PMC6311860_01
Picture of initial presentation.
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fig1
On examination, she was found to have a medial orbital mass causing ectropion of the lower eyelid and symptomatic epiphora (see Figure 1).
Left orbit: 2.0 x 1.6 x 1.0 cm nonenhancing soft tissue extraconal medial intraorbital lesion abutting the nasolacrimal duct, lateral and inferior to the globe. No thickening of the lateral rectus muscle or surrounding inflammation.
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fig2
The globe was intact (see Figure 2).
Pathology. (a) 100x, low power. Cellular neoplasm with microcystic areas associated with myxoid matrix deposition. Focally extensive fields of necrosis were also present in this case (bottom). (b) 400x, high power. Densely cellular neoplasm comprised variably cohesive cells with dense intracytoplasmic eosinophilic inclusions and eccentric nuclei with focally prominent nucleoli.
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fig3
The final pathology was positive for ES with rhabdoid features of the left medial orbital wall, stage pT2 N0 M0 (see Figure 3).
Picture after healing from left orbital exenteration surgery with closure.
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fig4
Following complete healing from her surgery (see Figure 4), she met with a radiation oncologist to discuss postoperative radiation treatment options.
Postoperative radiation therapy to the left orbit with IMRT. Graphic illustration of the radiotherapy dose cloud. The associated table shows the color map correlation with radiation dose in cGy.
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fig5
The recommended treatment was an intensity-modulated radiation therapy (IMRT) plan to a total dose of 6600 cGy in 33 fractions of 200 cGy (see Figure 5).