Retrobulbar lymphangioma in a 14-year-old girl
The present case has been reported in the Asian Journal of Neurosurgery. A 14-year-old girl presented with gradually progressive proptosis of the left eye (6 mm on Hertel) with lateral globe displacement. There was no history of visual loss, restricted eye movement, or diplopia. The patient underwent complete clinical ocular examination and radiological evaluation.

MRI showed well-defined mass lesion at superolateral aspect of left orbit in retrobulbar space with extension in both intra- and extraconal space and splaying the superior and lateral rectus muscles apart. It appeared to be isointense on T1 and hyperintense on T2 with irregular heterogeneous enhancement on contrast administration. It measured around 26 mm × 24 mm × 23 mm in size and was located predominantly in the posteromedial aspect of the globe.

Lesion caused minimal expansion of the left orbit with inferomedial displacement of the optic nerve. Proptosis of the left eye was noted. The left globe per se appeared normal. The right eye and orbit did not reveal any abnormality. Visualized intracranial structures were normal. There was no extension of this lesion intracranially. On the basis of imaging, the patient was diagnosed to have cavernous hemangioma of the left eye. The lesion was approached through a left lateral orbitotomy. Intraoperatively, the lesion was well defined with distinct borders and could be excised completely.

At histopathologic analysis, the malformation was composed of multiple large lymphatic channels, focally lined by flattened epithelium with small scattered mature lymphoid aggregates in the wall, and dysplastic channels were filled with pink, amorphous, homogeneous proteinaceous fluid, and lymphocytes. Features were suggestive of lymphangioma.

The surgical treatment was completely curative and successful. Pathological findings were suggestive of orbital lymphangioma. The postoperative course was uneventful with excellent esthetic result with the complete reduction of proptosis. At 1-year follow-up, the patient had no proptosis with normal clinical ocular examination.

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