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Housley SB, McPheeters MJ, Raygor KP, Bouslama M, Scullen T, Davies JM. Cavernous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:305-310. [PMID: 38782523 DOI: 10.1016/j.nec.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cavernous sinus thrombosis is a potentially lethal subset of cerebral venous sinus thrombosis that may occur as a result of septic and aseptic etiologies. The overall incidence is estimated to be between 0.2 and 1.6 per 100,000 persons; and treatments include antibiotics, anticoagulation, corticosteroids, and surgery. Recent morbidity and mortality estimates are approximately 15% and 11%, respectively. Rapid identification and treatment are essential and may reduce the risk of poor outcome or death.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Tyler Scullen
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14201, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA.
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2
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Yang CC, Chen TY, Tsui YK, Ko CC. Primary marginal zone B-cell lymphoma of the cavernous sinus: a case report and review of the literature. BMC Med Imaging 2021; 21:25. [PMID: 33579209 PMCID: PMC7881607 DOI: 10.1186/s12880-021-00556-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Primary lymphoma of the cavernous sinus is a rare form of extranodal non-Hodgkin lymphoma, of which very few cases have been reported in the published literature. This report presents the MRI findings with apparent diffusion coefficient (ADC) value in an exceedingly rare primary marginal zone B-cell lymphoma (MZBCL) of the cavernous sinus. Case presentation The case in this study is a 59-year-old immunocompetent male patient with a 2-month history of right ptosis and blurred vision. Right third cranial nerve palsy and binocular diplopia were observed upon neurological examination. Preoperative brain CT showed an extra-axial enhancing mass lesion in the right cavernous sinus. On MRI, ipsilateral internal carotid arterial encasement was noted without causing stenosis of the vessel. Isointense signal on T1-weighted and T2-weighted images, homogeneous contrast enhancement, and diffusion restriction were also observed. The mean ADC value of the tumor is 0.64 × 10–3 mm2/s (b value = 1000 s/mm2). Subtotal resection of the tumor was performed, and improvement of clinical symptoms were observed. The pathologic diagnosis of MZBCL was established by immunohistochemical examinations. Conclusions Primary MZBCL of the cavernous sinus is exceedingly rare, and preoperative confirmation poses a major challenge with CT and conventional MRI only. In this case, preoperative quantitative ADC value is shown to offer valuable additional information in the diagnostic process.
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Affiliation(s)
- Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Yu-Kun Tsui
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC. .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Mahalingam HV, Mani SE, Patel B, Prabhu K, Alexander M, Fatterpekar GM, Chacko G. Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation. Radiographics 2019; 39:795-819. [DOI: 10.1148/rg.2019180122] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Harsha Vardhan Mahalingam
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Sunithi E. Mani
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Bimal Patel
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Krishna Prabhu
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Mathew Alexander
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Girish M. Fatterpekar
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Geeta Chacko
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
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Sponton LES, Ayyad A, Archavlis E, Ringel FA. Unique case of trigeminal neuralgia due to Epstein-Barr-virus-associated B-cell lymphomatoid granulomatosis of the Meckel's cave and cavernous sinus: Important clinical and therapeutic implications. Surg Neurol Int 2018; 9:148. [PMID: 30105142 PMCID: PMC6080144 DOI: 10.4103/sni.sni_12_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Trigeminal neuralgia (TN) represents one of the most disabling pain syndromes. Several diseases have been described as etiological triggers of TN, vascular compression of the trigeminal nerve being the most frequent cause. Here, we describe for the first time a rare case of TN caused by an infiltration of an isolated Epstein–Barr virus (EBV) B-cell lymphomatoid granulomatosis (LYG) mass into the Meckel's cave and cavernous sinus. Case Description: A 51-year-old woman undergoing immunosuppressant treatment for Crohn's disease presented due to right-sided TN. Magnetic resonance imaging (MRI) scans revealed an isolated lesion affecting the right Meckel's cave and lateral wall of the cavernous sinus. We accomplished tumor resection through a subtemporal extradural approach and the patient recovered successfully from surgery. Histological examination revealed an LYG, and a blood test confirmed low but positive EBV counts. The immunosuppressant therapy was discontinued and we assumed a watchful waiting management. During a 41-months’ follow-up there was neither evidence of LYG recurrence nor an increase of EBV counts. Conclusions: LYG, an angiodestructive disease associated with EBV reactivation in the context of immune dysfunction and often associated with an aggressive behavior or even malignant transformation, should be considered as a rare differential diagnosis of TN associated with skull base lesions. The management of this rare disease is still controversial and varies from limiting the treatment to correcting immune dysfunction up to chemotherapy. In this case of an isolated mass, surgical excision and discontinuation of immunosuppressants were effective to prevent the relapse of the disease in a long-term follow-up.
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Affiliation(s)
| | - Ali Ayyad
- Department of Neurosurgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Eleftherios Archavlis
- Department of Neurosurgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
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Nassrallah G, Sun V, Guiot MC, Mikhail M, Arthurs B. Cavernous sinus syndrome associated with metastatic colorectal cancer and perineural spread along the trigeminal nerve. Am J Ophthalmol Case Rep 2017; 6:67-70. [PMID: 29260062 PMCID: PMC5722136 DOI: 10.1016/j.ajoc.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We report the case of a patient with cavernous sinus syndrome associated with biopsy-confirmed metastasis from colorectal cancer. Observations A patient known for laryngeal carcinoma and metastatic colorectal carcinoma presented with symptoms of left trigeminal neuralgia and progressive, near-complete ophthalmoplegia. Magnetic resonance imaging (MRI) revealed a mass in the left cavernous sinus, extending into Meckel's cave with perineural spread along the mandibular branch of the left trigeminal nerve. A transsphenoidal biopsy was performed and demonstrated metastatic colon adenocarcinoma. We review the existing literature on colorectal cancer associated cavernous sinus syndrome. Conclusions and importance Cavernous sinus metastasis from colorectal cancer is exceedingly rare. We report the second case of this entity with histopathologic confirmation, and the first case with concurrent perineural spread involving the trigeminal nerve. Cavernous sinus metastasis may represent a poor prognostic factor in colorectal cancer.
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Affiliation(s)
- Georges Nassrallah
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | - Vincent Sun
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | | | - Mikel Mikhail
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | - Bryan Arthurs
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
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Nambiar R, Nair SG. Cavernous Sinus Syndrome. Proc (Bayl Univ Med Cent) 2017; 30:455-456. [DOI: 10.1080/08998280.2017.11930227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features. Clin Neuroradiol 2014; 25:109-25. [PMID: 25410584 DOI: 10.1007/s00062-014-0360-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this article was to review the anatomy of the cavernous sinus (CS), illustrate numerous lesions that can affect the CS, and emphasize the imaging characteristics for each lesion to further refine the differential diagnoses. The CS, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The wide-ranging types of pathologies that can involve the CS can be roughly classified as tumoral, congenital, infectious/inflammatory/granulomatous, and vascular. Conditions that affect the CS usually lead to symptoms that are similar to each other; thus, for diagnosis, imaging procedures are required. Radiological evaluations are also required to detect pre- and postoperative CS invasion. Magnetic resonance imaging, which can be supplemented with thin-section contrast-enhanced sequences, is the preferred imaging technique for evaluating the CS. For correct diagnosis of CS lesions and accurate evaluations of CS invasions, it is essential to carefully analyze the anatomical structures within the CS and to acquire precise knowledge about the imaging features of CS lesions, which may frequently overlap.
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Diffuse large B-cell lymphoma within a cavernous hemangioma of the cavernous sinus. Brain Tumor Pathol 2011; 28:353-8. [PMID: 21833578 DOI: 10.1007/s10014-011-0053-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/27/2011] [Indexed: 10/18/2022]
Abstract
Cavernous angiomas or hemangiomas and malignant lymphomas rarely involve the cavernous sinus. We report the case of a 72-year-old man with right circumorbital pain and right oculomotor nerve dysfunction because of a mass in the right cavernous sinus. It was removed via a transsphenoidal approach and histological examination revealed the mass was a cavernous hemangioma containing atypical large B cells in some sinusoidal vessels; no other evidence of lymphoma was detected on (18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography or bone marrow biopsy. The patient underwent gamma knife radiosurgery (GKS) of the right cavernous sinus, but no systemic chemotherapy was administered. Although good local control was achieved, the patient developed a systemic diffuse large B-cell lymphoma (DLBCL) 1.5 years after the GKS. The atypical lymphocytes of the cavernous hemangioma and biopsied lymph nodes expressed multiple myeloma oncogene-1 protein. This is a rare case of DLBCL occurring within a cavernous sinus that was diagnosed as hemangioma of the cavernous sinus by neuroimaging, surgical findings, and rapid-freezing histological diagnosis. The case indicates a importance of surgical sampling and detailed histopathological analysis.
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9
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Ko F, Subramanian PS. Orbital and Cavernous Sinus Lymphoma Masquerading as Post-Herpetic Neuralgia. Neuroophthalmology 2011; 35:27-31. [PMID: 27956930 DOI: 10.3109/01658107.2010.511394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 11/13/2022] Open
Abstract
We report an unusual case of adult-onset B-cell lymphoma in the cavernous sinus presenting as post-herpetic neuralgia; additionally, we review the literature regarding primary B-cell lymphomas of the cavernous sinus. This case demonstrates the importance of maintaining a suspicion for malignancy when an atypical clinical course is seen, even when presented with seemingly common or innocuous disease.
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Affiliation(s)
- Fang Ko
- Departments of Ophthalmology, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Demirkaya M, Sevinir B, Ozdemir O, Nazlioğlu HO, Okan M. Lymphoma of the cavernous sinus mimicking Tolosa-Hunt syndrome in a child. Pediatr Neurol 2010; 42:351-4. [PMID: 20399391 DOI: 10.1016/j.pediatrneurol.2009.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 12/14/2009] [Accepted: 12/21/2009] [Indexed: 11/16/2022]
Abstract
Some children with malignancies initially present with neurologic signs. Cavernous sinus syndrome is a rare manifestation of lymphomas, more commonly reported in adults. A patient presenting with third and fourth cranial nerve palsies was initially thought to manifest Tolosa-Hunt syndrome, but during follow-up a diagnosis of lymphoma without systemic involvement was established. This patient is the youngest, to our knowledge, to be diagnosed with primary cavernous sinus lymphoma. He remains in remission 5 years after chemotherapy. Malignancies (especially non-Hodgkin's lymphoma) should be considered in young children with cavernous sinus syndrome, even without systemic involvement.
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Affiliation(s)
- Metin Demirkaya
- Department of Pediatric Oncology, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa, Turkey.
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Abstract
The rare occurrence of T-cell lymphoblastic lymphoma as a primary tumor in the cavernous sinus is described. The patient, a 17-year-old girl, presented with right-sided ophthalmic and maxillary neuropathy and diplopia due to neuropathies of cranial nerves III and VI. An enhancing mass in the cavernous sinus was identified on MR imaging. Dexamethasone was prescribed but did not provide symptomatic relief. Rapid progression of symptoms led to open biopsy, and a diagnosis of T-cell lymphoblastic lymphoma was made. The patient promptly underwent aggressive chemotherapy in which a modified hyper-cyclophosphamide, vincristine, and dexamethasone without doxorubicin regimen with concurrent radiotherapy was used. The patient achieved complete remission and is currently completing the 2-year maintenance phase of chemotherapy.
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Affiliation(s)
- Sarfaraz Sadruddin
- Departments of Neurosurgery and Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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12
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Tsuda H, Kashima Y, Ishikawa H, Ikeda M, Sawada U. Malignant lymphoma in the cavernous sinus with bilateral total ophthalmoplegia and tonic pupils. Neuroophthalmology 2009. [DOI: 10.1080/01658100490894799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Gómez J, Gupta J, Palacios E. Trigeminal Ganglion Dysfunction Secondary to Lymphoma. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708601205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Juan Gómez
- Department of Radiology, Tulane University Medical Center, New Orleans
| | - Jagan Gupta
- Department of Radiology, Tulane University Medical Center, New Orleans
| | - Enrique Palacios
- Department of Radiology, Tulane University Medical Center, New Orleans
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Abalo-Lojo JM, Gonzalez F, Pereiro-Zabala I. Metastatic B-cell lymphoma of the cecum masquerading as Tolosa-Hunt syndrome. Can J Ophthalmol 2007. [DOI: 10.3129/can.j.ophthalmol.i07-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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