PMC10408611_01
(a and b) Head computed tomography (CT) revealed a mass superior to the medial side of the right orbit. (c) CT angiography revealed an ophthalmic artery (arrow) outside the mass.
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F1
CT revealed a mass superior to the medial side of the right orbit [Figures 1a and b]. CT angiography revealed an ophthalmic artery outside the mass [Figure 1c], and magnetic resonance imaging (MRI) showed T1 isointense and T2 isointense lesions.
(a and b) T1-weighted Gd-enhanced magnetic resonance imaging showing a homogeneously enhanced lesion on the superior to medial side of the right orbit. (c and d) Constructive interference in steady-state sequence showing the internal rectus and superior oblique muscles compressed externally by the tumor.
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F2
Diffusion-weighted MRI revealed a hyperintense lesion, and T1-weighted Gd-enhanced MRI showed a homogeneously enhanced lesion [Figures 2a and b]. Constructive interference in steady-state sequencing showed that the internal rectus and superior oblique muscles were externally compressed by the tumor [Figures 2c and d].
(a) The right maxillary sinus entered through the right nasal cavity and was freed by excision of the cribriform stalk. The superior wall of the maxillary sinus is an important landmark because it serves as the inferior wall of the orbit. (b) The middle nasal meatus is punctured to release the ethmoid sinus, exposing the medial side of the orbit. (c) Mucosa of the medial orbit was dissected, and the bone was removed to expose the orbital periosteum. (d) The orbital periosteum was incised, but distinguishing between the fat, tumor, and medial rectus muscle was difficult. The medial rectus muscle and tumor area were bluntly dissected, and the tissue was removed. (e) The exposed orbital contents were partially covered with mucosa. (f) A silicone sheet is placed in an inverted U-shape to complete the surgery.
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F3
Bosmin (0.1%) was injected into the incision site of the nasal septal mucosa in the right nasal cavity, and the right maxillary sinus was opened by resecting the uncinate process of the ethmoid [Figure 3a]. Ethmoidectomy was performed to expose the medial side of the orbit [Figure 3b]. The ethmoidal mucosa of the medial orbit was then dissected, and the lamina papiracea was removed to expose the periorbita [Figure 3c]. The medial rectus muscle and tumor area were bluntly dissected, and a portion of the tumor was removed [Figure 3d]. To the extent possible, the exposed orbital contents were partially covered with the remaining ethmoidal mucosa [Figure 3e], and a silicone sheet was placed in an inverted U-shape to complete the surgery [Figure 3f].
(a and b) Histopathology showing proliferating lymphocytes with moderate cellular atypia. (c-f) Immunostaining was positive for CD5, CD20, and CD79a, and the Ki67 index was 70%.
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F4
Histopathological examination revealed proliferating lymphocytes with moderate cellular atypia [Figures 4a and b]. In addition, immunostaining showed positivity for CD5 [Figure 4c], CD20 [Figure 4d], and CD79a [Figure 4e], with a Ki67 index of 70% [Figure 4f].