PMC5943833_01
Case (9) A: The clinical appearance of an 8-year-old girl (Case 9) at presentation with left eye proptosis and squint since infancy. She received 3 botox injections, left eye for esotropia. B: CT scan done showing a well-defined intraconal homogenous left orbital mass. (C) FIESTA high resolution MRI T2-weighted axial image showing an intraconal isotense lesion. (D) Post-operative resolved proptosis with residual eye deviation and full extraocular motility following surgical intervention.
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The clinico-radiological findings of 3 cases are demonstrated in Fig. 1, Fig. 2, Fig. 3 in addition to Fig. 4A through D.
(Case 2) and (Case 4) A and B: T1-weighted coronal and axial MRI of the orbits, showing a high signal intensity lesion in the left orbital apex and non-traumatic sub-periosteal orbital hemorrhage (red arrows). C and D: T1 and T2-weighted coronal MRI of the orbits showing the typical appearance of an early subacute bleeding as rounded and well-circumscribed lesion (white arrow) in relation to the inferior and medial rectus muscles, where the belly of the inferior rectus muscle is seen running along the superior medial aspect of the lesion (white arrow head).
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The clinico-radiological findings of 3 cases are demonstrated in Fig. 1, Fig. 2, Fig. 3 in addition to Fig. 4A through D.
(Case 10) A: The clinical presentation of a 70-year-old lady with post-traumatic left eye protrusion and restricted motility with no diplopia, headache or numbness. B and C: Axial left proptosis on T1 and T2-weighted MRI images highlighting the intraconal mass as a homogenous isointense and hyper-intense lesion respectively. D: 6 weeks postoperative picture with resolved left proptosis. E: The corresponding histopathological appearance of the excised mass showing typical hematic cyst fibrous wall with organized hemorrhage (Original magnification X100 Hematoxylin and Eosin). F: Higher power of the fibrous wall with hemosiderin deposits (black arrows) (Original magnification X200 Hematoxylin and Eosin).
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Histopathologically all lesions demonstrated collection of blood (often thrombosed) with absent endothelial lining, variable proliferating reactive fibroblasts, and surrounding formation of a fibrous capsule (Fig. 4E). Other constituents included chronic inflammatory cells in 4/13 cases and blood break-down products (hemosiderin) in 4/13(Fig. 4F).
(Case 11) A: A case with hematic cyst showing the fibrous component and area of cholesterol granuloma (Original magnification X100 Hematoxylin and Eosin). B: Higher power of the adjacent area of cholesterol granuloma and hemosiderin-laden macrophages (Original magnification X200 Hematoxylin and Eosin). C: The area of cholesterol granuloma with hemosiderin deposits (Original magnification X400 Iron stain). D: The same area of cholesterol granuloma with epithelioid cells and few giant cells (Original magnification X400 CD68).
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We had 2 unique cases of cholesterol granulomas showing typical cholesterol clefts, hemosiderin-laden macrophages, and multinucleated giant cells (Cases 11 and 12, one of which is shown in Fig. 5A through D).