Presentation
One year history of left eye irritation. On exam in the clinic, he was known to have left proptosis and extraocular movement restriction. His conjunctiva was erythematous.
Patient Data
There is a redemonstration of soft tissue infiltration within the left intraconal orbit inferiorly insinuating along the margins of the mid to distal medial rectus muscle, inferior rectus muscle, and optic nerve sheath complex extending posteriorly near the orbital apex.
There is evidence of previous bilateral cataract surgery. The right intraconal fat planes are normal. There is pneumatization of both optic struts/anterior clinoid processes.
Case Discussion
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.
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