PMC4242685_01
(A) Clinical photograph showing no globe displacement or ocular abnormalities. (B) Additional clinical photograph demonstrating no mass on visual inspection.
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There was no globe displacement or proptosis (Figure 1), but there was paresthesia along the left infraorbital nerve.
(A) Sagittal and (B) axial CT images demonstrating a mass in the left inferior orbit, with suggestive orbital rim bone erosion (black arrows).. Abbreviation: CT, computed tomography.
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A head and orbit computed tomography (CT) scan showed a well-defined lesion in the left anterior aspect of the inferomedial orbit, just behind the rim, with suggestive bone erosion (Figure 2).
(A) Inferior fornix approach showing a 3.5 cm x1.5 cm well-defined grayish mass in the anteroinferior left orbit. (B) Operative photograph of inferior fornix approach, demonstrating complete removal of mass.
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During surgery, a well-defined, grayish 3.5 cm x1.5 cm mass was noticed disrupting the inferomedial periorbita in the posterior aspect of the medial left orbital rim, which extended posteriorly toward the medial orbital floor (Figure 3A). Due to these potential malignant features, with the paresthesia and bone erosion, a rectangular en bloc excision was performed including the mass with the surrounding left inferomedial orbital rim and the medial orbital floor (Figure 3B).
H&E microphotographs at (A and B) 4x and (C) 10x magnification, demonstrating moderately differentiated spindle cells with almost no mitoses. The hyperchromatic cells, which have coarse chromatin with mild pleomorphism, are arranged in short fascicles that split and merge, giving the classical herringbone architecture of fibrosarcoma. (D) Malignant spindle cells are seen in a fascicular pattern invading adjacent inferior orbital rim bone (black arrow).. Abbreviation: H&E, hematoxylin and eosin.
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Histopathology demonstrated spindle cells with a herringbone pattern without significant pleomorphism (Figure 4A-C), and the mass demonstrated invasion of bone (Figure 4D).