| Identifier |
walsh_2018_s1_c4-2 |
| Title |
A Tough Nut to Crack! - Slides |
| Creator |
Lauren Maloley; Sachin Kedar; Deepta Ghate; Dominick DiMaio; Jason Helvey; Sachin Kedar |
| Affiliation |
(LM) (SK) (DG) (DD) (JH) (SK) University of Nebraska Medical Center, Omaha, Nebraska |
| Subject |
Horner's syndrome, Abducens Nerve Palsy, Skull base tumors, Sphenoid sinus |
| History |
A 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednisone for acute sinusitis at a local urgent care facility. Her symptoms worsened and she was referred to an otolaryngologist who noted bloody material on nasal endoscopy and prescribed clindamycin and dexamethasone. The headache worsened and a week later, she developed blurred vision in the left eye. She was admitted to an outside facility and treated with intravenous levaquin and methylprednisolone. A maxillofacial and head CT was reported to show "complete opacification of bilateral sphenoid and right maxillary sinuses with mucosal thickening in the posterior ethmoid sinus and no intracranial abnormalities". Nasal endoscopy demonstrated edematous turbinates and mucosanguineous drainage from the right sphenoid ostium; no nasopharyngeal masses were seen. Baseline labs were unremarkable except mild elevation of white cell count (13.3 x 10^9 cells/L) and C-reactive protein (20.6 mg/L). At transfer, neuro-ophthalmic examination included a visual acuity of 20/25 OU, left Horner's syndrome and left esotropia with bilateral abduction deficits (worse left eye). Visual fields showed non-specific scatter. Fundus examination was normal. Corneal and facial sensations were intact. MRI brain and orbits showed a contrast enhancing sellar mass with extension superiorly to the hypothalamus, laterally into bilateral cavernous sinuses, anteriorly into the sphenoid sinus and inferiorly into the clivus. Treatment with broad-spectrum antibiotics-vancomycin, ceftriaxone and metronidazole was started. Extensive studies for autoimmune and infectious conditions (including fungal) were unremarkable. She underwent bilateral sphenoidotomy and right maxillary anstrostomy. Pathology showed nonspecific reactive changes and necrotic debris with negative cultures. A procedure was performed. |
| Disease/Diagnosis |
Nuclear protein of the testis (NUT) carcinoma |
| Presenting Symptom |
A 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednisone for acute sinusitis at a local urgent care facility. Her symptoms worsened and she was referred to an otolaryngologist who noted bloody material on nasal endoscopy and prescribed clindamycin and dexamethasone. The headache worsened and a week later, she developed blurred vision in the left eye. She was admitted to an outside facility and treated with intravenous levaquin and methylprednisolone. A maxillofacial and head CT was reported to show 'complete opacification of bilateral sphenoid and right maxillary sinuses with mucosal thickening in the posterior ethmoid sinus and no intracranial abnormalities'. Nasal endoscopy demonstrated edematous turbinates and mucosanguineous drainage from the right sphenoid ostium; no nasopharyngeal masses were seen. Baseline labs were unremarkable except mild elevation of white cell count (13.3 x 10^9 cells/L) and C-reactive protein (20.6 mg/L). At transfer, neuro-ophthalmic examination included a visual acuity of 20/25 OU, left Horner's syndrome and left esotropia with bilateral abduction deficits (worse left eye). Visual fields showed non-specific scatter. Fundus examination was normal. Corneal and facial sensations were intact. MRI brain and orbits showed a contrast enhancing sellar mass with extension superiorly to the hypothalamus, laterally into bilateral cavernous sinuses, anteriorly into the sphenoid sinus and inferiorly into the clivus. Treatment with broad-spectrum antibioticsvancomycin, ceftriaxone and metronidazole was started. Extensive studies for autoimmune and infectious conditions (including fungal) were unremarkable. She underwent bilateral sphenoidotomy and right maxillary anstrostomy. Pathology showed nonspecific reactive changes and necrotic debris with negative cultures. A procedure was performed. |
| Date |
2018-05 |
| References |
1) Bair RJ, Chick JF, Chauhan NR, et al. Demystifying NUT midline carcinoma: radiologic and pathologic correlations of an aggressive malignancy. AJR. 2014;203(4): 391-399. 2) Diffalha SA, Aukla NA, Hasan S, et al. NUT midline carcinoma: a rare malignancy. Cancer Control. 2017;24(2): 202-206. 3) Edgar M, Caruso AM, Kim E, et al. NUT midline carcinoma of the nasal cavity. Head Neck Pathol. 2016;11: 389-392. 4) Hellquist H, French CA, Bishop JA, et al. NUT midline carcinoma of the larynx: an international series and review of the literature. Histopathology. 2017;70: 861-868. 5) Lemelle L, Pierro G, Freneaux P, et al. NUT carcinoma in children and adults: a multicenter retrospective study. Pediatr Blood Cancer. 2017;64(12): 1-9. 6) Sun H, McGuire MF, Zhang S, et al. NUT midline carcinoma: morphoproteomic characterization with genomic and therapeutic correlates. Ann Clin Lab Sci. 2015;45(6): 692-701. 7) Wasserman JK, Purgina B, Sekhon H, et al. The gross appearance of a NUT midline carcinoma. Int J Surg Pathol. 2016;24(1): 85-88. |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
2018 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2018 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6s79kn1 |
| Setname |
ehsl_novel_fbw |
| ID |
1326573 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6s79kn1 |
