Abstract
A patient with a past medical history of chronic sinusitis and hypothyroidism presented with six months of progressive right-sided proptosis and orbital discomfort. Her visual acuity was 20/40 in the right eye and 20/20 in the left, and the intraocular pressure was normal in both eyes. Extraocular movements were intact, there was no afferent pupillary defect, Ishihara color plates were full, and the optic nerves were without pallor or edema. Hertel testing was significant for proptosis in the right eye of 5 mm. Review of systems was notable for diarrhea, poor appetite, insomnia, unintentional weight loss, and intermittent headaches. MRI revealed a 5.0 × 3.1 × 4.9 cm right medial orbital mass centered on the lacrimal sac, with extension along the nasolacrimal duct into the right nasal cavity and involvement of the inferior turbinate. The mass demonstrated extensive local invasion, including erosion of the lamina papyracea, extension into the right frontal sinus and adjacent maxillary subcutaneous tissues, and involvement of the upper and lower eyelids. Biopsy of the mass confirmed diffuse large B-cell lymphoma (DLBCL). The patient subsequently underwent six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), achieving remission. Orbital DLBCL is an important consideration in patients presenting with progressive proptosis and an orbital mass, even in relatively young adults. Although orbital lymphomas may present with nonspecific symptoms, extensive local invasion and constitutional symptoms should raise suspicion for an underlying malignancy. Prompt imaging, tissue biopsy, and multidisciplinary management are essential for accurate diagnosis and timely treatment.
Presentation Date: 10/22/2026
Issue Date:10/23/2026
