Orbital fibroblastic reticular cell tumor A case report and literature review for a rare disease

Rationale: This study investigates the clinical, imaging, and pathological features of fibroblastic reticular cell tumors (FRCTs) through a retrospective analysis of a patient with FRCT, along with a review of relevant literature. Patient concerns: A 49-year-old male was admitted to our hospital because of swelling and discomfort in the right eye, occasionally accompanied by double vision, for more than 3 months. Physical examination revealed an obliquely downward right eye, ptosis, and a palpable medium-hard tumor at the supraorbital rim of the orbit. Diagnoses: An orbital B-type ultrasound, orbital computed tomography, and orbital contrast-enhanced magnetic resonance imaging were performed, and the findings suggested a diagnosis of right orbital hemangioma. Interventions: Following imaging studies, the tumor was surgically excised. Microscopic pathological examination revealed that the lesion was composed of lymphatic follicles and spindle cells. Immunohistochemistry revealed that: the tumor is mainly composed of spindle fibroblastic cells, accompanied by the formation of lymphoid follicles. Immunohistochemical staining shows that the lymphoid follicles express CD20 positively, while the Ki67 positive index of the spindle tumor cells is lower. Based on these findings, the pathologists believed that the lesion was consistent with an FRCT. Outcomes: The patient refused subsequent treatment and was discharged. Postoperative imaging (computed tomography and magnetic resonance imaging) conducted at 4 and 24 weeks revealed no recurrence of the tumor. Lessons: FRCTs are exceedingly rare in clinical practice, This is the first case report of an orbital FRCT. The main clinical manifestation is a painless orbital mass, and the imaging findings are nonspecific; therefore, the diagnosis mainly depends on the pathology and immune phenotype of the tumor. Currently, there are no detailed data regarding the effects of postoperative adjuvant therapy. With more reports and studies on patients with FRCT, the diagnostic accuracy for this disease can be increased, and more accurate and personalized treatment plans can be developed.