PMC8178000_01
(a, b) Contrast-enhanced coronal and sagittal CT images, demonstrating an expansive lesion arising from the roof of the right orbit with a heterogeneous enhancement and soft tissue attenuation. Inside view of the lesion reveals several small foci of mineralization (arrow). The lesion shows the osseous expansive changes, with thinning of superior and inferior wall of the roof which leads to an invasion over the frontal sinus and into the orbit. (c) Coronal T2-weighted MRI shows a well-defined lesion with a low-signal-intensity margin representing either osseous sclerosis or a pseudocapsule. The lesion shows a multilobulated lytic pattern which reveals markedly increased signal intensity, reflecting the expansive cystic component, and low signal intensity in the small solid regions. (d) Sagittal postcontrast T1-weighted MR image shows a well-encapsulated mass with homogenous contrast enhancement.
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fig1
It also disrupted the inferior wall of the roof and invaded the orbit, displacing the superior rectus muscle and the globe inferiorly (Figures 1(a) and 1(b)). Magnetic resonance imaging (MRI) revealed a well-defined, heterogeneously enhancing mass, measuring 30 mm x 19 mm x 27 mm, hyperintense on T1-weighted images, and with lobulated, "pseudonodular" appearance on T2-weighted images, with markedly increased signal intensity, reflecting the expansible cystic component (Figures 1(c) and 1(d)).
(a) Surgical approach through an upper eyelid crease incision to access the orbital roof. Intraoperative photograph showing bone destruction in the roof of the orbit and the presence of a red-yellowish mass, with evidence of dark coagulated blood and fragments of bone within the soft tissue. The tumor extends into the anterior cranial fossa. (b) The handpiece of SONOPET  ultrasonic aspirator used for aspiration and emulsification of the tumor tissue in the superior orbit and its extension into cranial cavity. (c) Resection of abnormal tissue from the upper orbit and its extension into anterior fossa.
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An orbitotomy was performed via an upper eyelid crease incision, and a red-yellowish friable mass, with evidence of dark coagulated blood, and fragments of bone tissue within the soft tissue was observed (Figure 2(a)). The handpiece is lightweight and ergonomic, allowing it to be inserted into narrow spaces with poor visibility, thus making possible the approach to the cranial fossa through the orbital roof (Figure 2(b)). Once the tumor tissue was removed, we performed a curettage, removing the capsule and the tissue attached to the cortical surface of bone (Figures 2(c) and 2(d)).
PMC8178000_02
(a, b) Coronal and sagittal CT images, demonstrating an expansive lesion arising from the roof of the right orbit with soft tissue attenuation. Small foci of mineralization (arrow) into the lesion are presented. The lesion protrudes into the orbit. (c) Coronal T2-weighted MR image shows a well-defined lesion arising from the bone with an extraosseous component. The majority of the tumor has high signal intensity on the T2-weighted image, with low signal areas which represent the solid component of the tumor. (d) Volume-rendered 3D-CT reconstruction images show lytic areas with bone destruction in the roof of the orbit.
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Orbital CT revealed a cystic mass measuring 30 mm x 15 mm x 20 mm that eroded the orbital roof, with thinning and pushing the cortex, but without invading the cranial cavity (Figures 3(a)-3(c)). The majority of the tumor had high signal intensity on the T2-weighted image, with low signal areas which represented the solid component of the tumor (Figure 3(c)).
(a, b) Histopathology (hematoxylin and eosin stain (40x) showing multinucleated foreign body giant cells (cholesterol crystals) with xanthomized cells, presence of hemosiderin deposition, and lymphocytic inflammatory infiltrate. Multinucleated giant cells (thick blue arrows), cholesterol crystals (short green arrows), xanthomized cells (wavy black arrows), and hemosiderin deposits (fine yellow arrow).
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There were no areas of malignancy (Figures 4(a) and 4(b)).