PMC5602125_01
There is an elastic, nontender, and nonmovable mass around left lacrimal sac without inflammatory signs (arrow).
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F1
The ophthalmic examinations revealed an elastic, nontender, and nonmovable mass around the left lacrimal sac (Fig. 1).
(A) Facial paranasal sinus computed tomography reveals a homogeneous high-density cyst-like lesion over the left lacrimal sac (arrow). Marked periosteal mucosal thickening of the nasal cavity with polypoid lesions is also noted. (B) Head orbits postgadolinium T1-weighted magnetic resonance imaging (MRI) reveals an iso- to hyperintense homogeneous lesion (17 mm x 12 mm x 20 mm) with contrast enhancement over left lacrimal sac. Paranasal sinusitis is also noted. (C) T2-weighted MRI reveals slightly hyperintense signal of the lesion.
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F2
Orbital computed tomography (CT; Fig. 2A) and magnetic resonance (MR) imaging (Fig. 2B and C) revealed chronic paranasal sinusitis and a homogeneous cystic lesion (17 mm x 12 mm x 20 mm) over the left lacrimal sac.
(A) Histopathological studies reveal diffuse infiltration of medium-sized to large neoplastic cells with high mitotic activity (arrow; hematoxylin and eosin stain, x400). (B) The immunohistochemical stain shows the neoplastic cells with CD20 (+) (x400).
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F3
The pathological results revealed a diffuse infiltration of medium-size to large neoplastic cells with high mitotic activity (Fig. 3A). The immunohistochemical stains showed the characteristic CD20 (+), CD3 (-), CD5 (-), and CK (-), compatible with the diagnosis of diffuse large B cell lymphoma (Fig. 3B).
(A) Whole-body fludeoxyglucose positron emission tomography (FDG PET) scan demonstrates focal increased FDG uptake in the inferior medial aspect of left orbital cavity (arrow). (B) One year after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, no abnormal glucose metabolic region is found in the whole-body FDG PET scan.
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F4
A whole-body fludeoxyglucose (FDG) positron emission tomography scan demonstrated focal increased FDG uptake in the inferior medial aspect of the left orbital cavity without metastasis (Fig. 4A). No abnormal glucose metabolic region was found in the whole-body FDG positron emission tomography scan 1 year after the chemotherapy (Fig. 4B).