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21 February 2014 - Case of the Week #301

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Thanks to Drs. Saroona Haroon and Muhammad Usman, The Aga Khan University Hospital (Pakistan), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.

June 16-19, 2014
The Sea Pines Resort
Hilton Head Island, South Carolina

Diagnosing Lymphomas and Leukemias:
Challenges for the Surgical Pathologist


Steven H. Swerdlow, M.D., Course Director, University of Pittsburgh School of Medicine, Pittsburgh, PA;
Kathy Foucar, M.D., University of New Mexico, Albuquerque, NM;
Marsha C. Kinney, M.D., University of Texas Health Sciences Center, San Antonio, TX;
Lawrence M. Weiss, M.D., Clarient, Inc., Aliso Viejo, CA.


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Case of the Week #301

Clinical History:
A 45 year old woman presented with a 6 month history of blurry vision and proptosis of the right eye. Clinically, there was a soft tissue swelling confined to the orbit.

Radiologic images:

Radiologic images

Micro images:

What is your diagnosis?


Orbital cavernous hemangioma


Hemangioma of the orbit is a common lesion of the orbit (Radiopaedia, EyeWiki), and occurs more frequently than lymphangioma. Most cases occur in adults (Cases J 2009;2:6912), and most tumors are cavernous.

CT and MRI scans often show a round mass with well defined margins in the extraocular muscles (Int J Ophthalmol 2011;4:195). Moderate to severe adhesion is frequent. In these cases, CT/MRI may show an irregular or ovoid mass filling the orbital apex, or distorted / spiky margins in the posterior region of the mass.

Microscopically, these tumors are large and encapsulated, with cavernous vascular channels or spaces separated by scant connective tissue stroma. The vascular spaces are lined by a single layer of bland endothelial cells with variable smooth muscle in their walls. The differential diagnosis includes other vascular tumors which show mitotic activity, pleomorphism or atypia.

Hemangioma of the orbit is benign, but may be slowly progressive.

Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
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Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
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