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Photos courtesy of: Bita Esmaeli, M.D. / M.D. Anderson Cancer Center
Used with permission. Not to be reproduced.

A 57-year-female presented with painless right lacrimal fossa fullness and diplopia. MRI and histology of a touch prep and permanent section of an incisional biopsy specimen are shown.

1.	This represents:
	e -- the most common primary orbital malignancy in adults This patient had MALT orbital lymphoma. The MRI shows a well circumscribed orbital mass that molds to orbital structures without bony destruction. The touch prep identifies abnormal appearing lymphocytes, and the permanent section slide confirms lymphoma showing a monotonous population of lymphocytes. Orbital lymphoma is the most common primary orbital malignancy in adults, however it is a lymphoproliferative (and not epithelial) tumor.
2.	The next step in the care of this patient should be:
	e -- systemic evaluation of involvement of other sites All ocular adnexal and orbital lymphoproliferative lesions warrant systemic evaluation to investigate other potential anatomic sites involved prior to treatment considerations. Work-up may include head and neck imaging through CT or MRI, neck ultrasound, CT of the chest/abdomen/pelvis, whole body PET CT, bone marrow biopsy, and when warranted upper endoscopy.
3.	If the patient’s disease is localized to the orbit, treatment may be:
	d -- radiotherapy Treatment of orbital lymphoma may include radiotherapy, chemotherapy, or radioimmunotherapy (Rituximab) or a combination thereof.