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

Nam Eok Kim; Soo Jin Kim

doi:10.3341/jkos.2014.55.9.1401

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

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

Case Report

J Korean Ophthalmol Soc 2014;55(9):1401-1405.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1401

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

Nam Eok Kim, MD, Soo Jin Kim, MD

Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

Address reprint requests to Soo Jin Kim, MD, Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 600-730, Korea, Tel: 82-51-461-2469, Fax: 82-51-462-3534, E-mail: pearlsj@hanmail.net

Received 28 March 2014 Revised 3 July 2014 Accepted 20 August 2014

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 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.

Keywords: Debulking surgery, Limitation of abduction, Sphenoidal sinus carcinoma

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Figure 1.

Photograph at presentation shows ptosis, esodeviation and dilated pupil of the right eye.

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.

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.

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).

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).

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