[An unusual foreign body in the orbit]. / Un corps étranger orbitaire insolite.

INTRODUCTION: Foreign bodies in the orbit are rare. They can generate more or less serious complications depending on their nature and size. We report an exceptional case of a bulky foreign body in the orbit (the tip of a pen), which did not lead to any complication. OBSERVATION: A 13-year-old child presented with a right orbital trauma caused by a pen. He consulted 3 months later when a small palpebral swelling appeared. The CT scan showed the presence of a foreign body on the orbital floor. Wound debridement allowed extracting the tip of a pen measuring 3.5cm without any complication. There were no postoperative complications. DISCUSSION: The originality of this observation is two-fold; the singularity of the foreign body and its total harmlessness in spite of its large size. However, orbital trauma and a secondary orbital syndrome must lead to emergency imaging.

[Cheek paraganglioma: a rare location]. / Paragangliome jugal: une localisation rare.

OBSERVATION: A 29 year-old-woman presented with a massive painless slow-growing tumor of the right cheek, with a benign aspect on clinical examination. The CT scan with injection, showed a solid-cystic mass, well defined, and partially enhanced. The mass was easily removed with a complete endobuccal excision. The histological examination and immunohistochemical study revealed a paraganglioma. There was no postoperative complication. No recurrence was noted after six months of follow-up. DISCUSSION: The paraganglioma is a rare neuroendocrine tumor and its location in the cheek has never been reported.

[Primary palpebral tuberculosis]. / La tuberculose palpébrale primaire.

INTRODUCTION: Isolated-eyelid tuberculosis is exceptional. Its clinical polymorphism explains the delayed diagnosis. OBSERVATION: A 36-year-old male nurse, with no specific history, presented with a lower-eyelid nodule. The treatment was not effective and the lesion-exeresis biopsy proved the diagnosis of tuberculosis. Follow-up did not reveal any other tuberculosis focus and the patient's evolution was good under antibacilli treatment. DISCUSSION: Eyelid tuberculosis is exceptional. Unlike in our case, it is usually secondary to pulmonary tuberculosis. The eyelid contamination may be hematogenic or secondary to trauma.

[Metastasis of a pleomorphic adenoma]. / Métastase d'un adénome pléomorphe.

OBSERVATION: A 53-year-old man underwent a right parotidectomy in 1993 for a pleomorphic adenoma. The tumor relapsed locally, three years later, imposing a reoperation. The histology was unchanged. Two years later, the excision of a new local recurrence revealed a histological evolution with intravascular emboli, some cellular atypia and some mitoses. One year later, in a context of cephalgia and amaurosis, metastases were discovered on the calvarial skull. These were treated by radiotherapy. The patient died of a cerebral hemorrhage related to a history of familial autoimmune thrombocytopenia. DISCUSSION: Regional and systemic metastases of pleomorphic adenomas are exceptional. The local recurrence is characteristic of metastatic forms of pleomorphic adenomas; it occurs in 90% of the cases. No clinical or histological criterion allows distinguishing between recurrent metastatic forms and non-recurrent metastatic pleomorphic adenomas. The metastatic mechanism is not clearly elucidated yet. The best treatment for metastases of a pleomorphic adenoma is surgical excision. The recurrence after a complete surgical excision is rare and the prognosis excellent.