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Clinical Challenge
March 7, 2019

An Aggressive Diffuse Supraorbital Mass

Author Affiliations
  • 1Bon Secours Mercy Health, Department of Otolaryngology, St Elizabeth Boardman Hospital, Boardman, Ohio
  • 2Northeast Ohio Medical University, Rootstown
  • 3Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
  • 4West Virginia School of Osteopathic Medicine, Lewisburg
JAMA Otolaryngol Head Neck Surg. 2019;145(5):477-478. doi:10.1001/jamaoto.2019.0016

A white man in his 70s presented with a gradually enlarging right supraorbital mass that had been neglected for 4 years. His comorbidities included congestive heart failure, atrial fibrillation, coronary artery disease, chronic obstructive pulmonary disease, hypertension, and a 50-pack-year history of tobacco abuse. Physical examination revealed a firm, nonmobile, nontender, bulging mass situated over the right frontal sinus, which expanded to the upper right eyelid. The mass covered the globe completely, resulting in total vision obstruction (Figure, A). However, the patient’s vision remained intact when the mass was elevated off the eye with great effort. His right pupil was round and reactive to light without afferent pupillary defect. No palpable lymphadenopathy was noted. A non–contrast-enhanced computed tomography (CT) scan demonstrated a large, right supraorbital mass with bony destruction of the anterior table of the right frontal sinus (Figure, B). It extended into the superior aspect of the orbit, displacing the right globe inferiorly. Air was seen within the mass (Figure, C). A fine-needle aspiration biopsy yielded inconclusive results. After medical clearance, the patient was taken to the operating room for a wedge excisional biopsy with decompression of the right supraorbital mass under monitored anesthesia care. Histopathological investigation revealed large nests of neoplastic epithelioid cells surrounded by fibrotic tissue and necroinflammatory debris. The neoplastic cells contained round nuclei with single prominent nucleoli and abundant clear to vacuolated cytoplasm (Figure, D).

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