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Clinical Problem Solving: Pathology |

Pathology Quiz Case 2

Matthew E. Spector, MD; Sara Akbari, MD; Nicholas A. Dewyer, BSE; Christine Nelson, MD; Brent Ward, DDS, MD; Jonathan B. McHugh, MD; Melissa A. Pynnonen, MD
Arch Otolaryngol Head Neck Surg. 2011;137(9):965. doi:10.1001/archoto.2011.151-a.
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An otherwise healthy 15-year-old girl presented with an 8-month history of gradually progressive right superior globe dystopia and right nasal obstruction without diplopia, eye pain, or pressure. Ophthalmologic examination showed 2 mm of superior displacement of the right globe, with 3 mm of orbital proptosis and 2 mm of inferior scleral show. There was a palpable mass extending from the inferior orbital rim to the gingivobuccal sulcus. Anterior rhinoscopy revealed medial displacement of the inferior turbinate and lateral nasal wall. A computed tomogram demonstrated a 7 × 6 × 5-cm cystic expansile mass centered in the right maxillary sinus, with expansion into the soft tissues of the cheek, the nasal cavity, and the ethmoid region (Figure 1). There was secondary obstruction of the frontal, ethmoid, and sphenoid sinuses, with substantial bone thinning along the floor of the orbit. An unerupted/displaced tooth was also seen in the superomedial portion of the cyst (Figure 2).

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