Orbital apex tumour caused by chronic lymphocytic leukaemia: an unlikely suspect

An 88-year-old woman with a background of chronic lymphocytic leukaemia (CLL) and presented with unilateral ptosis and dull facial pains for 1 month. Examination revealed a complete right-sided ptosis and pupillary dilation. Vision in her right eye was limited to light perception. She had total external ophthalmoplegia. Her corneal reflex was not present in her right eye and she had lost sensation on the right side of her forehead. MRI revealed abnormal enhancement in the right orbital apex extending posteriorly to the sphenoid sinus. The mass invaded the superior orbital fissure, optic canal and cavernous sinus. The lumbar puncture was normal. Owing to the proximity of the mass to the cavernous sinus, it was deemed that surgical excision of the tumour was unsafe; however, it was amenable to biopsy. Histology of the biopsies was consistent with CLL. The patient declined to undergo single high-dose radiotherapy followed by dexamethasone.