A 32-year-old woman presented with left proptosis that she claimed started 3 days prior. Her past medical history was negative. She had just given birth to her first child 2 weeks prior to presentation and was breast-feeding when the proptosis occurred.
On clinical examination her visual acuity was 20/20 ou. Color plates were full ou. Ocular motility was full ou. Pupils were equal, round and reactive to light without an afferent pupillary defect. Intraocular pressures were 15 od and 16 os. Slit lamp examination and dilated fundoscopic examination were within normal limits. Of note, she had approximately 3mm of left proptosis.
A CT scan was obtained.
Present was an orbital mass near or involving the left medial rectus muscle. There was no apparent bony destruction.
The patient was scheduled for excision of the orbital mass.
A medial 270-degree conjunctival peritomy was performed. The medial rectus muscle was detached and the mass was dissected off of the lateral edge of the muscle. It was tightly adherent to the medial rectus, but was distinct from it.
The mass was removed in its entirety. It measured approximately 3 cm and was beige and rubbery, resembling a schwannoma. The pathology did not show schwannoma however, but came back as granular cell tumor.
Granular cell tumor is a rare benign tumor consisting of cells similar to neural tissue. Most involve the head and neck, with 70% of the head and neck tumors presenting intraorally. These tumors are rarely malignant, 10% are multiple and they tend to occur between the 4th and 6th decades of life, mostly in women. They are slow growing, although our patient only noticed the growth for 3 days per her history. Treatment is surgical resection and recurrence rates with clear margins are between 2 and 8%.
The timing of the appearance of her tumor during or shortly after her pregnancy and during breastfeeding peak curiosity of whether there is a link to certain tumors and hormones. We are currently investigating the presence of hormone receptors on this particular tumor. Ingram et. al. studied the presence of steroid receptors on granular cell tumors of the breast. Neither estrogen nor progesterone receptor protein was present in these tumors in detectable amounts, but carcinoembryonic antigen and S100 protein localized in the cytoplasm. Our study will aim to check for the presence of hormones present toward the end or pregnancy or during breastfeeding, such as elastin, relaxin and prolactin.