Polymorphous low-grade adenocarcinoma with cavernous sinus involvement presenting as third nerve palsy

Area of Science:

• Ophthalmology
• Neurology
• Oncology

Background:

• Polymorphous low-grade adenocarcinoma (PLGA) is a salivary gland neoplasm typically found in the oral cavity.
• Rarely, PLGA can extend beyond the nasopharynx, presenting diagnostic challenges.

Observation:

• A 68-year-old woman developed isolated left third cranial nerve palsy 10 weeks after glaucoma surgery.
• Initial differential diagnoses included ischemic neuropathy and postoperative complications.
• MRI identified a left cavernous sinus mass, confirmed as PLGA via biopsy.

Findings:

• This case details an atypical presentation of PLGA.
• The tumor involved the cavernous sinus, leading to neuro-ophthalmic symptoms.

Implications:

• This report underscores the importance of considering rare diagnoses in neuro-ophthalmic presentations.
• PLGA should be included in the differential diagnosis of cavernous sinus masses, even with unusual initial symptoms.