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要約 目的:眼窩先端症候群を呈した蝶形骨洞腺癌の症例を報告する。症例:62歳の女性が右顔面のしびれと眼痛で近医を受診し,顔面神経痛と診断された。1か月後に右眼視力が急激に低下し,その翌日に当科を受診した。所見と経過:矯正視力は右10cm指数弁,左0.6で,右眼に外転制限と内斜視があった。右眼乳頭に軽度の発赤・腫脹があり,右眼視野が高度に狭窄していた。磁気共鳴画像検査(MRI)で眼窩先端部に巨大な腫瘤があり,病理学的に蝶形骨洞腺癌と診断された。精査により肝転移と骨転移が発見され,当科初診から5か月後に死亡した。結論:原因不明の持続性眼痛では,稀ではあるが副鼻腔または眼窩腫瘍の可能性がある。
Abstract. Purpose:To report a case of sphenoid sinus adenocarcinoma presenting with orbital apex syndrome as the initial manifestation. Case:A 62-year-old woman noted right facial numbness and ocular pain. She was tentatively diagnosed with facial neuralgia. She noticed sudden visual failure in her right eye and visited us the following day. Findings:Her corrected visual acuity was counting fingers/10cm right and 0.6 left. The right eye showed esotropia, restricted abduction and swelling of optic disc. The right visual field was severely constricted. Magnetic resonance imaging(MRI) showed a giant tumor in the right orbital apex. It was diagnosed, histopathologically, as adenocarcinoma of sphenoid sinus. Further examinations showed metastasis to the liver and bones. She deceased 5 months after her initial visit. Conclusion:Persistent ocular pain may be caused by malignancy in the paranasal sinus or orbit.
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