Presentation
Large left orbital mass. No discomfort in the area or any changes in vision, but limited left ocular motion, left eye swelling, and proptosis.
Patient Data
CT of the orbits without IV contrast shows a large left orbital mass with severe associated proptosis/exophthalmos. There are no calcifications in the mass. There is mild bony remodeling of the left lamina papyracea without focal bony erosion or periosteal reaction. The paranasal sinuses and mastoid air cells are normal.
MRI without and with IV contrast shows a large left orbital mass. The mass is intraconal. It demonstrates heterogenous T1 signal and heterogenous T2 signal with heterogenous enhancement. The left globe is displaced anteriorly, medially, and superiorly. The left optic nerve is displaced in a similar direction. The mass/enhancement extends posteriorly into the left optic canal. There is no extension of the mass into the cavernous sinus or brain.
Case Discussion
Left orbitotomy and biopsy of the orbital mass were performed. Pathology from the biopsy was consistent with schwannoma. The patient subsequently underwent extensive tumor resection, with surgical pathology also consistent with schwannoma. The entire lesion could not be removed, particularly the portion in the optic canal. Follow-up MRIs have shown a significant decrease in the size of the left orbital mass. Due to continued improvement in swelling and proptosis of the left eye, the patient deferred radiation therapy and is currently continuing to follow up with ophthalmology for interval monitoring.
Case co-author: Paul de Bustros, MD (Loyola Department of Ophthalmology), Xhulio Arolli, BS, MS (Stritch School of Medicine)
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