Compressive Optic Neuropathy Secondary to Sinonasal Undifferentiated Carcinoma in a Young Male

Abstract

Sinonasal undifferentiated carcinoma (SNUC) is an extremely aggressive malignancy. Extension to the orbit and adjacent structures is common, but isolated visual loss as a presenting symptom is rare. We report a rare case of SNUC with bilateral visual loss as the initial manifestation. A 34-year-old gentleman was presented with acute onset loss of vision in both eyes for one week. It was followed by recurrent headaches and epistaxis. Visual acuity in the right eye was 2/60 and 3/60 in the left eye. Funduscopy showed a bilateral swollen disc. Neuroimaging revealed a large mass in the ethmoidal sinus extended laterally causing compression to recti muscles and the optic nerves. The histopathological examination of nasal tissue biopsy showed features of SNUC with bone and perineural invasion. A diagnosis of SNUC with bilateral compressive optic neuropathy was established. The patient underwent tumor debulking and base of skull reconstruction by the neurosurgical team. This was then followed by chemotherapy and radiotherapy. The patient's right eye visual acuity initially improved to 6/9. However, his both eye vision developed into no light perception during treatment. In conclusion, SNUC is a highly aggressive tumor that may present with acute blindness. Early treatment may save a life, but the visual prognosis is guarded due to extensive optic nerve damage caused by tumor compression.

Intracranially Extended Sinonasal Undifferentiated Carcinoma: A Case Report and Literature Review

“…Tumors with undifferentiated cells may not have such an adverse cell proliferation and thus tend to respond better to such treatment [ 3 ]. Chemotherapy can also reduce a lesion’s apposition in regions proximal to regions with critically low radiation threshold (eg, optic nerves), thus improving the outcomes [ 3 , 20 ].…”

Non-Epstein-Barr Virus Sinonasal Undifferentiated Carcinoma Presenting as Diplopia and Rhinorrhea

“…Tumor diagnosis via surgical biopsy and tumor extension can be determined via CT or MRI. It is typically diagnosed in later stages due to fairly benign and non-acute presentation [ 2 , 3 ]. Imaging typically shows an advanced lesion within the orbit and expanding to other adjacent structures, and intracranial extension is possible.…”

Nasal cavity tumor successfully treated with urgent combined proton and photon therapy to preserve visual function: A case study

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To the EditorHead and neck tumors can compress the optic nerve, leading to ocular symptoms and potential blindness. [1][2][3][4][5][6] Surgical decompression restores visual function but is invasive and challenging in pediatric patients. 7,8 Endoscopic surgery, although requiring expertise, is limited to select facilities.

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