Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report

Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report

Diego Ochoa-Cacique1, María Elena Córdoba-Mosqueda1, José Ramón Aguilar-Calderón1, Gonzalo Solís y-Maldonado2, Ulises García-González1, Victor Andrés Reyes-Rodríguez3, José de Jesús Lomelí-Ramírez4, Rosa María Vicuña-González5, Rodrigo Efraín Hernández-Reséndiz6, Erick Alberto Castañeda- Ramírez7, Mauricio Daniel Sánchez-Calderón1, Daniel Alejandro Vega-Moreno1, Rafael Sánchez-Mata1

1Departament of Neurosurgery, Hospital Central Sur de Alta Especialidad de PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Ciudad de México, México. 2Departament of Neurosurgery, Hospital Ángeles del Pedregal, Camino a Santa Teresa 1055-S, Héroes de Padierna, La Magdalena Contreras, 10700, Ciudad de México, México. 3Departament of Neurosurgery, Hospital Central Norte PEMEX, Campo Matillas 52, San Antonio, Azcapotzalco, 02720, Ciudad de México, México. 4Departament of Neurosurgery, Hospital Vossan, Carretera Lerma-Champotón km 193, Country club, 24500, Campeche, México. 5Departament of Pathological Anatomy, Hospital Central Sur de Alta Especialidad de PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Ciudad de México, México. 6Departament of Neurosurgery, Hospital Ángeles Clínica Londres, Calle Frontera 74, Colonia Roma, Cuauhtémoc, 06700, Ciudad de México, México. 7Departament of Neurosurgery, Hospital Regional No. 1 del IMSS, Morelos, 85110, Ciudad Obregón, Sonora, México.

Primary lymphomas of the skull base are rare (1% of lymphomas in adults); they can originate from the cavernous sinus and the parasellar region. Diffuse large B-cell lymphoma is the most common histologic subtype. Currently, the origin of these lymphomas is controversial, and their clinical characteristics are not very specific. There are various treatments for these lesions with a variable response; therefore, the prognosis of these lesions is variable.

Clinical case: We present the case of a 52-year-old man who spontaneously presented with diplopia. Physical examination revealed a limitation in adduction of the right eye, right palpebral ptosis, and limitation in the abduction of the left eye. Brain magnetic resonance imaging revealed a well-defined and homogeneous extra-axial lesion at the cavernous sinus level. The patient was biopsied and diagnosed with B-cell lymphoma; received chemotherapy and radiotherapy. In this article, we present a clinical case that considers the characteristics of the diagnosis and is the first B-cell lymphoma at the cavernous sinus level reported in Mexico.

Conclusion: Skull base lymphomas have a broad clinical spectrum. Minimally invasive surgery for biopsy purposes is the gold standard for diagnosis, and the treatment with the best results is chemotherapy.

Keywords: lymphoma; skull base; cranial nerves.

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Diego Ochoa-Cacique, María Elena Córdoba-Mosqueda, José Ramón Aguilar-Calderón, Gonzalo Solís y-Maldonado, Ulises García-González, Victor Andrés Reyes-Rodríguez, José de Jesús Lomelí-Ramírez, Rosa María Vicuña-González, Rodrigo Efraín Hernández-Reséndiz, Erick Alberto Castañeda- Ramírez, Mauricio Daniel Sánchez-Calderón, Daniel Alejandro Vega-Moreno, Rafael Sánchez-Mata. Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report. International Journal of Case Reports, 2021 5:234. DOI: 10.28933/ijcr-2021-07-1505


1. Meng X, Zhou S, Wan J. Primary lymphoma of the skull base in the chinese: clinical, radiological, pathological, and therapeutic experience in a series of 8 patients. World Neurosurg 2019; 123: 171–9.
2. Pesce A, Acqui M, Cimatti M, Caruso R, Wierzbicki V, Raco A. Primary lymphomas of the skull base from a neurosurgical perspective: Review of the Literature and Personal Experience. J Neurol Surgery, 2017; 78: 60–6.
3. Messerer M, Dubourg J, Saint-Pierre G, Jouanneau E, Sindou M. Percutaneous biopsy of lesions in the cavernous sinus region through the foramen ovale: diagnostic accuracy and limits in 50 patients. J Neurosurg 2012; 116: 390–8.
4. Ojeda H, Silva F, Acha E, Ceballos I, Ibarra-de la Torre I. Tuberculoma del seno cavernoso. Arch Neurociencias 2005; 10: 38–42.
5. Orozco I, Acosta JA, Bravo G, Martínez F, Enríquez A, Espinoza M, et al. Epidemiología de tuberculosis pulmonar en población migrante. Neumol Cir Torax 2018; 77: 125–31.
6. Marinelli JP, Modzeski MC, Lane JI, Van Gompel JJ, Stokken JK, Thanarajasingam G, et al. Primary skull base lymphoma: manifestations and clinical outcomes of a great imitator. Otolaryngol – Head Neck Surg 2018; 159: 643–9.
7. Chowdhury D, Rahman A, Rashid MH, Chaurasia B, Kamal M, Barua KK. Primary Non-Hodgkin lymphoma of sphenoid sinus involving cavernus sinus and clivus with Isolated 3rd nerve palsy. Mymensingh Med J 2018; 27: 888–93.
8. Levy RM, Rock JP, Shepard SR, Bilsky MH, Sawaya RE. Atypical central nervous system lymphoma at the cranial base: Report of four cases. Neurosurgery 1998; 43: 615–6.
9. Yang L, Li W, Chen M. Primary Non-Hodgkin lymphoma of lateral skull base mimicking a trigeminal schwannoma: Case report. Int J Clin Exp Med 2015; 8: 10091–4.
10. Dare AO, Datta RV, Loree TR, Hicks J, Grand W. Sinonasal Non-Hodgkin’s lymphoma with skull base involvement. Skull Base 2001; 11: 129–35.
11. Wang L, Lin S, Zhang J, Wang C. Primary Non-Hodgkin’s lymphoma of the skull base: A case report and literature review. Clin Neurol Neurosurg 2013; 115: 237–40.
12. Tsai VW, Rybak L, Espinosa J, Kuhn MJ, Kamel OW, Mathews F, et al. Primary B-cell lymphoma of the clivus: Case report. Surg Neurol 2002; 58: 246–50.
13. Hans FJ, Reinges MHT, Nolte K, Reipke P, Krings T. Primary lymphoma of the skull base. Neuroradiology 2005; 47: 539–42.
14. Ang WJ, Khanna A, Walcott BP, et al. Central nervous system lymphoma presenting as trigeminal neuralgia: A diagnostic challenge. J Clin Neurisci 2015; 22: 1188–90.
15. Bromberg JEC, Issa S, Bakunina K, Minnema MC, Seute T, Durian M, et al. Rituximab in patients with primary CNS lymphoma (HOVON 105/ALLG NHL 24): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 2019; 20: 216–28.

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