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Case Reports
. 2014 Nov 20:8:2319-23.
doi: 10.2147/OPTH.S70843. eCollection 2014.

Diagnostic challenges in primary orbital fibrosarcoma: a case report

Brittni A Scruggs  1 , Son T Ho  1 , Alejandra A Valenzuela  1
Affiliations
Case Reports

Diagnostic challenges in primary orbital fibrosarcoma: a case report

Brittni A Scruggs et al. Clin Ophthalmol. .

Abstract

Fibrosarcoma is a rare and malignant spindle cell tumor of mesenchymal origin that infrequently presents in the orbit. Evolving diagnostic criteria confound the identification of these tumors, as well as the interpretation of previous studies on this unusual entity. We report a case of a 66-year-old man with a mass on his left inferior orbit, with associated paresthesia. A computed tomography (CT) scan showed a lesion on the left anteroinferomedial orbit, with bone erosion. An en bloc surgical excision followed by a thorough immunohistologic evaluation allowed diagnosis of an orbital fibrosarcoma. The patient has had no recurrence after 14 months of follow up. Once a commonly identified soft tissue malignancy, fibrosarcoma has become a diagnosis of exclusion as a result of improved diagnostic and classification techniques, such as immunohistochemistry and fluorescence in situ hybridization (FISH). This type of soft tissue tumor is now an uncommon entity, and we report the first case of a primary orbital fibrosarcoma in an adult, using modern diagnostic and classification methods.

Keywords: fibroblasts; mesenchymal tumor; soft tissue malignancy; spindle cell orbital tumor.

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Figures

Figure 1
Figure 1
(A) Clinical photograph showing no globe displacement or ocular abnormalities. (B) Additional clinical photograph demonstrating no mass on visual inspection.
Figure 2
Figure 2
(A) Sagittal and (B) axial CT images demonstrating a mass in the left inferior orbit, with suggestive orbital rim bone erosion (black arrows). Abbreviation: CT, computed tomography.
Figure 3
Figure 3
(A) Inferior fornix approach showing a 3.5 cm ×1.5 cm well-defined grayish mass in the anteroinferior left orbit. (B) Operative photograph of inferior fornix approach, demonstrating complete removal of mass.
Figure 4
Figure 4
H&E microphotographs at (A and B) 4× and (C) 10× magnification, demonstrating moderately differentiated spindle cells with almost no mitoses. The hyperchromatic cells, which have coarse chromatin with mild pleomorphism, are arranged in short fascicles that split and merge, giving the classical herringbone architecture of fibrosarcoma. (D) Malignant spindle cells are seen in a fascicular pattern invading adjacent inferior orbital rim bone (black arrow). Abbreviation: H&E, hematoxylin and eosin.
See this image and copyright information in PMC

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