An attempt to define the type of biopsy in a sinonasal lesion showing bony erosion

Abstract

To present a case of sino-nasal destructive mass initially diagnosed as an inflammatory lesion following punch biopsy from the lesion however the post surgical histopathology was diagnostic of Grade 2 angiocentric immunoproliferative lesion (AIL). The reasons for the initial misdiagnosis are analyzed. A 76-year-old male patient presenting with progressive bilateral nasal obstruction for 1 year. Repeated punch biopsies from the mass were suggestive of an inflammatory lesion. The patient underwent surgical exenteration of the mass and the final histopathology report suggested AIL Grade 2. The patient was thereafter treated with chemotherapy and radiotherapy. Initial superficial punch biopsies lead to incorrect diagnosis leading to an unnecessary surgical exenteration. The explanations for the initial misdiagnosis are given below and appropriate diagnostic protocols, mode and depth of biopsy are suggested based on the case study.