Ophthalmic manifestations of an undifferentiated sinonasal carcinoma

Sinonasal undifferentiated carcinoma (SNUC) are uncommon, highly aggressive neoplasms arising in the nasal cavity and paranasal sinuses. Unlike the majority of sinonasal carcinomas, SNUC possess an uncertain histological origin and pleomorphic composition. Their heterogeneous composition prohibits their distinction from other more commonly encountered nasal tumors on the basis of imaging alone. Patients afflicted with SNUC often complain of symptoms of chronic, progressive sinus congestion, and epistaxis. Imaging studies of SNUC often illustrate rapidly enlarging masses involving multiple sinonasal sites with frequent evidence of extension beyond the sinonasal tract. Orbital extension is a frequent finding encountered during radiographic investigations.

A 28-year-old white man presented complaining of diplopia in superior gaze, pain on eye movement, and gaze-evoked amaurosis which progressed during a 2-day period. Funduscopic examination revealed choroidal folds in the papillomacular region OS. Magnetic resonance imaging (MRI) revealed a 3 cm x 3.5 cm x 4 cm mass emanating from the left ethmoid sinus with bony destruction of the left orbital floor, nasal wall of the left and right orbits, and the cribriform plate. A transcutaneous aspiration fine-needle biopsy confirmed the presence of a SNUC. After a 7-wk course of combined chemoradiotherapy marked regression in the mass was attained with resolution of the ophthalmic symptoms.

SNUC is an aggressive malignancy that is often discovered in its advanced stages after having afflicted serious insult on the nasal and sinus cavities. Ocular involvement is feasible owing to the thin composition of the orbital walls and the fast growing nature of the neoplasm.