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Abstract
Case summary
A 15-year-old male presented with an 8-month history of left hypertropia. The best-corrected visual acuity was 20/20 in both eyes. The exophthalmometry showed no exophthalmos, with 13 mm in both eyes. There was a hard palpable mass at the superonasal orbit of the left eye. Orbital computed tomography showed a heterogenous soft tissue shadow at the superonasal orbit of the left eye, and orbital magnetic resonance imaging revealed a 25 × 16 × 20 mm well-defined mass with low signal intensity in the T1-weighted image, high signal intensity in the T2-weighted image, and heterogenous enhancement in the contrast enhanced T1-weighted image. The mass was surgically removed with anterior orbitotomy. A 27 × 17 mm well-capsulated lobular mass was found, and histopathological examination revealed hyaline cartilage and chondrocyte. The mass was diagnosed as a chondroma.
Conclusions
A chondroma is a benign tumor, which usually occurs in long bones and the small bones of the hands and feet. It is very rare in the facial and pelvic bones. The sites of chondroma occurring in the head and neck include the ethmoid sinus and maxilla, but it is extremely rare in the orbit.
Figures and Tables
Figure 1
Preoperative photographies and the Hess screen test of the patient. (A) Clinical photograph demonstrates inferior dystopia of the left eye. (B) In primary position, the patient has left hypertropia of 25 prism diopters, and exotropia of 4 prism diopters. Note secondary overaction of the left inferior oblique muscle and mild limitation of depression when looking down. (C) The Hess screen test also shows secondary overaction of the left inferior oblique muscle with a limitation of inferior gaze of the left eye.
Figure 2
The patient's computed tomography images. Orbital computed tomography images taken preoperatively demonstrate an orbital mass at the superonasal orbit of the left eye which has a bony component (A, B). Superior orbital wall remodeling is found (B, C), and the eyeball is placed inferolaterally (C). The mass shows no enhancement in the contrast-enhanced image (D).
Figure 3
The patient's orbit magnetic resonance images. They show 25 × 16 × 20 mm-sized mass at the superomedial portion of the left orbit. M ass showing low signal intensity with small high signal intensity portion in the T1-weighted images (A, B), and high signal intensity with small low signal intensity portion in the T2-weighted images (C, D). Gadolinium-enhanced T1-weighted axial (E) and coronal (F) images demonstrate heterogeneous enhancement.
Figure 4
Intraoperative findings and Histopathological images. (A) Through a superomedial sub-brow incision, orbital mass excisional biopsy was done. The mass is located at the superomedial orbit, and surrounds superior oblique muscle. (B) Gross image of mass shows 27 × 17 mm-sized mass with pearly white and pinkish surface. (C) Histopathological image shows well-differentiated chondrocytes which is clustered as lobulated manner. The mass is hypocellular with cartilaginous matrix and shows no atypia. The mass contains small portion of bone marrow tissue and calcification (arrow) is seen at between the chondroid tissue and the bone marrow tissue (hematoxylin-eosin, ×40). (D) The chondrocytes are placed in the lacunar spaces with ovoid nuclei without nuclear pleomorphism or mitosis (hematoxylin-eosin, ×200)
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