This is a case of an orbital lymphoma. The patient underwent an endoscopic endonasal orbital decompression for biopsy of the orbital apex lesion. Histopathology was notable for fibroconnective tissue and lymphoid tissue. Immunohistochemical stains were positive for CD20 which highlighted an expanded B-cell proliferation. The lymphocytes stained positive for PAX5 and BCL2. Flow cytometry revealed diffuse proliferation consisting of small monocytoid-appearing lymphocytes and plasma cells. The overall findings are most consistent with an extranodal marginal zone B-cell lymphoma. She was scheduled for radiation therapy.