PMC4448056_01
CT scan demonstrating the right-sided orbital mass, with the frontal lobe herniating into the superior orbit.
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F1
A head CT was performed upon arrival to the emergency department which revealed a right-sided hyperdense encephalocele with a protrusion into the orbit (fig. 1).
MRI, T1, and T2 images showing the right lateral orbital encephalocele.
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F2
An MRI confirmed the right-sided encephalocele; it revealed a herniation of the frontal lobe into the orbit with a displacement of the globe and a superior rectus muscle inferiorly as well as blurring of the gray matter in the encephalocele (fig. 2). On T2 images, there was a signal change around the area of strangulation (fig. 2), but DWI did not reveal a diffusion restriction.
a, b HE and neurofilament stains, respectively x4 objective. The neurofilament stain with paired HE highlights that the tumor predominantly involves the leptomeninges. c HE. x40 objective. Much of the tumor was composed of monotonous-appearing cells with round and relatively regular nuclei. d HE. x40 objective. In areas of the tumor, the cells had slightly more elongated cell nuclei, and the tumor contained Rosenthal fibers (arrows). e GFAP. x40 objective. The tumor cells are strongly positive for GFAP. f Ki-67. x20 objective. The tumor had a low level of proliferative activity which is highlighted by only occasional scattered Ki-67-positive cells.
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F3
Pathological findings confirmed disorganized neuroglial tissue consistent with an encephalocele (fig. 3).