case_images: PMC3039196_01
case_images: Clinical photograph of the erythematous swelling of the left eyelid.
case_images: kjo-25-54-g001.jpg
case_images: PMC3039196_01_kjo-25-54-g001.jpg
case_images: F1
case_images: He returned six weeks later with symptoms of mild fever, cough, and chills, as well as left facial erythema, swelling, and tenderness (Fig. 1).
case_images: Enhanced extraconal and intraconal infiltrations in the left orbit, and an inferolateral view of the silicone ball sphere in the eyelid.
case_images: kjo-25-54-g002.jpg
case_images: PMC3039196_01_kjo-25-54-g002.jpg
case_images: F2
case_images: An orbital computed tomography (CT) scan revealed enhanced soft tissue infiltrations in his left extraconal and intraconal spaces and a thickening of the left eyelid (Fig. 2).
case_images: The tumors were composed of cells with hyperchromatic eccentric nuclei (suggesting signet ring cells), prominent eosinophilic cytoplasm, and intracytoplasmic vacuolations (H&E, x400).
case_images: kjo-25-54-g003.jpg
case_images: PMC3039196_01_kjo-25-54-g003.jpg
case_images: F3
case_images: Some cells had signet ring cytology, with a dominant cytoplasmic vacuole and an eccentrically placed, crescent-shaped nucleus (Fig. 3).
case_images: A positron emission tomography image revealed the multiple intense hypermetabolic foci on the left orbit and the skull as well as along the spine.
case_images: kjo-25-54-g004.jpg
case_images: PMC3039196_01_kjo-25-54-g004.jpg
case_images: F4
case_images: However, brain magnetic resonance imaging and positron emission tomography revealed metastatic lesions on the left frontal and temporal lobes of the skull; nasal bone; left basal skull; right mandibular ramus and sternum; vertebra in the cervical, thoracic, lumbar and sacral regions; and the left ischium (Fig. 4).