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).