case_images: PMC10517617_01
case_images: Magnetic resonance imaging. T2-weighted axial image at the age of 41 years at the initial visit (A), showing lobulated fluid-containing mass with probable connection with ethmoid sinus (arrow). T2-wighted axial images with fat suppression by short-T1 inversion recovery, at the age of 48 years (B) and 49 years (C), and (D) just before surgery, showing evident connection with ethmoid sinus (arrows in (B) and (C)) and possible connection posteriorly with sphenoid sinus (large arrow in (C)).
case_images: 10.1177_23247096231201013-fig1.jpg
case_images: PMC10517617_01_10.1177_23247096231201013-fig1.jpg
case_images: fig1-23247096231201013
case_images: Magnetic resonance imaging demonstrated a lobulated fluid-containing tubular mass that extended from the posterior to the anterior part of the orbit along the medial orbital wall, nasal to the eyeball (Figure 1A). She was followed once a year for 8 years (Figure 1B) until the age of 49 years when she decided to undergo surgical resection because of the enlargement of the mass (Figure 1C and D).
case_images: Macroscopic view of extirpated orbital lobulated mass before formaldehyde fixation (A). Microscopic images of the mass in hematoxylin-eosin stain ((B) in low magnification, (C) in high magnification), showing sparse cells in amorphous substance. The amorphous substance is stained positive with alcian blue (D), indicative of mucous substance while cells are positive for CD34 (E). Scale bar = 1000 microm in (B) and 200 microm in (C)-(E).
case_images: 10.1177_23247096231201013-fig2.jpg
case_images: PMC10517617_01_10.1177_23247096231201013-fig2.jpg
case_images: fig2-23247096231201013
case_images: The lobulated large mass (Figure 2A) was resected, and pathology showed sparsely distributed spindle cells (Figure 2B and C), positive for CD34 (Figure 2E), in alcian blue-positive mucous substances (Figure 2D), indicative of myxoma.
case_images: Magnetic resonance imaging. T2-wighted axial (A), (B), and coronal (C) images with fat suppression by short-T1 inversion recovery 3 months after the surgery at the age of 49 years. T2-wighted axial (D), (E), and coronal (F) images with fat suppression by short-T1 inversion recovery at the age of 60 years, 11 years after the surgery. Note connection of the remaining lobulated mass with ethmoid sinus (arrows in (A) and (D)) and possible connection posteriorly with sphenoid sinus (large arrow in D).
case_images: 10.1177_23247096231201013-fig3.jpg
case_images: PMC10517617_01_10.1177_23247096231201013-fig3.jpg
case_images: fig3-23247096231201013
case_images: Postoperative magnetic resonance imaging showed residual lobulated tubular mass along the optic nerve on the medial side and superior to the eyeball (Figure 3A-C). The residual mass showed stable structure for the 12 years until the age of 61 years at the latest follow-up (Figure 3D-F). The connection of the residual orbital lesions with the ethmoid sinus lesion became more evident in the follow-up (Figure 3A and D).