JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2010.51.2.286 jkos-51-286 Original Article Orbital Apex Syndrome with Nasal Type Natural Killer(NK)/T-cell Lymphoma of Sphenoid and Ethmoid Sinus BaikSeung Hwa MD 1 YeomDong Ju MD 1 KangYun Kyung MD 2 SungMi Sun MD 3 MoonSang Woong MD 1 Department of Ophthalmology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea Address reprint requests to Sang Woong Moon, MD Department of Ophthalmology, Seoul Paik Hospital, Inje University College of Medicine #85 Jeo-dong 2ga, Jung-gu, Seoul 100-032, Korea Tel: 82-2-2279-0229, Fax: 82-2-2266-6159, E-mail: ophmoon@hanmail.net 09 2010 07 09 2010 51 2 286 291 03092009 29102009 Copyright © 2010 Korean Ophthalmological Society 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To report a case of nasal-type NK/T cell lymphoma occurring in the sphenoid and ethmoid sinuses of an orbital apex syndrome patient.

 Case summary:

A 61-year-old male patient visited our hospital for the impairment of vision in the right eye for the previous month, and for right-side blepharoptosis, pain around the eyeball, and limitation of extraocular movement in the right eye for three days earlier. In MRI (magnetic resonance image) and CT (computed tomography), shades with vague boundaries were observed in the right sphenoid and ethmoid sinuses, and open biopsy and decompression were performed for the lesions. After the surgery, the vision of the right eye increased, and improvement was observed in the right blepharoptosis, the pain around the eyeball, and in the limitation of motility of the extraocular muscle in the right eye. The patient was diagnosed with nasal type NK/T cell lymphoma in biopsy, and radiotherapy and chemotherapy were performed.

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Frontal aspect of the patient on the first visit to our hospital. Ptosis of the right eye is observed.

A photograph of the preoperative extraocular movement showing limitation on the lateral, medial and superior gaze of the right eye.

Gadolinium-enhanced MRI (Left). MRI T1-weighted image on the first visit to the hospital showing shadows of somewhat strong signal in the sphenoid and ethmoid sinuses (Right). T2-weighted image showing heterogeneous shadows of high signal intensity in the same parts.

PNS CT at the first visit to the hospital showing shadows of soft tissue not filled with contrast agent in the sphenoid and the ethmoid sinuses.

Postoperative PNS CT showing the removal of lesions in the sphenoid and ethmoid sinuses.

Postoperative extraocular movement of right eye was nearly full to all directions.

Nasal-type NK/T-cell lymphoma. (A) In microscopic view, there are many atypical lymphocytes of various sizes of nuclei. (H-E stain×100) (B) Angiocentric and angiodestructive growth pattern of tumor cells are observed around the vessel. (H-E stain ×200) (C) Tumor cells are immunopositive for CD3. (Immunohistochemistry CD3 ×200) (D) Tumor cells are immunopositive for CD56. (Immunohistochemistry CD56 ×200)