Abstract
BackgroundSolitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus.Case presentationA 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI) demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI.ConclusionIt is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.
Highlights
Solitary involvement of the sphenoid sinus has rarely been reported in nonHodgkin's lymphoma
It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, it is extremely rare
10–34% of all non-Hodgkin's lymphomas arise from extranodal sites [1,2,3]
Summary
10–34% of all non-Hodgkin's lymphomas arise from extranodal sites [1,2,3]. We report a case of isolated oculomotor nerve involvement presenting in a woman with non-Hodgkin's lymphoma originating from the sphenoid sinus. This case demonstrates the resolution of oculomotor nerve palsy after chemotherapy. The final histological diagnosis was non-Hodgkin's lymphoma, diffuse large B-cell type, which has uniform, round-to-oval nuclei with vesicular chromatin and one or multiple conspicuous nucleoli. These tumor cells were positive for CD20 and negative for CD3 (Figure 2). The patient received chemotherapy consisting of eight cycles of CHOP (cyclophosphamide, adriamycin, vincristine (oncovin), and prednisone) with adjuvant Rituxi-
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