Contributed by Yan Qu1,4*, James E Davis2*, John Chi3, Santosh Kesari1
1Department of Neurosciences, Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093
2Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, MA 02115
3Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115
4Department of Neurological Surgery; Xijing Hospital, The Fourth Military Medical University, Shanxi, China
CLINICAL HISTORY AND IMAGING
A 71-year-old female presented to the emergency room with intermittent headache and several months of right eye proptosis. She had noticed some decrease in visual acuity for which she had been seeing an eye doctor. She denied blurry or double vision, focal weakness, bowel or bladder incontinence, numbness, tingling, fevers, chills, or difficulty swallowing. In retrospect, she admitted to right ear pain many years prior to presentation. A CT scan was performed which revealed an intracranial and temporal mass located on the right lateral orbital wall, abutting her optic nerve with features of osteoblastic activity (Figure 1). Head CT scan with bone windows shows expansion of the bone (Figures 1- axial, 2- sagittal, 3, 4- coronal views). The arrows in Figure 4 point to the contents of the orbit being compressed compared to the normal side. An MRI showed an avidly enhancing mass on T1 pre- (Figure 5) and post-contrast (Figure 6) images without dural involvement. The patient was consented for pterional craniotomy and resection of this unknown bone lesion.
GROSS AND MICROSCOPIC PATHOLOGY
The surgeon removed tissue labeled "sphenoid wing, right" which grossly consisted of multiple irregular fragments of tan-pink to tan-white bone and scant soft tissue measuring in aggregate 2.6 x 2.0 x 0.4cm. Following decalcification the specimen was entirely submitted. Pathologic examination revealed trabecular bone with tumor cells with ovoid to round nuclei and no atypical features (Fig 7 Low power H & E 8, 9 High power H & E). EMA immunostaining was positive within the cytoplasm of the neoplastic cells (Fig. 10).