Confounding case of seromucinous hamartoma

Area of Science:

• Neurology
• Otolaryngology
• Pathology

Background:

• Diplopia and vocal fold paralysis can indicate serious underlying conditions.
• Cranial nerve palsies require thorough investigation to determine etiology.

Observation:

• A 67-year-old man presented with progressive diplopia and unilateral vocal fold paralysis.
• Imaging revealed a T2-bright left ethmoid mass.
• Biopsy confirmed a benign seromucinous hamartoma.

Findings:

• The ethmoid mass was incidental and unrelated to the patient's neurological deficits.
• Blood work revealed high titers of anti-acetylcholine receptor antibodies, confirming myasthenia gravis.
• The patient experienced improvement in ocular cranial neuropathies after treatment with pyridostigmine.

Implications:

• This case highlights the importance of differentiating between incidental findings and the primary cause of neurological symptoms.
• Early diagnosis and management of myasthenia gravis are crucial for improving patient outcomes.
• Benign sinonasal tumors can coexist with systemic autoimmune diseases, necessitating comprehensive diagnostic approaches.