title: Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: a case report.
abstract: We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.
authors.affiliation: Department of Otolaryngology, St. John's Medical College Hospital, Koramangala, Bangalore, India.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Tandon
authors.forename: Arun
authors.initials: A
authors.lastname: Nair
authors.forename: Anisha
authors.initials: A
authors.lastname: Sawkar
authors.forename: A M
authors.initials: AM
authors.lastname: Balasubramanya
authors.forename: Diganta
authors.initials: D
authors.lastname: Hazarika
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000209:etiology; D010255:Paranasal Sinus Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D013101:Sphenoid Sinus / Q000473:pathology