PMC3659441_01
Physical examination showing right cheek erythematous lesion of size 3 x 3 cm and a similar erythematous mass over left upper medial canthus of size 1 x 2 cm with ptosis.
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Physical examination revealed right cheek erythematous mass of size 3 x 3 cm and a similar erythematous mass over left upper eyelid of size 1 x 2 cm (Figure 1); however, clinical examination revealed no lymphadenopathy or any visceromegaly.
Biopsy showing (a) large histiocytes found with vesicular nuclei and emperipolesis. And (b) immunohistochemistry demonstrated the positivity for S-100, CD68, and CD45 and negativity for CD1a, consistent with the diagnosis of extra-nodal RDD.
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Immunohistochemistry demonstrated the positivity for S-100, CD68, and CD45 and negativity for CD1a, which confirmed the diagnosis of extra-nodal RDD (Figure 2).
Intensity modulation radiation therapy (IMRT) to left medial canthus (a) 22.5 Gy in 15 fractions to the clinical target volume (CTV), and (b) 30 Gy in 15 fractions to the gross tumor volume (GTV) using 6 MV photons.
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MV photons to left eyelid mass (Figure 3). Magnetic resonance imaging (MRI) of head and neck showed more than 90% of reduction in size of eyelid lesion.
Magnetic resonance imaging (MRI) ((a) and (b)) axial and (c) coronal images of head showing recurrent mass tissue lesion involving the left eyelid, mainly superiorly and medially progressing deeply to surround the superior and medial recti muscles as well as superior oblique muscle mainly at their insertion on the ocular globe and another mass tissue lesion involving the right cheek included within the subcutaneous tissue showing intense enhancement measuring about 3 x 2 cm without obvious deep extension.
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After 3 months of radiation therapy, MRI of head and neck revealed the reappearance of masses in left eyelid and right cheek (Figure 4).