This is the surgical specimen from a boy.

• What does the specimen show?


Answer
An exenternated eye containing retrobulbar mass.

Histological appearance of the above lesion.

• What is the most likely diagnosis?
a
Answer
Rhabdomyosarcoma. The histological slide shows the presence of spindle cells indicating the tumour originates
in the muscle. Rhabdomyosarcoma with some 
differentiation is called the embyronal type.
Exenternation of the orbit is an uncommon procedure in
children and is performed only in a few conditions such 
as retinoblastoma with orbital spread or rhabdomyosarcoma. 
With early diagnosis, rhabdomyosarcoma can now be treated with combined radiation and chemotherapy without exenternation.

This boy presented with a swollen right eye and fever.

• What clinical signs can help differentiate the first patient from the one above?

a
AnswerThe patient above suffered
from orbital cellulitis. The CT scan shows ethmoidal
sinusitis, a common cause of orbital cellulitis in children.
Both rhabdomyosarcoma and orbital cellulitis can 
present rapidly with progressive proptosis and red eye. 
However, in the case of rhabdomyosarcoma, the eye
does not feel hot and there is no fever. Rhabdomyosarcoma does not respond to antibiotics.
A high index of suspicion is important in atypical orbital cellulitis and CT scan of the orbit can demonstrate abnormal masses.