Visual loss following treatment of sphenoid sinus carcinoma

A case of extramedullary plasmacytoma in the sphenoid sinus with unilateral loss of vision

Extramedullary plasmacytomas are localized tumours formed of monoclonal plasma cells in an extra-skeletal area. They constitute approximately 3% of all neoplasms originating from plasma cells. They generally display a destructive course. When the literature in English was reviewed, only 19 cases with the primary disease localized in the sphenoid sinus were found. We present the case of a 50-year-old male patient who presented with gradually increasing visual loss over 6 weeks, whose radiological tests revealed a formation of mass in the sphenoid sinus pressing against the optic nerve and internal carotid artery. A biopsy obtained by endoscopic sinus surgery was reported to be a plasmacytoma. A diagnosis of extramedullary plasmacytoma was made after investigations for other neoplastic plasma cell conditions proved negative. Extramedullary plasmacytomas were assessed by reviewing the literature.

Primary cancer of the sphenoid sinus--a GETTEC study

BACKGROUND

Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable.

METHODS

A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival.

RESULTS

Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases.

CONCLUSION

Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.

Central and Paracentral Visual Field Defects and Driving Abilities

The effect of central and paracentral visual field defects on driving abilities has until now received little attention. To date studies and surveys have concentrated on visual acuity and peripheral field loss. Here we summarise for the first time those diseases causing central visual field defects likely to be associated with binocular visual acuity adequate for driving.

Imaging of neoplasms of the paranasal sinuses

The assessment of sinonasal malignancies requires a multidisciplinary team approach.Advances in pretherapeutic imaging have significantly contributed to the managementof sinonasal tumors. CT and MR imaging play complementary roles in the assess-mentand staging of these malignancies by determining the presence or absence of exten-sionof disease into the skull base and its foramina, the orbit, and the intracranial compartment.

Imaging of neoplasms of the paranasal sinuses

The assessment of sinonasal malignancies requires a multidisciplinary team approach. Advances in pretherapeutic imaging have significantly contributed to the management of sinonasal tumors. CT and MR imaging play complementary roles in the assessment and staging of these malignancies by determining the presence or absence of extension of disease into the skull base and its foramina, the orbit, and the intracranial compartment.

An imaging guide to the evaluation of third cranial nerve palsies

PURPOSE

To devise a cost-effective imaging guide for the evaluation of third nerve palsies (TNP), based on an extensive review of the literature.

METHODS

A review of the pertinent English language literature was performed to devise a guideline for the evaluation and neuroimaging of TNP. The authors also report a retrospective review of the cost of imaging studies performed on 91 patients with TNP.

RESULTS

On the basis of the available literature, an imaging guide was developed and applied to a retrospective chart review of 91 patients from a single tertiary care center (Baylor College of Medicine). The cost effectiveness as well as the efficacy of the imaging guide was analyzed.

CONCLUSIONS

The evaluation of TNP can be difficult; however, using such guides may allow for more appropriate and cost-effective evaluation of these patients.