PMC8645509_01
(a) Preoperative axial T1WI MRI without contrast; (b) contrast enhancement showing enhancement at the right orbital apex and cavernous sinus; (c) coronal T1WI with contrast at the level of the orbital apex.
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F1
Neuroimaging showed enhancing soft tissue within the right cavernous sinus extending into the right orbital apex and posterior aspect of the right lateral rectus muscle, with enlargement of the superior ophthalmic vein [Figure 1].
(a) High-power view showing dense fibrous tissue with lymphocyte and plasma cell-rich inflammatory infiltrate (H&E, x400); (b) CD138 immunohistochemical stain highlights plasma cells within the inflammatory infiltrate (IHC, x200); (c) IgG4 immunohistochemical stain stains approximately half of the plasma cells (IHC, x200).
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F2
No granulomatous inflammation or evidence of a neoplastic process was seen [Figure 2].
At 6 months follow-up, visual field and extraocular movements improved on the right eye.
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F3
Improvement was also noted in the patient's visual field [Figure 3].
(a) Postoperative CT scan showing right anterior clinoidectomy and orbit decompression from pretemporal approach; (b) postoperative axial MRI T1WI without gadolinium at 6 months after surgery; (c) coronal MRI T1WI with gadolinium showing lack of enhancement in the orbital apex.
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F4
There were also no signs of disease reoccurrence [Figure 4].