Case Report:
A 57-year-old female was referred to the department of otolaryngology
and head and neck surgery, with 3 months history of ptosis and headache.
On admission there was complete immobilization and decreased visual
acuity of the right eye; the patient’s past medical and drug history was
unremarkable. There was no history of weakness, weight loss, nasal
discharge, infectious diseases, or bone pain. On physical examination
patient appeared well, and no lymphadenopathy was found. Abdominal
examination showed no hepatomegaly or splenomegaly. A neurologic
examination of cranial nerves revealed paralysis of right III, IV, and
VI of cranial nerves and also hypesthesia of the right lateral face in
the region of V1 and V2 of the trigeminal nerve.Furthermore, fundoscopy
evaluation of the right eye revealed an atrophic optic disc; other
neurological examination produced normal results.
Computerized tomography (CT) scan and magnetic resonance imaging (MRI)
demonstrated an expansile mass lesion in the right sphenoid sinus
eroding the sinus lateral wall and roof. The mass extension was observed
in the right orbital apex and right superior orbital fissure and around
the right internal carotid artery (figure2, 3).
Endonasal endoscopic observation and biopsies were performed under
general anesthesia. Plasmacytoma was confirmed by histological analysis
of multiple biopsy specimens of sphenoid sinus mass. Tumor samples were
composed of several pieces of whitish-yellow soft tissue. The
histopathological examination revealed monoclonal infiltration of plasma
cells with atypical vesiculo nucleated nuclei and occasional binucleate
forms; cytoplasm was basophilic in most cells (figure 1).