| Identifier |
walsh_2015_s2_c1 |
| Title |
Requiem for a Cabinet Maker |
| Creator |
Jennifer I. Doyle; Michael S. Vaphiades; James R. Hackney; Lanning B. Kline; Lina Nagia |
| Affiliation |
(JID) (MSV) (JRH) (LBK) (LN) University of Alabama, Dept. of Ophthalmology Birmingham, AL; (MSV) University of Alabama, Dept. of Neurology Birmingham, AL; (MSV) University of Alabama, Dept. of Neurosurgery Birmingham, AL; (JRH) University of Alabama, Dept. of Neuropathology Birmingham, AL |
| 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 left sided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30 years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color vision is 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 V1 sensation on the left. Fundus examination is normal. A contrasted cranial and orbital MRI showed an enhancing mass in left superior orbit. He was treated with a Medrol dose pack and had mild improvement in symptoms. Left orbital biopsy was read as orbital fibrotic histiocytoma. One month later his examination showed NLP vision OS associated with an amaurotic pupil. He had decreased abduction OS. He had 4 mm of proptosis OS. Left V1 sensation was still diminished and fundus remained normal OU. He was admitted to the hospital and prescribed IV methylprednisone. Repeat MRI showed increased in size of left orbital mass, now involving the optic nerve. CT orbits showed adjacent bone demineralization. He underwent left orbital radiation. Five months later, patient presents to ED with shortness of breath and transient visual loss OD. Vision remained 20/20 OD and NLP OS. Ductions now show limited superior gaze OD and limited all directions OS. Decreased left sided V1 and V2. No optic disc edema OD and mild optic nerve edema OS. MRI shows enlarging left sided orbital mass with a new right-sided retro-orbital mass. Further work up reveals new bilateral pulmonary nodules 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 |
| 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 |
| 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/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s61c4tgb |
| Setname |
ehsl_novel_fbw |
| ID |
179267 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s61c4tgb |
