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Figure 1. A mass is present above the right eye, shown here four months after it was first noted as a slight asymmetry
Figure 2. Coronal MRI shows a mass above the right eye.		Figure 3. The mass is shown in saggital view.		Figure 4. Normal appearance of the child is shown in a picture taken five months earlier.

This six-year-old girl presented with a history of slight asymmetry caused by a fullness in the right upper lid beginning four months ago.  This mass has gradually enlarged as seen in Figure 1.  Coronal and saggital MRI, shown in Figures 2 and 3 above, demonstrate this mass.  A picture of this child taken five months earlier confirms that this is a new finding.  The child’s visual acuity was measured at OD 20/25 and OS 20/20.  Except for the mass in the right upper lid, the child’s eye examination was normal.  She was completely healthy prior to this event and has had no unusual exposure or trauma.

1.	The diagnosis to be considered in this case includes:
	a. rhabdomyosarcoma b. eosinophilic granuloma c. juvenile xanthogranuloma d. atypical inflammation e. all of the above
2.	A week later an apparent collection of fluid with an elastic consistency was noted in the nasal aspect of the mass:
	a. This indicates the likelihood of a chocolate cyst. b. The condition is probably benign. c. The differential diagnosis is unchanged. d. This clearly points to inflammation as the cause. e. none of the above
3.	The next step in the management of this case is:
	a. biopsy through the upper lid crease b. a trial of steroids c. broad spectrum antibiotics d. irradiation e. (b) followed by (d)

For answers to the above, click here on or after July 31, 2012.