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Ophthalmic Images |

Sinonasal Undifferentiated Carcinoma Presenting With Bilateral Compressive Optic Neuropathy Online Only

Ferhina S. Ali, MD, MPH1; Joseph B. Alsberge, MD1; M. Reza Vagefi, MD1
[+] Author Affiliations
1Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2016;134(6):e155494. doi:10.1001/jamaophthalmol.2015.5494.
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This case report describes a man in his 50s with sinonasal undifferentiated carcinoma and bilateral 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.

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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).

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