{"ops":[{"insert":"A 67-year-old man presents with diplopia, blurred vision in his left eye, and an intermittent headache, all for around two weeks. Further questioning reveals recurrent left-sided nasal stuffiness with a blood-streaked mucus discharge for around six months.\n\nHe has refused to obtain medical attention thus far, and it was only today that his family members were able to persuade him to see a doctor. His medical, surgical, and family histories are otherwise unremarkable, and he is not on any medications.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-246_en.png"}},{"insert":"\n"}]}
2
Investigate
Anterior rhinoscopy
{"ops":[{"insert":"Rhinoscopy reveals a\u00a0voluminous mass in the lateral wall of the left nasal cavity, which is friable, and bleeds to the touch. Multiple biopsies are subsequently obtained.\n\nHistological analysis of the biopsy specimens reveals large epithelioid cells with hyperchromatic pleomorphic nuclei and prominent nucleoli. Immunohistochemistry is positive for S-100 protein, Melan-A, and HMB-45.\n"}]}
Contrast MRI head + neck
{"ops":[{"insert":"MRI reveals a\u00a0mass measuring 2.8 \u00d7 2.1 \u00d7 4.2 cm in the left nasal cavity, which is invading\u00a0the ipsilateral ethmoidal sinus and orbital wall. The lesion is\u00a0hyperintense in T1 weighted images, and intermediate-hypointense on T2-weighted images.\n\nMild to\u00a0moderate enhancement is noted followed administration of\u00a0gadolinium contrast. There is no evidence of regional lymphadenopathy.\n"}]}