Vol 130, No 6, June 2012

Archives Clinical Challenge: You Make the Diagnosis

Sudden-Onset Painless Caruncular Mass in a 54-Year-Old Woman

REPORT OF A CASE

A 54-year-old woman had a 1-week history of a rapidly growing, painless, right caruncular mass (Figure). Her medical history was significant for a grade II infiltrating ductal adenocarcinoma of the breast 4 years prior for which she underwent left mastectomy with axillary lymph node examination negative for metastases. She subsequently underwent adjuvant chemotherapy and received long-term anastrozole therapy. A magnetic resonance imaging scan revealed an enhancing mass in the medial aspect of the right orbit inferior to the medial rectus muscle, measuring 9 x 11 x 13 mm. An incisional biopsy was performed, and histopathological analysis showed sheets of medium-sized malignant cells with minimal cytoplasm, pleomorphic nuclei, and numerous mitoses and apoptotic cells. Immunohistochemical stain findings were negative for keratin, estrogen and progesterone receptors, and lymphoid and melanocytic markers.

What is your diagnosis?

Figure.
Rapidly growing, painless, right caruncular mass.

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.

Congratulations to the winner of our May quiz, Anita Agarwal, MD, Vanderbilt Eye Institute, Vanderbilt School of Medicine, Nashville, Tennessee.

The correct answer to our May challenge was endogenous endophthalmitis caused by Salmonella.

For a complete discussion of this case, see the Research Letters section in the June Archives (Rachitskaya AV, Flynn HW Jr, Davis JL. Endogenous endophthalmitis caused by Salmonella serotype B in an immunocompetent 12-year-old child. Arch Ophthalmol. 2012;130[6]:802-804).

Next month's quiz will be available on July 9, 2012, at 3pm Central time.