J Korean Ophthalmol Soc.  2010 Feb;51(2):286-291. 10.3341/jkos.2010.51.2.286.

Orbital Apex Syndrome with Nasal Type Natural Killer(NK)/T-cell Lymphoma of Sphenoid and Ethmoid Sinus

• Baik SH
• Yeom DJ
• Kang YK
• Sung MS
• Moon SW

• KMID: 2213154
• DOI: http://doi.org/10.3341/jkos.2010.51.2.286

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.

Keyword

Nasal type NK/T-cell lymphoma; Orbital apex syndrome; Sphenoid and ethmoid sinus

MeSH Terms

Biopsy
Blepharoptosis
Decompression
Ethmoid Sinus
Eye
Humans
Lymphoma
Male
Middle Aged
Muscles
Orbit
Vision, Ocular

Figure

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  Figure 1. Frontal aspect of the patient on the first visit to our hospital. Ptosis of the right eye is observed.

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  Figure 2. A photograph of the preoperative extraocular movement showing limitation on the lateral, medial and superior gaze of the right eye.

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  Figure 3. 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.

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  Figure 4. 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.

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  Figure 5. Postoperative PNS CT showing the removal of lesions in the sphenoid and ethmoid sinuses.

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  Figure 6. Postoperative extraocular movement of right eye was nearly full to all directions.

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  Figure 7. 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)

Reference

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