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A 13-year-old girl presented with a 4-month history of progressive left upper eyelid fullness, proptosis, hypoglobus, and diplopia in upgaze and left gaze. She had no pain, tenderness or parasthesia. She denied trauma or recent sickness. On exam her vision was 20/20 in both eyes, she had no relative afferent pupillary defect, and visual field was full to confrontation. She had a non-tender, palpable soft mass in her left lacrimal fossa with overlying mild erythema, causing proptosis and inferonasal globe dystopia. After orbital MRI was obtained, an incisional biopsy was performed.

1.	The most likely diagnosis is:
	a. thyroid eye disease b. idiopathic orbital inflammation c. lymphoma d. rhabdomyosarcoma e. adenoid cystic carcinoma of the lacrimal gland
2.	The histopathologic subtype with the worst prognosis is:
	a. embryonal b. alveolar c. differentiated d. all subtypes carry a poor prognosis
3.	Appropriate treatment would include:
	a. systemic chemotherapy and radiotherapy b. steroids c. excision d. no intervention e. antibiotics

For answers to the above, click here on or after November 3, 2009.