A Toddler With a Fixed Brow Mass

Seongmu Lee, MD; Michael T. Yen, MD; Kimberly G. Yen, MD


March 09, 2011

Clinical Presentation

A 2-year-old boy presented to the clinic after his parents noticed a soft mass over his left brow. The lesion was first noted 3 months prior to presentation, was not painful, and had not changed in size. The parents reported no other associated symptoms.

On examination, an oval-shaped mass was palpable just lateral to the left superotemporal orbital rim. The subcutaneous lesion was firm and tethered to the underlying bone, with no overlying discoloration, edema, erythema, or tenderness. The patient was able to fix and follow with both eyes and had no evidence of an afferent pupillary defect. The globe was not displaced and extraocular motility was full. The ocular examination was otherwise unremarkable.

Question 1. What is the most likely diagnosis?

A. Rhabdomyosarcoma
B. Capillary hemangioma
C. Dermoid cyst
D. Lacrimal gland tumor
E. Plexiform neurofibroma

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Question 2. Which of the following is a feature of this condition?

A. Abnormal proliferation of endothelial cells, forming capillary-like vessels separated by fibrous tissue septa
B. Rapid growth over several weeks, followed by spontaneous regression over months to years
C. May present with a sudden onset of proptosis, pain, and orbital hemorrhage following upper respiratory tract infection
D. Results from entrapment of epithelial structures at sites of fetal fissure closure
E. Contains tissues derived from endoderm, ectoderm, and mesoderm

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Question 3. Which of these findings would be expected on CT imaging?

A. Well-defined homogeneous mass isodense to the extraocular muscles, with bony destruction and enhancement with contrast
B. Diffuse, homogeneous mass that displays molding around the globe, nerve, and orbital walls without bony involvement
C. Bony thickening and sclerosis with a ground-glass appearance and narrowing of orbital foramina
D. Well-circumscribed cystic mass with a well-defined and hyperdense wall, hypodense lumen, and adjacent bony changes
E. Mildly enhancing, loculated, cystic mass with irregular expansion and destruction of bone

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