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A 35-year-old woman had a large subconjunctival swelling in her right eye (Figure 1). Prominent conjunctival vessels were first noticed during her pregnancy 10 months earlier. A firm elastic mass was palpated. Funduscopy showed an inferomedial indentation. Visual acuity was 20/20. Ultrasonography showed a well-circumscribed tumor with peripheral vascularization. Orbital magnetic resonance imaging showed an anterior soft tissue mass that was hypointense to isointense on both T1- and T2-weighted sequences (Figure 2). Gadolinium-enhanced sequences showed homogeneous filling that was isointense relative to muscle. With a transconjunctival approach, the tumor was dissected free from the medial rectus muscle and excised completely (Figure 3). Histopathological examination revealed a typical leiomyoma (Figure 4). The postoperative course was uneventful, and there was no recurrence in 16 months of follow-up.
Clinical photograph showing a large subconjunctival swelling with prominent overlying vessels medially in the right orbit.
Coronal T1-weighted magnetic resonance image (A) and axial T2-weighted magnetic resonance image (B) of an anteriorly located extraconal oval soft tissue tumor medial to the medial rectus muscle.
Fresh gross appearance. A smooth yellow-white tumor (23 × 15 × 10 mm) was dissected free from the medial rectus muscle.
A, Photomicrograph showing characteristic compact bundles of spindle cells with cigar-shaped nuclei. Nuclear palisading, mitotic activity, and necrosis are absent (hematoxylin-eosin, original magnification ×200). B, Immunohistochemical analysis showing strong expression of smooth muscle actin (original magnification ×200). C, Immunohistochemical analysis showing strong expression of desmin (original magnification ×200).
Leiomyoma posterior in the orbit is often speculated to have a vascular wall origin.1 This anterior tumor, however, may have originated from the relatively abundant smooth muscle cells in the medial rectus muscle pulley or a dense band connecting it with the inferior rectus muscle around the globe equator.2 Carrier et al3 described a high T2-weighted intensity in a well-vascularized leiomyoma. Therefore, depending on tumor vascularity, leiomyoma magnetic resonance imaging characteristics can resemble those of other orbital masses. Although rare, the differential diagnosis of well-circumscribed orbital tumors should include leiomyoma. Risk of malignant degeneration is small; however, careful surveillance is advised because leiomyoma can recur if it is not removed completely.1
Correspondence: Dr Paridaens, Department of Oculoplastic and Orbital Surgery, Rotterdam Eye Hospital, PO Box 70030, 3000 LM, Rotterdam, the Netherlands (paridaens@icapi.nl).
Financial Disclosure: None.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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