PMC3039196_01
Clinical photograph of the erythematous swelling of the left eyelid.
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F1
He returned six weeks later with symptoms of mild fever, cough, and chills, as well as left facial erythema, swelling, and tenderness (Fig. 1).
Enhanced extraconal and intraconal infiltrations in the left orbit, and an inferolateral view of the silicone ball sphere in the eyelid.
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F2
An orbital computed tomography (CT) scan revealed enhanced soft tissue infiltrations in his left extraconal and intraconal spaces and a thickening of the left eyelid (Fig. 2).
The tumors were composed of cells with hyperchromatic eccentric nuclei (suggesting signet ring cells), prominent eosinophilic cytoplasm, and intracytoplasmic vacuolations (H&E, x400).
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F3
Some cells had signet ring cytology, with a dominant cytoplasmic vacuole and an eccentrically placed, crescent-shaped nucleus (Fig. 3).
A positron emission tomography image revealed the multiple intense hypermetabolic foci on the left orbit and the skull as well as along the spine.
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F4
However, brain magnetic resonance imaging and positron emission tomography revealed metastatic lesions on the left frontal and temporal lobes of the skull; nasal bone; left basal skull; right mandibular ramus and sternum; vertebra in the cervical, thoracic, lumbar and sacral regions; and the left ischium (Fig. 4).