PMC7849864_01
(a) Pre-operative clinical photograph showing left eye ptosis. (b) Mulberry-like mass lesion in the left superior fornix with overlying dilated and tortuous blood vessels
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F1
A 69-year-old male presented with complains of painless progressive swelling inthe left eye for 6 months [Figure 1a]. On examination, reddish, mulberry like mass lesion was seen in superior fornix withoverlying dilated tortuous blood vessels, blanching on digital pressure, but showing no variation with the Valsalva maneuver [Figure 1b].
(a) T1 weighted Magnetic Resonance Imaging (MRI) showing a well circumscribed isointense lesion in left superior obit. SR-LPS complex cannot be identified separately. (b) T2 weighted images showing heterogenous centrally hyperintense but peripherally hyopintense lesion. (c) Post Contrast MRI showing moderate heterogenous enhancement
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F2
On T1weighted images, the mass was isointense whereas on T2 weighted images a central hyperintense area with peripheral hypointensity was seen [Figure 2a-c].
(a) Carotid angiogram showing small tumor blush in left supraorbital region (fed by anterior branch of middle-meningeal artery (Arrow). (b) Post embolization angiogram showing complete obliteration of tumor blush
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F3
Post embolization angiogram showed complete obliteration of tumor blush [Figure 3a and b].
(a) Peroperative appearance of the lesion inseparable from sr-LPS complex (SR hooked by squint hook). (b) Photomicrograph showing large lymphoid cells arranged around blood vessels (Hematoxylin& Eosin Stain; 100)
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F4
The SR-LPS complex could not be separated from the mass and was excised partially along with the lesion [Figure 4a]. Histopathological examination was suggestive of diffuse non-Hodgkin's lym- phoma [Figure 4b].
Postoperative clinical photograph of the patient after excision of the mass showing left eye complete ptosis
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F5
The patient had complete ptosis of the left upper eyelid for which he was advised surgical correction [Figure 5].