thirty-four years of age. !fr. W.

J. Collins, of London,b operated on a man of forty-eight

years of age for sarcoma of the orbit. The growth appearedto spring from the region of the lachrynlal sac, and proved tobe a round-celled sarcoma. Dunn, of Richmond,c describesa round-celled, giant-celled sarcoma of the orbit which was

operated on four times in two years, and finally caused thedeath of the patient from exhaustion. He notes that at the

third operation the neoplasm had chosen as its points of

... American Journal of Ophthalmology. June, 1893.b Lancet. 16th Sept., 1893.C American Journal of Ophthalmology. April, 1893.

374 Orbital Tumour.

origin all the areas of bone from which the periosteum hadbeen stripped in the former endeavours to eradicate thegrowth. White, of Richmond,& gives the notes of a case offibro-sarcoma filling the left orbit.

Dr. GRAVES, who examined the tumour microscopically, reportetlit to be .a large round-celled alveolar sarcoma, with, in one place,near its anterior surface, a pigmented patch.

DR. MCWEENEY entirely agreed with the diagnosis made by Dr.Graves. He had himself lately examined a similar tumour removedhy Dr. Werner. In his case, however, the greater part of thetumour consisted of fibrous tissue, with here and there iRlets ofsarcomutous cells, with an alveolar arrangernent. At first sig-ht,without the history, the ~pecimen would suggest a carcinoma, buthe was of opinion that it was a large, round-celled, alveolarsarcoma.

DR. PARSONS thougbt it was probably an example of alveolarsarcoma. But the dia@;nosis was very difficult. The alveolarstructure was seldom present in sarcomata, but was always presentin cancer. The only way to be absolutely sure would be to find'vhtjuce tIle tumour grew.

MR. BENSON, replying, said that at first Dr. Graves was uncertainas to the diagnosis, and it ,,'as only after examining a series ofsections that he came to the conclusion that it was an alveolarsarcoma.

a Ophthalmic Review. London. Sept., 1893.