Nasopharyngeal carcinoma presenting with rapidly progressive severe visual disturbance: a case report.
BACKGROUND
Nasopharyngeal carcinoma is one of the most difficult tumors to diagnose correctly at the initial phase because of the occasional lack of nasal symptoms. The perineural spread of the trigeminal nerve is one of the most common and important routes in the intracranial paracavernous extension of nasopharyngeal carcinoma, but visual loss is very rare.


METHODS
We report the case of a 54-year-old Japanese man with nasopharyngeal carcinoma, who presented with rapid and severe disturbance of left monocular visual acuity and eye movement with a 10-month history of ipsilateral otitis media and facial pain. Magnetic resonance imaging revealed a lesion in the left fossa of Rosenmüller, pterygopalatine fossa, sphenoid and ethmoid sinus, and the left cavernous sinus extending to the orbital apex through the superior orbital fissure. The histopathological diagnosis was nonkeratinizing undifferentiated nasopharyngeal carcinoma. Epstein-Barr virus was detected by in situ hybridization. Although focal radiotherapy induced remarkable tumor shrinkage and relieved ocular motor disturbance and facial pain, his visual acuity did not improve.


CONCLUSIONS
The awareness of cranial nerves in addition to intracranial and orbital apex involvement, as in this case, is important for appropriate diagnosis and treatment planning of nasopharyngeal carcinoma.
Yoshinobu
Y
Kamio
Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan. nsakaineurosurg@gmail.com.
Naoto
N
Sakai
Goro
G
Takahashi
Satoshi
S
Baba
Hiroki
H
Namba
D001706:Biopsy; D002277:Carcinoma; D018450:Disease Progression; D005133:Eye Movements; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000821:virology; D009361:Neoplasm Invasiveness; D049268:Positron-Emission Tomography; D014786:Vision Disorders / Q000473:pathology*; D014792:Visual Acuity