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JAMA Ophthalmology Clinical Challenge |

Man With Painful Proptosis of the Left Eye QUIZ

Landon C. Meekins, MD1; Pradeep Mettu, MD1; M. Tariq Bhatti, MD1,2
[+] Author Affiliations
1Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina
2Department of Neurology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina
JAMA Ophthalmol. 2016;134(6):705-706. doi:10.1001/jamaophthalmol.2015.3605.
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A man in his 20s presents with decreased vision in the left eye that was associated with intermittent left orbital pain that does not improve with 2 weeks of oral corticosteroids. What would you do next?

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Figure 1.

A, Left eye at initial presentation showed proptosis with hypoglobus, S-shaped blepharoptosis, and retinochoroidal folds. B, Results of coronal, T1-weighted, postcontrast, fat-suppressed magnetic resonance imaging (MRI) of the orbits showing a 2 × 3 x 2.8-cm well-defined lesion of the lacrimal gland with inferior displacement of the globe and lateral rectus muscle.

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Figure 2.

Biopsy specimen demonstrates a cribriform growth pattern of basaloid cells with hyperchromatic nuclei surrounding cystlike spaces resembling a “Swiss cheese” pattern, consistent with adenoid cystic carcinoma (hematoxylin-eosin, original magnification ×40).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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