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A 49-year-old man was evaluated for left jaw pain and swelling. He had a left neck mass that he noticed a week prior to presentation, which had rapidly enlarged and become painful. The patient also had a 2-month history of an enlarging left lower eyelid mass (figure 1). The patient denied fevers, chills or weight loss, but admitted to having night sweats. He had no recent history of oral abscesses or dental procedures and denied having any ocular pain, dysphagia, dypsnea or difficulty breathing. He denied having a history of HIV.
CT of the head and neck revealed a large soft tissue mass in the left lower eyelid, measuring 5×4 cm. The mass extended into the superomedial orbit, compressing and displacing the globe laterally. Additionally, the CT revealed a 5×5-cm neck mass with central necrosis, as well as enlarged submental and bilateral jugular lymph nodes. The findings were suspicious for an abscess, and the patient underwent biopsy with incision and drainage of the neck mass and biopsy of the left lower eyelid mass. Cultures from the neck mass were negative. The patient gave permission for a laboratory testing for HIV, and it showed that he was positive with a CD4 count of 187/mm3 and a viral load of 131 000 copies/ml.
Microscopic examination of the eyelid specimen was performed (figure 2A, B). Special stains for fungi and bacteria including acid-fast bacilli were negative. Immunohistochemical stains were positive for CD45, CD68 and Ki-67 in many cells with Ki-67 cell fraction of 50% (figure 2D), CD20 in …