Journal List > J Korean Ophthalmol Soc > v.55(9) > 1009795

Kim and Kim: A Case of Sphenoidal Sinus Carcinoma Associated with Partial Oculomotor and Abducens Nerve Palsy

Abstract

Purpose

To report a rare case of a patient with diplopia due to a mass in the sphenoidal sinus, histologically diagnosed as carcinoma.

Case summary

A 57-year-old male visited our clinic complaining of diplopia and ptosis for 10 days. He had esotropia 45 prism diopters in the primary position, markedly limited abduction, and a 4 mm dilated pupil in the right eye compared with a 2 mm pupil in the left eye. Enhanced magnetic resonance imaging revealed a sphenoidal sinus mass extended into the pituitary gland and sella turcica with homogeneous intense enhancement. Metastatic workups, including CT of the head, neck, chest, and abdomen were unremarkable. He underwent a transsphenoidal approach mass debulking surgery followed by radiotherapy for 6 weeks. Histological findings were compatible with carcinoma. Six weeks after radiotherapy he had esotropia of 20 prism diopters in the primary position. Abduction limitation was partially recovered postoperatively.

Conclusions

Diplopia may develop as a result of multiple cranial nerve palsy due to carcinoma in the sphenoidal sinus and may be improved by debulking surgery and radiation treatment.

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Figure 1.
Photograph at presentation shows ptosis, esodeviation and dilated pupil of the right eye.
jkos-55-1401f1.tif
Figure 2.
Nine cardinal gaze photographs at the first visit showing approximately 40 prism diopters of right esodeviation (center) and limitation of extraocular movement in the right eye.
jkos-55-1401f2.tif
Figure 3.
T1-weighted coronal (A) and sagittal (B) magnetic resonance image. Preoperative magnetic resonance (MR) images show homogenous intense enhanced mass in the sphenoidal sinus extended into pituitary gland and sella turcica.
jkos-55-1401f3.tif
Figure 4.
Histopathologic findings and immunochemical staining of the specimen. (A) The tumor cells were positive for cytokeratin immunostaining (immunochemical stain for the selected proteins, ×100). (B) Tissue shows numerous pleomorphic cell with hyperchroma sia and atypical mitotic figures (hema toxylin-eosin stain, ×200).
jkos-55-1401f4.tif
Figure 5.
Nine cardinal gaze photographs taken 6 weeks after radiotheraphy showing approximately 20 prism diopters of right esodeviation (center) and limitation of abduction of −2.5 in the right eye (left middle).
jkos-55-1401f5.tif
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