Malignancies involving the orbit may require the removal not only of the eye but of all of the orbital soft tissue as well. The malignancies may arise within the orbit (e.g., adenoid cystic carcinoma of the lacrimal gland), or may invade the orbit secondarily (such as advanced basal cell carcinoma of the eyelid).
Orbital infections by Murcormycosis may also be an indication for orbital exenteration.
Obital mucomycosis. The organisms, identifiable here on routine hematoxylin-eosin staining, have a tendency to invade into blood vessels, provoking thrombosis and secondary infarct of soft tissues. Note the non-septate organisms with wide-angle branching (insert).
It is important that the exenteration specimen be well fixed in an appropriately large volume of formalin. It may be difficult for fixative to penetrate into layers of orbital fat that surround the eye. At the very least, the specimen should be covered by formalin.
Orbital fat does not fix well. Alcoholic formalin preparations may be preferable to fixatives that contain only formalin. Our technical staff can offer suggestions concerning commercially available products that are effective in fixing orbital soft tissues.
Many pathologists take a vertical section through the eyelids and orbit. This cut produces an aesthetically pleasing tissue slide that includes the eye, orbital soft tissue, and eyelids in one section plane. However, this vertical section plane may not include the area of interest to the surgeon (a particular margin, for example).
We contend that there is no standard method for the dissection of exenteration specimens -- that the method of dissection should be tailored to discovering the information of surgical importance. We frequently dissect the soft tissues of the orbit away from the eye and submit them separately.
If you have more questions about orbital exenteration specimens, please contact one of us:
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