Requiem for a Cabinet Maker

54 year-old white male with visual acuity of 20/20 OU presents with nystagmus and decreased sensation along left V1 distribution and subsequently goes to NLP OS. Left orbital mass biopsy prior to vision loss and subsequent to visual loss OS indicated orbital pseudotumor and patient was treated with steroids and orbital radiation. MRI shows enlargement of left orbital mass and new right orbital mass. Systemic work up reveals pulmonary nodules, pleural effusion, and liver lesion. Second orbital biopsy, pleural biopsy, and liver biopsy all showed poorly differentiated carcinoma with sarcomatoid features. Patient continued to have visual loss OD. He remained on oral steroids in an attempt to retain vision as long as possible. He was placed on hospice and passed away two weeks later. Sarcomatoid carcinoma (Carcinosarcomas) is defined by the World Health Organization as a biphasic tumor consisting of malignant epithelial and mesenchymal elements (1). There have only been three cases of sarcomatoid carcinoma of the orbit not associated with paranasal sinus malignancy (2,3). These types of cancers in the orbit and elsewhere are very aggressive and with poor prognosis.