Tandon Shantanu, Nair Arun, Sawkar Anisha, Balasubramanya A M, Hazarika Diganta
Department of Otolaryngology, St. John's Medical College Hospital, Koramangala, Bangalore, India.
Ear Nose Throat J. 2012 Jan;91(1):E10-3. doi: 10.1177/014556131209100116.
We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.
我们报告了一例罕见病例，一名53岁男性，患有源自未确诊肝细胞癌（HCC）的蝶窦转移瘤，表现为逐渐进展的眼球外肌麻痹。影像学检查显示右侧蝶窦病变浸润鞍旁区域。尽管蝶窦原发性活检结果不明确，但乙肝表面抗原阳性及CT引导下细针穿刺细胞学检查提示为HCC。再次经蝶窦内镜活检及免疫组化证实该病变为转移性HCC。鼻窦转移极为罕见，肝脏原发性肿瘤转移至鼻窦更是罕见。由于原发性和转移性病变在临床及影像学上具有相似性，蝶窦转移瘤常难以诊断。具有蝶窦恶性肿瘤特征的患者也应评估转移性肿瘤的可能性。在本文中，我们强调了该肿瘤的罕见性、不寻常的临床表现及早期诊断的问题。
