Vol 130, No 7, July 2012

Archives Clinical Challenge: You Make the Diagnosis

Posterior Orbital Mass Found on Enucleation

REPORT OF A CASE

A 44-year-old highly myopic woman had an outpatient surgical consultation for a blind, painful left eye. A decade prior, she was struck in the left eye, causing a retinal detachment. Four vitreoretinal operations were performed and no encircling band was placed. During the most recent procedure, 5 years prior to her consultation, silicone oil tamponade was performed. Her visual acuity had been no light perception since surgery. Two years prior to the consultation, she began having pain that she described as a constant ache in the orbit and brow that worsened with eye movement. On examination, she had a closed angle without inflammation and a 70% silicone oil fill over a flat retina. The intraocular pressure was 55 mm Hg. An enucleation was carried out in the standard fashion, and a hard mass was felt posterior to the globe. On dissection posterior to the Tenon fascia, a retrobulbar mass attached to the posterior aspect of the globe was discovered and was removed in its entirety (Figure).

What is your diagnosis?

Figure.
Low-magnification histologic photograph of the globe with iatrogenic scleral discontinuity (arrow) and a large mass extending off the posterior sclera (asterisk) (hematoxylin-eosin, original magnification x1).

Please e-mail your diagnosis to ophthquiz@jamanetwork.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our website and will receive a 1-year complimentary online subscription to Archives of Ophthalmology. Because of the volume of responses we are able to respond to the first person with the correct answer only.

For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of the Archives.

The correct answer to our June challenge was caruncular alveolar rhabdomyosarcoma.

For a complete discussion of this case, see the Research Letters section in the upcoming August Archives (Ramstead C, Buffam F, White V. Caruncular alveolar rhabdomyosarcoma in a woman previously treated for breast cancer. Arch Ophthalmol. 2012;130[8]. doi:10.1001/archophthalmol.2012.313)."

Next month's quiz will be available on August 13, 2012, at 3pm Central time.