Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 16, Number 2, February 2025, pages 61-68

Partial Oculomotor Nerve Palsy as the First Presentation of Extranodal Natural Killer/T-Cell Lymphoma

Figures

Figure 1.
Figure 1. Gaze positions demonstrating partial oculomotor nerve palsy with pupillary involvement in the right eye.
Figure 2.
Figure 2. Magnetic resonance imaging (MRI) of the orbit: T2-weighted images demonstrate heterogeneous isointensity in the right superior, medial, and inferior rectus muscles, intraorbital fat, and perioptic nerve sheath complex, with post-gadolinium enhancement. No masses were detected in the paranasal sinuses (PNS). (a) Axial T2-weighted view. (b) Axial T1-weighted view with gadolinium enhancement. (c) Coronal T2-weighted view. (d) Coronal T1-weighted view with gadolinium enhancement. The yellow arrows indicate the position of the right optic nerve.
Figure 3.
Figure 3. Histological and immunohistochemical images of the tumor. (a) The cells are positive for in situ hybridization for Epstein-Barr virus-encoded RNA (EBER) (× 40). (b) The cells are positive for CD3 staining (× 40). (c) The lymphocytes are positive for CD56 staining (× 40). (d) The lymphocytes are positive for TIA-1 staining (× 40).
Figure 4.
Figure 4. Gaze positions demonstrating improvement of oculomotor nerve palsy in the right eye.

Table

Table 1. Laboratory Test Results of the Case
 
Laboratory testResults (reference range)
AST: aspartate aminotransferase; ALT: alanine aminotransferase.
Complete blood count
  Hematocrit (%)34.5 (38 - 51.1)
  Hemoglobin (g/dL)11.8 (12.9 - 17.1)
  White blood cell (WBC) count (/µL)5,400 (4.5 - 10.5)
  Neutrophils (%)64.5 (42.7 - 69.6)
  Lymphocytes (%)22.1 (20.4 - 65.8)
  Eosinophils (%)1.6 (0.7 - 8.3)
  Monocytes (%)11.4 (3.8 - 11.2)
  Basophils (%)0.4 (0.1 - 1.7)
  Platelet count (/µL)145,000 (162,000 - 402,000)
Renal function
  Blood urea nitrogen (BUN) (mg/dL)19 (6 - 20)
  Creatinine (mg/dL)0.9 (0.67 - 1.17)
Electrolytes
  Sodium (mmol/L)135.7 (136 - 145)
  Potassium (mmol/L)3.95 (3.5 - 5.1)
  Chloride (mmol/L)103 (98 - 107)
  Bicarbonate (mmol/L)24.2 (22 - 29)
Liver function
  Total protein (g/dL)6.95 (6.6 - 8.7)
  Albumin (g/dL)3.63 (3.5 - 5.2)
  Total bilirubin (mg/dL)0.58 (0 - 1.2)
  Direct bilirubin (mg/dL)0.32 (0 - 0.3)
  AST (U/L)34 (0 - 50)
  ALT (U/L)4 (0 - 50)
  Alkaline phosphatase (U/L)81 (40 - 129)