A 7-year-old boy develops rapidly progressive proptosis over 3 weeks with downward and outward displacement of the globe. A firm superonasal orbital mass is palpable and there is early ptosis. The MOST appropriate next step is:

• A Orbitotomy with incisional biopsy ✓
• B Systemic corticosteroids as a therapeutic trial
• C Observation with repeat imaging in 3 months
• D Fine needle aspiration of the contralateral orbit

Explanation

Rapidly progressive proptosis in a young child with a palpable mass strongly suggests rhabdomyosarcoma, the most common primary malignant orbital tumour of childhood, typically arising superonasally around age 7 to 8 years. Diagnosis requires prompt tissue biopsy via orbitotomy because treatment with chemotherapy and radiotherapy depends on histological confirmation. A steroid trial risks masking lymphangioma or inflammation while the tumour progresses, and observation delays definitive therapy dangerously.

Reference: Kanski's Clinical Ophthalmology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.