PMC5944016_01
(A) The clinical appearance of the patient with apparent fullness of the right upper eyelid; (B) Coronal computerized tomography scan showing bilateral superior orbital cystic lesions, more prominent on the right side (Red arrows); (C) Sagittal computerized tomography scan of the right orbit showing the fusiform lesion occupying the superior orbit pushing the superior rectus muscle and extending posteriorly towards the apex of the orbit (Blue Arrow head).
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The superior fullness over the right upper eyelid was evident to the patient and disturbing for her cosmetically (Fig. 1A). The remaining extraocular muscles were preserved (Fig. 1B and C).
(A and B) Intra-operative photo showing the neurofibromatous lesion after dissection and isolation. The photo labeled: B shows the relation of the lesion to the nerve; (C) Histopathologic photo of the solitary neurofibroma with neural tissue: myelinated axons and schwannian-like cells within loose myxoid stroma surrounded by perineurium (Original magnification x 200 Hematoxylin & eosin); (D) The continuation of the lesion deep in the orbit showing histopathologically unremarkable nerve tissue excised at the deep margin of the lesion excision (Original magnification x 100 Hematoxylin & eosin).
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It appeared intra-operatively to be cystic in nature (Fig. 2A) arising in relation to the supra-orbital nerve and extending deeply along the course of the frontal sensory nerve into the superior orbital fissure (Fig. 2B). The tissue was surrounded by a thin layer of perineurium and continues as a thickened unremarkable nerve (Fig. 2C and D).