Orbital osteosarcoma masqueraded as hyperostotic meningioma

Osteosarcoma is the most common primary bone malignancy. It typically originates in the long bones, with only 6 - 13% of patients presenting with a primary tumor of the head and neck. Osteosarcoma of this region has a peak incidence in the fourth decade of life, more than a decade older than osteosarcoma of the long bones [1]. The prognosis is more favorable than that for osteosarcomas of the extremities, with the mainstay of therapy being surgical resection. The mandible and maxilla are the predominant sites of head and neck osteosarcomas [2]; those that present in the orbit are extremely rare. We report the case of a primary orbital osteoblastic osteosarcoma that masqueraded as a hyperostotic meningioma. The osteosarcoma was successfully resected via a modified orbitozygomatic approach, after preoperative planning with a team of neurosurgeons, radiologists, oncologists, and radio-oncologists.