| Identifier |
walsh_2015_s2_c1-2 |
| Title |
Requiem for a Cabinet Maker |
| Creator |
Jennifer I. Doyle |
| Subject |
Transient Monocular Visual Loss; Orbital Tumor; Facial Numbness; MRI; Pathology special staining |
| History |
A 54-year-old white male presents with 3 weeks of painless horizontal nystagmus and 6 months of leftsided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color visionis 8 of 8 OU and confrontational fields are full OU. Pupils are equal and reactive without an R APD.Ductions are full but with end gaze nystagmus. There is no proptosis or ptosis but there is decreased V1sensation on the left. Fundus examination is normal. A contrasted cranial and orbital MRI showed anenhancing mass in left superior orbit. He was treated with a Medrol dose pack and had mildimprovement in symptoms. Left orbital biopsy was read as orbital fibrotic histiocytoma. One monthlater his examination showed NLP vision OS associated with an amaurotic pupil. He had decreasedabduction OS. He had 4 mm of proptosis OS. Left V1 sensation was still diminished and fundusremained normal OU. He was admitted to the hospital and prescribed IV methylprednisone. RepeatMRI showed increased in size of left orbital mass, now involving the optic nerve. CT orbits showedadjacent bone demineralization. He underwent left orbital radiation. Five months later, patient presentsto ED with shortness of breath and transient visual loss OD. Vision remained 20/20 OD and NLPOS. Ductions now show limited superior gaze OD and limited all directions OS. Decreased left sidedV1 and V2. No optic disc edema OD and mild optic nerve edema OS. MRI shows enlarging left sidedorbital mass with a new right-sided retro-orbital mass. Further work up reveals new bilateral pulmonarynodules and metastatic appearing hepatic lesion. A diagnostic procedure was performed. |
| Disease/Diagnosis |
Poorly differentiated carcinoma with sarcomatoid features of the orbit, liver, and pleura |
| Date |
2015-02 |
| References |
1. Wick MR and Swanson PE. Carcinosarcomas: current perspectives and an historical review of nosological concepts. Seminars in Diagnostic Pathology. 1993; 10(2): 118-127. 2. Prakalapakorn SG, Bernardino,CR, Auclair PL, Grossniklaus HE. Carcinosarcoma of the Orbit: Report of Two cases and Review of the literatutre. Ophthalmology. 2008. November;114(11): 2065- 2070 3. Sadaba LM, Garcia-Lavan A, Garcia-Gomex PJ, Salinas-Alaman A. Sarcomatoid carcinoma and orbital apex syndrome. Eur J Ophthalmol. 2006 Jul-Aug;16(4):608-10 |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2015 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6216 |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6wh5mnm |
| Setname |
ehsl_novel_fbw |
| ID |
179299 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6wh5mnm |
