Abstract
Case summary
A 66-year-old man was evaluated for swelling of the left upper eyelid without pain that developed 2 months earlier. ACT scan and MRI of the orbit showed a large superior orbital mass with adjacent bony erosion, which had a central necrotic area. Incisional biopsy of the orbital mass was performed through a sub-brow incision. Histopathologic examination revealed a hypercellular tumor composed of spindle-shaped pleomorphic cells arranged in a fascicular pattern with necrotic foci. High-power magnification showed mitotic figures and nuclear pleomorphism. Subsequently, a malignant peripheral nerve sheath tumor was diagnosed.
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Figure 2.
(A) Axial CT reveals a large superior orbital mass with adjacent bony erosion. (B) Coronal CT depicts invasion of the superior muscle by the mass with destruction of the superior orbital wall.
![jkos-50-1409f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-50-1409f2.gif)
Figure 3.
(A) T1-weighted precontrast axial image demonstrating a well-defined mass in the right orbit with central necrosis. (B) T2-weighted precontrast axial image showing high signal intensity in the central necrotic area. (C, D, E) T1-weighted postcontrast images demonstrating significant homogenous peripheral enhancement and invasion into the dura mater without intracranial extension.
![jkos-50-1409f3.tif](/upload/SynapseXML/0035jkos/thumb/jkos-50-1409f3.gif)