Ashraf Davin C, Kalin-Hajdu Evan, Levin Marc H, Kersten Robert C
Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, San Francisco, CA, 94143, USA.
Department of Ophthalmology, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA, 94301, USA.
Am J Ophthalmol Case Rep. 2018 Dec 19;13:136-139. doi: 10.1016/j.ajoc.2018.12.018. eCollection 2019 Mar.
To report a diagnostically challenging case of cranial neuropathy due to perineural invasion by a basal cell carcinoma presenting 7.5 years after treatment of the primary tumor with Mohs micrographic surgery.
A 62-year-old male with a history of Mohs micrographic surgery for basal cell carcinoma (BCC) of the left brow presented with insidious onset of diplopia and paresthesia localizing to the ipsilateral cranial nerves V, V, and VI. He had no evidence of recurrent cutaneous BCC. Magnetic resonance imaging of the orbits and skull base identified equivocal, subtle abnormalities in the ipsilateral superior orbital fissure and cavernous sinus, with normal appearance of the clinically involved nerve branches. A radiographically normal branch of cranial nerve V was biopsied and histopathology identified perineural invasion by recurrent basal cell carcinoma.
The diagnosis of perineural invasion by BCC can pose several challenges, including subtle to absent imaging findings of clinically involved nerves and a lengthy latent period following primary tumor treatment. This case represents, to our knowledge, the longest reported interval between primary treatment and biopsy-proven recurrence with perineural invasion by BCC.
报告一例诊断具有挑战性的颅神经病变病例，该病变由基底细胞癌沿神经周围浸润引起，发生于原发性肿瘤经莫氏显微外科手术治疗7.5年后。
一名62岁男性，有左侧眉部基底细胞癌（BCC）经莫氏显微外科手术治疗史，出现隐匿性复视和感觉异常，定位于同侧颅神经V、V和VI。他没有复发性皮肤BCC的证据。眼眶和颅底的磁共振成像显示同侧眶上裂和海绵窦存在可疑的细微异常，而临床受累神经分支外观正常。对放射学表现正常的颅神经V分支进行活检，组织病理学检查发现复发性基底细胞癌沿神经周围浸润。
基底细胞癌沿神经周围浸润的诊断可能面临若干挑战，包括临床受累神经的影像学表现细微或无异常，以及原发性肿瘤治疗后较长的潜伏期。据我们所知，该病例是报告的原发性治疗与经活检证实的基底细胞癌沿神经周围浸润复发之间间隔时间最长的病例。
