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Blindness Following Endoscopic Excision of Acinic Cell Carcinoma of Sphenoid Sinus: A Case Report.

ABSTRACT: Acinic cell carcinoma (A.C.C.) is a low-grade malignancy involving salivary glands. A.C.C. accounts for only 1-4% of all sinonasal malignancies. We report the case of a 45-year-old female who presented with A.C.C. of paranasal sinus who developed loss of vision after Endoscopic sinus surgery (E.S.S.). Blindness, though rare, is a devastating complication of E.S.S. In this report, the rare occurrence of a papillary cystic variant of A.C.C. in the sphenoid sinus is reported. The causes that may lead to blindness during E.S.S. are analyzed in the absence of direct neural trauma.

Supplementary information

The online version contains supplementary material available at 10.1007/s12070-022-03190-2.

SUBMITTER: K V A

PROVIDER: S-EPMC10188821 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Blindness Following Endoscopic Excision of Acinic Cell Carcinoma of Sphenoid Sinus: A Case Report.

K V Aswathi A Karakkandy Vinusree V Chappity Preetam P Nayak Anindya A

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 20221208 Suppl 1

Acinic cell carcinoma (A.C.C.) is a low-grade malignancy involving salivary glands. A.C.C. accounts for only 1-4% of all sinonasal malignancies. We report the case of a 45-year-old female who presented with A.C.C. of paranasal sinus who developed loss of vision after Endoscopic sinus surgery (E.S.S.). Blindness, though rare, is a devastating complication of E.S.S. In this report, the rare occurrence of a papillary cystic variant of A.C.C. in the sphenoid sinus is reported. The causes that may le ...[more]

PMID: 37206856

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Project description:IntroductionSphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for safe transsphenoidal surgeries because of nearby vital structures. They exhibit variable pneumatization and often have an intersinus septum. This case emphasizes the importance of understanding sphenoid sinus anatomy, particularly in the context of transsphenoidal surgeries. It also introduces a novel case involving a congenital roof defect, previously unreported in medical literature.Case presentationA 52-year-old male presented with left cheek swelling that progressed to the eyelid, accompanied by low visual acuity, nasal symptoms, and a high temperature. Clinical examination revealed purulent discharge. A CT scan indicated opacity in the left maxillary sinus and a roof defect in the left sphenoid sinus. However, endoscopic surgery revealed the sphenoid sinus to be normal. This indicates that the defect is congenital. A biopsy from the maxillary sinus lesion confirmed lymphoma, and he was sent to the oncology hospital. There was no extension of the maxillary sinus lesion into the sphenoid sinus. This unique case had no history of drainage, taste issues, meningitis, or pituitary surgery.DiscussionThe complete absence of the sphenoid sinus roof is a unique and rare anatomical anomaly with significant implications for surgical procedures. Transsphenoidal surgery, which benefits from endoscopic advancements, provides enhanced visualization but also poses risks due to the proximity to critical structures. Pneumatization of the sphenoid sinus typically reaches maturity during adolescence, with individual variations in extent, Septations, extensions, and asymmetry are common in sphenoid sinus anatomy. This underscores the need for surgeon awareness and adjusted surgical approaches in such rare instances.ConclusionsWe emphasize the importance of a thorough anatomical understanding through precise radiological study before any sinus surgery due to the possibility of unexpected anatomical abnormalities.

Project description:BackgroundIn this paper, we present a rare case of tumor-induced osteomalacia (TIO) and a literature review of this rare disease.MethodsA case of TIO of the isolated sphenoid sinus was reported. Furthermore, the clinical features of TIO in the sphenoid sinus and other sinonasal sinuses were also reviewed and summarized.ResultsA 35-year-old man with muscle weakness and lower back pain came to the Department of Neurology. No obvious neurological disease was found; however, magnetic resonance imaging of the extremities accidentally showed a tumor in the axilla. Bone scintigraphy showed suspicious bone metastasis. Hypophosphatemia was neglected. Interestingly, 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) detected a tumor in the axilla and another in the sphenoid sinus, but only the tumor in the sphenoid sinus had somatostatin receptor (SSTR) expression in 68-gallium 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid octreotate (Ga-68 DOTATATE) PET/CT. The sphenoid sinus tumor was proven to be a phosphaturic mesenchymal tumor (PMT), and the phosphate levels returned to normal after surgery. The literature review showed only 17 cases of TIOs that occurred in the sphenoid sinus, with an average age of 43.3 ± 13.7 years. Only three cases of TIOs in the sphenoid sinus did not invade the nasal cavity or other paranasal sinuses, which could be identified as isolated sphenoid sinus diseases. We compared the clinical features of sphenoid TIOs with those of non-sphenoid sinonasal TIOs, and it was found that the concentration of 1,25-dihydroxy vitamin D in the group with sphenoid TIOs was much higher than that in the group with non-sphenoid sinonasal TIOs. A total of 153 cases of TIOs in the sinonasal sinus were reviewed. The ethmoid sinus was found to be the major site (64.7%), followed by the nasal cavity (50.3%), maxillary sinus (19.0%), frontal sinus (16.4%), and sphenoid sinus (11.8%). There were 66 patients (43.1%) who showed tumors invading more than one sinus. Most of the tumors (69.3%) were diagnosed as PMTs by pathology, followed by hemangiopericytoma (14.3%). Immunostaining was beneficial in the differential diagnosis of these tumors; however, larger sample sizes are needed for better accuracy.ConclusionTIO in the sinonasal sinus, especially in the sphenoid sinus, is rare. Moreover, isolated sphenoid sinus disease can be easily misdiagnosed. When the clinical manifestation of osteomalacia is atypical, associating it with sphenoid sinus disease is even more difficult. Thus, TIO in the sphenoid sinus needs further exploration.

Dataset Information

Blindness Following Endoscopic Excision of Acinic Cell Carcinoma of Sphenoid Sinus: A Case Report.

Supplementary information

Publications

Blindness Following Endoscopic Excision of Acinic Cell Carcinoma of Sphenoid Sinus: A Case Report.

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