Recurrent Orbital Cavernous Hemangioma due to Overlooked Multiple Tumors
A 32-year-old woman presented with gradually decreasing vision and progressive hyperopia of several months’ duration in 1999. Best corrected visual acuity (BCVA) was 20/200 and 20/15 with optical correction of +4.5 diopters (D) and plano in her right and left eyes, respectively. There was 1+ relative afferent pupillary defect (RAPD) in the right eye. Hertel exophthalmometry revealed 6 millimeters (mm) of proptosis in the right eye (readings were 25 mm for the right eye and 19 mm for the left eye) with no limitation in eye movements. Fundus examination disclosed right optic disc edema. Orbital computed tomography (CT) scan with contrast revealed a large septated intraconal mass lesion in the right orbit displacing the optic nerve superiorly (a). Magnetic resonance imaging (MRI) was not performed at that point.\nWith an initial impression of orbital cavernous hemangioma, the patient underwent lateral orbitotomy and an encapsulated mass was completely excised. Histopathologic examination confirmed the presumptive diagnosis.\nTen years later, the patient presented with recurrent proptosis of the right eye together with downward displacement of the globe. BCVA in the right eye was counting fingers at 2 meters with 3+ RAPD. External examination revealed 9 mm of proptosis together with hypoglobus and exotropia in the right eye (a). In addition, limitation of upward gaze was noted. Orbital CT scan revealed a soft tissue mass in the intraconal space engulfing the optic nerve (b). Contrast-enhanced MRI demonstrated a smooth intraconal mass lesion which was hypointense on T1-weighted images and hyperintense on T2-weighed images, compressing and displacing the optic nerve superonasally (Figs. 3a and 3b).\nRight lateral orbitotomy was performed through the previous incision and an elliptical strawberry-like encapsulated mass lesion was completely excised. Light microscopy confirmed the tumor to be a cavernous hemangioma.\nOne month after the operation, proptosis, limited motility and hypoglobus had improved, but visual acuity was limited to counting fingers at 3 meters in the right eye (b).