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Clinical Problem Solving: Pathology
April 2007

Pathology Quiz Case 2

Author Affiliations

GATAHaydarpasa Training Hospital, Istanbul, Turkey (Drs Cincik, Ertugrul, Gungor, and Yildirim), and University of Pittsburgh Eye and Ear Institute, Pittsburgh, Pa (Dr Sok)



Arch Otolaryngol Head Neck Surg. 2007;133(4):412. doi:10.1001/archotol.133.4.412

A 35-year-old woman presented with an 8-month history of progressive right eye proptosis without nasal congestion, nasal discharge, or epistaxis. For several weeks, she had experienced horizontal diplopia along with intermittent pain in the right eye. Her medical and social histories were otherwise unremarkable. Nasal endoscopy revealed prominence of the right agger nasi, with a normal-appearing infundibulum and bulla ethmoidalis. A computed tomographic scan of the paranasal sinus showed a homogeneous soft tissue mass obliterating the frontal sinus and extending into the right orbit, with bony erosion (Figure 1). The mass was pushing the right globe laterally without extension into the anterior cranial fossa or fovea ethmoidalis. The mass demonstrated high signal intensity on T2-weighted magnetic resonance images (MRIs) and low signal intensity on T1-weighted MRIs, with rim enhancement after contrast injection (Figure 2).