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Intraosseous Cellular Hemangioma of the Orbit: A Rare Subtype

      A 72-year-old woman presented with a month's history of worsening left eye vision, redness, and discomfort. Examination of the left eye revealed a relative afferent pupillary defect, proptosis, and inferior dystopia with limitation on all gazes (A). Magnetic resonance imaging demonstrated a lobulated frontal bone mass extending to the fronto-parietal dura (B, C). Computed tomography delineated bony involvement of the superior orbital rim and a breach of the outer cortex of the frontal bone (D). Excisional biopsy of the lesion showed compact, cellular proliferation of slit-like blood vessels lined by a thin layer of endothelial cells without atypia (E). CD31 highlighted the single layered endothelium (F). Smooth muscle actin immunostain demonstrated the intact pericytic layers around these blood vessels (G). The tumor was a cellular hemangioma – a subtype rarely seen in adults.
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