[Malignant lymphoma presenting with bilateral orbital apex syndrome]

This is the first report of bilateral orbital apex syndrome caused by malignant lymphoma. A 73-year-old man suffered from right forehead pain, diplopia and right numb cheek. Thereafter progressed bilateral visual disturbance rapidly, and soon he became blind. Cavernous sinus thrombosis was suspected clinically, but histological study of the biopsied specimen from the nasopharynx revealed malignant lymphoma (non-Hodgkin, diffuse, large cell type) (LSG). The patient died 5 months after the onset of his illness. Autopsy revealed lymphoma cell invasion and necrosis in parasellar region, bilateral optic nerves, nasopharynx, and left posterior root of L3. There was no lymphoma cell in the liver, spleen, or gastrointestinal tract. The nasopharynx was suspected to be the primary site of the tumor. In bilateral orbital apex syndrome, malignant lymphoma should be taken into consideration. Remission can be expected if treatment is started in early stage.