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Sinonasal Undifferentiated Carcinoma Presenting With Bilateral Compressive Optic Neuropathy

Sinonasal Undifferentiated Carcinoma Presenting With Bilateral Compressive Optic Neuropathy A man in his early to mid-50s with a history of paranoid schizophrenia presented with decreased vision in the left eye after 2 months of left facial numbness and swelling. External examination revealed left-sided proptosis with globe dystopia, ptosis, and decreased facial sensation. Uncorrected visual acuity was 20/200 OD and hand motions OS with a left-sided relative afferent pupillary defect. There was marked limitation of extraocular movements on the left side. The right optic nerve was without pallor or edema and the left optic nerve was notable for disc edema. Imaging (Figure, A) and biopsy (Figure, B) revealed sinonasal undifferentiated carcinoma. The patient’s cancer was staged at T4N0M0. He refused chemotherapy and surgical resection. Radiotherapy was not thought to be a sole effective therapy given the size and aggressive nature of the tumor. The patient elected for hospice care and died 5 months after initial presentation. Figure. View LargeDownload Axial and coronal T1-weighted magnetic resonance imaging (MRI) of an enhancing necrotic mass of the left sinonasal cavity and central skull base with bilateral optic nerve and chiasm compression. B, Endonasal biopsy demonstrates large ovoid nuclei (hematoxylin-eosin, ×20) staining keratin positive (inset, ×20). Back to top Article Information Corresponding Author: M. Reza Vagefi, MD, Department of Ophthalmology, University of California, 10 Koret Way, Room 201, San Francisco, CA 94143 (reza.vagefi@ucsf.edu). Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Ophthalmology American Medical Association

Sinonasal Undifferentiated Carcinoma Presenting With Bilateral Compressive Optic Neuropathy

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Sinonasal Undifferentiated Carcinoma Presenting With Bilateral Compressive Optic Neuropathy

Abstract

A man in his early to mid-50s with a history of paranoid schizophrenia presented with decreased vision in the left eye after 2 months of left facial numbness and swelling. External examination revealed left-sided proptosis with globe dystopia, ptosis, and decreased facial sensation. Uncorrected visual acuity was 20/200 OD and hand motions OS with a left-sided relative afferent pupillary defect. There was marked limitation of extraocular movements on the left side. The right optic nerve was...
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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6165
eISSN
2168-6173
DOI
10.1001/jamaophthalmol.2015.5494
Publisher site
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Abstract

A man in his early to mid-50s with a history of paranoid schizophrenia presented with decreased vision in the left eye after 2 months of left facial numbness and swelling. External examination revealed left-sided proptosis with globe dystopia, ptosis, and decreased facial sensation. Uncorrected visual acuity was 20/200 OD and hand motions OS with a left-sided relative afferent pupillary defect. There was marked limitation of extraocular movements on the left side. The right optic nerve was without pallor or edema and the left optic nerve was notable for disc edema. Imaging (Figure, A) and biopsy (Figure, B) revealed sinonasal undifferentiated carcinoma. The patient’s cancer was staged at T4N0M0. He refused chemotherapy and surgical resection. Radiotherapy was not thought to be a sole effective therapy given the size and aggressive nature of the tumor. The patient elected for hospice care and died 5 months after initial presentation. Figure. View LargeDownload Axial and coronal T1-weighted magnetic resonance imaging (MRI) of an enhancing necrotic mass of the left sinonasal cavity and central skull base with bilateral optic nerve and chiasm compression. B, Endonasal biopsy demonstrates large ovoid nuclei (hematoxylin-eosin, ×20) staining keratin positive (inset, ×20). Back to top Article Information Corresponding Author: M. Reza Vagefi, MD, Department of Ophthalmology, University of California, 10 Koret Way, Room 201, San Francisco, CA 94143 (reza.vagefi@ucsf.edu). Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Journal

JAMA Ophthalmology – American Medical Association

Published: Jun 1, 2016

Keywords: optic nerve compression,optic nerve disorders

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