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Timothy Peiris, H. Deniz Gur, Howard Pomeranz; Diffuse Large B-Cell Lymphoma of the Sphenoid Sinus Initially Presenting with Binocular Diplopia. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2929.
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© ARVO (1962-2015); The Authors (2016-present)
To report a case of rare primary diffuse large B-cell lymphoma arising from the sphenoid sinus initially manifesting as binocular diplopia
Observational case report. Spectral domain optical coherence tomography (SD-OCT), automated visual field testing, magnetic resonance imaging (MRI), and computed tomography (CT) were used to assist in diagnosis and management.
A 57-year-old Asian male patient with remote history of tobacco use presented to clinic with two weeks of binocular diplopia and mildly diminished visual acuity of his right eye. He was diagnosed with sixth nerve palsy versus skew deviation and recommended to follow closely; however, his visual acuity continued to diminish and an afferent pupillary defect was noted. MRI performed in tertiary care hospital revealed a mass arising from the sphenoid sinus with orbital and intracranial extension, encasing the right optic nerve. Subsequent biopsy of the lesion identified diffuse large B-cell lymphoma. After treatment with high dose steroids and chemotherapy induction, visual acuity improved and the patient remains under close multidisciplinary management.
Primary diffuse large B-cell lymphoma of the sphenoid sinus is a rare neoplasm and an extremely uncommon cause of unilateral oculomotor nerve palsy. Previous reports of this entity have not been described in the ophthalmic literature.
This is a 2020 ARVO Annual Meeting abstract.
MRI scan revealing encasement of the right optic nerve by diffuse large B-cell lymphoma.
H&E stain of the neoplasm demonstrates multiple fragments of lymphoid tissue showing diffuse proliferation of large, atypical cells with round to irregular nuclei, vesicular chromatin, and indistinct multiple nucleoli. There is brisk mitosis and apoptosis.
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