PMC10062108_01
(a) Preoperative clinical photograph showing a large swelling of the lower lid and medial ectropion, also to be noted is the conjunctival scarring present medially. (b) Gross tissue specimen measuring 25 mm x 15 mm. (c) Postoperative appearance at 1 month
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F1
On examination, a firm diffuse left lower lid mass measuring approximately 20 mm across with poorly defined posterior extent and mild medial ectropion was present [Figure 1a]. T1W and hyperintense on T2W sequence encroaching into the extraconal space with the indentation on the anteroinferior globe; furthermore, nasolacrimal duct seems to be obliterated [Figure 2a,b]. A total tumor excision through a conjunctival approach was carried out, and a well-defined mass measuring 25 mm x 15 mm adherent to the overlying conjunctiva was identified and retrieved ensuring complete excision [Figure 1b]. The patient recovered well with only mild medial ectropion of the lower lid remaining [Figure 1c].
(a) Fat saturated T1W sagittal and T2W axial scan showing a well-defined postseptal lesion. (b) Coronal T2W and T1W show a lobular, T2 hyperintense, and T1 isointense lesion in medial aspect of left lower lid. (c) Observe diffusely proliferating tumor cells arranged in fascicles and occasional storiform pattern (H and E, x40). (d) Oval to spindle tumor cells with vascular spaces (H and E, x100). (e) Tumor cells avidly staining with CD34 immunostain
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F2
T1W and hyperintense on T2W sequence encroaching into the extraconal space with the indentation on the anteroinferior globe; furthermore, nasolacrimal duct seems to be obliterated [Figure 2a,b]. A total tumor excision through a conjunctival approach was carried out, and a well-defined mass measuring 25 mm x 15 mm adherent to the overlying conjunctiva was identified and retrieved ensuring complete excision [Figure 1b]. The patient recovered well with only mild medial ectropion of the lower lid remaining [Figure 1c]. Tumor also showed epitheloid and hemangiopericytomatous morphology at places; however, no mitosis or necrosis was seen [Figure 2c,d]. On immunohistochemistry, cells were found positive for CD34 and negative for S-100 [Figure 2e].