PMC8326082_01
(a and b) Pre- and post-operative photographs of the patient showing clinical improvement in axial proptosis.
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F1
We report the case of a 65-year-old female who presented with complaints of painless proptosis of the right eye since 1 year followed by gradual progressive visual loss and restricted right eye movements since 3 months [Figure 1]. Hertel's exophthalmometer revealed a 3 mm proptosis of the right eye [Figure 1]. In the immediate postoperative period, patient's proptosis and vision improved (finger counting at 2 feet) [Figure 1].
(a-c) Preoperative MRI images showing heterogeneous contrast enhancing intraorbital mass in the right eye with proptosis.
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F2
Computed tomography and magnetic resonance imaging (MRI) of the orbits (plain plus contrast) revealed an intra-orbital, intra-conal, and heterogeneous contrast enhancing mass in the right eye [Figure 2]. The lesion was causing displacement of the globe anteriorly and slightly inferiorly, resulting in proptosis [Figure 2].
Intraoperative photographs (a) showing the tumor mass after opening the periorbita (b) The right optic nerve (arrow) which was compressed but free from the tumor.
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F3
The tumor was identified after opening the periorbita [Figure 3]. The right optic nerve, though compressed and displaced inferiorly, was free from the lesion [Figure 3].
The histological images showing a) a tumor comprising of thick meningeal tissue with outlining multiple cystic spaces, a distinct area formed by conglomerate of vascular channels and focal lymphoid aggregates {hematoxylin & eosin (H and E) 20x}, b) junctional area highlighting both angiomatous and microcystic components (H and E 100x), c) Both thin and thick walled variably sized vessels in angiomatous component (H and E 40x), d) microcysts are lined by meningothelial cells with elongated slender nuclei (H and E 100x).
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F4
The final histopathological diagnosis was "Meningioma-mixed microcystic angiomatous pattern, WHO Grade I" [Figure 4].
(a and b) Postoperative MRI images at 3 months follow-up showing complete excision of the mass with no radiological evidence of recurrence.
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F5
At 3 months follow-up, patient's vision in the right eye was 6/12 and there was no clinical or radiological evidence of recurrence [Figure 5].