PMC3640222_01
Intraoperative image from eyebrow incision and orbital craniotomy
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F1
He returned for follow-up 1 month later with left gaze palsy. He underwent a follow-up brain magnetic resonance imaging (MRI), which showed a new lesion in the left orbit and lateral rectus muscle [Figure 1].
(a) Preoperative and (b) Postoperative images demonstrating resection of lateral orbital lesion
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F2
We first performed an incision starting within the left eyebrow [Figure 2].
(a) The tumor is composed of monomorphic neoplastic cells with chromophobic or mildly acidophilic cytoplasm, coarse chromatin, and prominent nucleoli (H and E, magnification x100). (b) The neoplastic cells are weakly to moderately immunopositive for growth hormone (GH) (immunohistochemistry, magnification x200). (c) There are occasional p53-immunopositive nuclei (immunohistochemistry, magnification x200). (d) The Ki-67 proliferation index approaches 30% in the most densely labeled area (immunohistochemistry, magnification x200)
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F3
Microscopic examination of the current biopsy showed sheets of monomorphic cells infiltrating bone marrow between bone trabeculae [Figure 3].