Garala Kanai, Jayaramachandran Pavitra, Knopp Michael, Critchley Peter
University Hospitals Leicester, Leicester, UK.
BMJ Case Rep. 2013 Jul 9;2013:bcr2013200166. doi: 10.1136/bcr-2013-200166.
An 88-year-old woman with a background of chronic lymphocytic leukaemia (CLL) and presented with unilateral ptosis and dull facial pains for 1 month. Examination revealed a complete right-sided ptosis and pupillary dilation. Vision in her right eye was limited to light perception. She had total external ophthalmoplegia. Her corneal reflex was not present in her right eye and she had lost sensation on the right side of her forehead. MRI revealed abnormal enhancement in the right orbital apex extending posteriorly to the sphenoid sinus. The mass invaded the superior orbital fissure, optic canal and cavernous sinus. The lumbar puncture was normal. Owing to the proximity of the mass to the cavernous sinus, it was deemed that surgical excision of the tumour was unsafe; however, it was amenable to biopsy. Histology of the biopsies was consistent with CLL. The patient declined to undergo single high-dose radiotherapy followed by dexamethasone.
一名88岁女性，有慢性淋巴细胞白血病（CLL）病史，出现单侧上睑下垂和面部隐痛1个月。检查发现右侧完全性上睑下垂和瞳孔散大。右眼视力仅存光感。她有完全性眼球外肌麻痹。右眼角膜反射消失，右侧前额感觉丧失。磁共振成像（MRI）显示右眶尖异常强化，向后延伸至蝶窦。肿块侵犯眶上裂、视神经管和海绵窦。腰椎穿刺结果正常。由于肿块靠近海绵窦，认为手术切除肿瘤不安全；然而，可行活检。活检组织学检查结果与CLL相符。患者拒绝接受单次大剂量放疗及随后的地塞米松治疗。
