Ciclosporin
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Ciclosporin Epstein-Barr virus–associated cavernous sinus tumour: case report
A 47-year-old man developed epstein-Barr virus–associated cavernous sinus tumour during immunosuppressant therapy with ciclosporin [durations of treatment to reaction onset not stated]. The man presented with a 2-year history of left facial pain. He had been initially diagnosed with trigeminal neuralgia. He had a significant history of acute myeloid leukaemia and had received unspecified chemotherapy. At the age of 39 years, he underwent bone marrow transplantation and thereafter had complete remission. Two months prior to the current presentation, he was diagnosed with myositis secondary to chronic graft-versus-host disease and immunosuppressant therapy with oral ciclosporin [cyclosporine] was initiated [dosage not stated]. His MRI showed nodular lesion in the left cavernous sinus nodular lesion in the left cavernous sinus and was referred to a hospital for further investigations. Neurological examination demonstrated right upper visual field defect of the right eye, but no loss of visual acuity or oculomotor dysfunction was noted. He also experienced sensory disturbance and paroxysmal pain in the territory innervated by the first branch of the trigeminal nerve. Gadolinium-enhanced brain MRIs revealed a 17 × 14 mm well circumscribed mass with homogeneous enhancement in the left cavernous sinus. The lesion was hypointense and was located on the lateral side of the internal carotid artery and in contact with branches of the trigeminal nerve. A differential diagnosis of trigeminal schwannoma, granulocytic sarcoma, nasopharyngeal carcinoma, meningioma, solitary fibrous tumour and granulomatous lesions such as sarcoidosis were considered. He received medical treatment with gabapentin, but his condition did not improve. Hence, surgery approach was decided. The man underwent transnasal endoscopic surgery and tumour was removed successfully. Histological examination of the the tumour specimen demonstrated spindle-shaped cells with eosinophilic cytoplasm arranged in bundles and nuclei were elongated with only mild atypia. No haemorrhage or necrosis was observed. The tumour showed positive cytoplasmic staining for muscle markers (smooth muscle actin and desmin). However, it was negative for epithelial membrane antigen, STAT6, PgR and S-100. EBVencoded small RNA in situ hybridization revealed diffuse nuclear positivity in the spindle cells. Based on the findings, a diagnosis of epstein-Barr virus–associated cavernous sinus tumour (i.e. Epstein-Barr virus–associated smooth muscle tumour [EBV-SMT]) was confirmed. His follow-up MRI demonstrated complete removal of the left cavernous sinus tumour. Following the surgery, the trigeminal neuralgia disappeared. Atrophy of the left masseter muscle also gradually improved. Further, his myositis also healed and cyclosporine was discontinued. Fifteen months after the surgery, no evidence of recurrence without adjuvant chemotherapy or radiotherapy was observed. Yokoyama D, et al. Transnasal endoscopic res
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