Intranasal Mass Research Articles

Hemangiopericytoma in infants and children: A report of six patients

The case histories of six infants and children (five male and two female) with hemangiopericytoma have been reviewed (two patients were born with the tumor). The tumor originated on an extremity in three patients, in the intranasal fossa in one, in the neck and upper mediastinum in one, and in the abdomen in another. In the patients with the tumor on the extremity, the lesion was removed with a margin of normal tissue. These patients remained well for 2, 8, and 1.5 years after diagnosis. In the patient with an intranasal mass, the tumor was removed, but local recurrence developed 3 months later. The recurrent tumor was removed, and the patient remained well for 10 years. The patient with the neck and upper mediastinal tumor was born with the lesion and presented with airway obstruction at 2 months of age. This patient received radiotherapy and cyclophosphamide with no apparent response. He underwent partial excision of the lesion 1 month after diagnosis but died 1 month later from massive hemorrhage into the airway. The patient with the abdominal mass had extensive retroperitoneal tumor, and excision was not possible. He received chemotherapy and radiotherapy, and although the tumor decreased in size, osseous metastases developed 4 months after diagnosis. The metastatic lesions in this child disappeared with further chemotherapy, and at second-look operation 9 months after diagnosis, the tumor was removed. Postoperatively, new bone metastasis developed but again responded to chemotherapy with complete disappearance of the metastatic lesion. The patient had no evidence of disease 16 years after diagnosis.

Intranasal granuloma faciale

A 49-year-old man had a recurring intranasal mass accompanied by erythematous plaques on the forehead. Biopsy specimens of the skin and intranasal mass led to a diagnosis of granuloma faciale, a rare benign skin disorder. Lateral intranasal location and associated facial lesions help to clinically differentiate this lesion from more ominous midline granulomatous diseases. The lesions were treated with intralesional steroid injections. This may be the first reported intranasal occurrence of granuloma faciale.

Lymphoma of the nose and paranasal sinuses.

The records of 37 patients with lymphoma of the nose and paranasal sinuses in an 18-year period were studied. The symptoms were divided into three categories: (1) local symptoms: obstruction, bleeding, and rhinorrhea; (2) symptoms of invasion of adjacent structures: facial pain and ear fullness; and (3) systemic symptoms: fever, weight loss, and nocturnal sweating. The presence of an intranasal mass was the most common physical finding. Conventional tomography and computed tomography were helpful for diagnosis. Abnormalities were usually disclosed on biopsy specimens from the nose or mouth. As a rule, several sites in the nose and sinuses were involved. An early diagnosis of sinonasal lymphoma and other malignant neoplasms generally allows effective treatment; therefore, the otorhinolaryngologist should be alert for such disease and, if the clinical picture warrants, should add tomography to the diagnostic workup.

Renal clear cell carcinoma metastatic to the nose and paranasal sinuses

Two cases of metastatic renal clear cell carcinoma to the nose and the paranasal sinuses are reported. Case 1 was a 73-year-old man with metastases to the bilateral maxillas and left cervical lymph nodes. These metastatic lesions were surgically eliminated together with the primary renal cancer. Case 2 was a 48-year-old man with a right maxilloethmoidal metastasis. Because of severe repeated bleeding and profound necrosis, conclusive diagnosis was hard to obtain. In both cases primary renal carcinoma was detected after the nasal tumors were confirmed to be a metastatic clear cell carcinoma. Early diagnosis and surgical removals of both primary and metastatic tumors are important to prolong the patient's life. When persistent epistaxis with intranasal necrotic mass occurs, the possibility of metastatic renal clear cell carcinoma should be considered.

Nasal gliomas.

Nasal glioma is a developmental abnormality of neurogenic origin with o malignant potential. An intranasal mass requires careful rhinologic and occassionally ophthalmologic, neurologic, and roentgenologic examinations. With a bony defect, pneumoencephalography, angiography, or computerized tomography may be helpful. In such cases, a neurosurgeon should be available at the time of biopsy. Biopsy is necessary for establishing a histopathologic diagnosis. Aspiration of the tumor with a needle or incisional biopsy may yield inconclusive findings and may be associated with CSF rhinorrhea and meningitis, especially if there is an intracranial connection. With adequate initial removal, excisional biopsy usually offers complete cure. A frontal craniotomy approach is preferred for those patients who have nasal glioma with an intracranial connection, CSF rhinorrhea, or recurrent episodes of meningitis. With no evidence of an intracranial connection, a conservative extracranial approach is recommended.

Resident's Page

<h3>PATHOLOGIC QUIZ CASE 1</h3><h3>Maj Michael Leo Lepore, MC, USA, Washington, DC</h3> A 15-year-old boy came to Walter Reed Army Medical Center with a chief complaint of unilateral nasal obstruction. In 1970, nasal surgery was performed for nasal polyps. On that admission, a diagnosis of chronic maxillary sinusitis was also made. He is receiving hyposensitization for a substantial allergy to pollens. On physical examination, the left nasal cavity was completely obstructed by a dense mass of tissue. The tissue was firm and adherent to the nasal septum. A more friable tissue was encountered near the middle meatus. The remaining physical examination results were within normal limits. Sinus series demonstrated opacification of the left maxillary sinus with antral wall erosion. Tomographic sections are demonstrated in Fig 1. At surgery, a left Caldwell-Luc procedure was performed, followed by removal of the intranasal tissue mass. Histologic representation of the tissue obtained from

Chordomas: nasopharyngeal presentation and atypical long survival.

Atypical clinical and pathological features of a cranio-cervical chordomas have prompted a review of these neoplasms at the University of Michigan Medical Center. Contrary to prior investigations, 92% of the spheno-occipital chordomas reported in this study clinically presented with a nasopharyngeal or intranasal mass. This high incidence indicates the requirement for an otorhinologic examination on all patients presenting with the neuro-ophthalmologic syndrome and roentgenologic findings characteristic of chordomas in this anatomical region. Special attenion is called to a histologically distinctive variant of chordoma - the "chondroid chordoma.' Apparently restricted to the cranio-cervical region, this variant has been associated with long survival.

Benign nasal tumor appearing as neonatal respiratory distress. First reported case of nasopharyngeal fibrous histiocytoma.

A full-term neonate developed respiratory distress on the first day of life; a nasopharyngeal mass was discovered. Roentgenograms and polytomography suggested a right intranasal mass and an apparent loss of the cribiform plate with separation of the ethmoid air cells. A diagnosis of encephalocele was made, but neurosurgical exploration showed no evidence for an encephalocele and no defect in the floor of the anterior fossa. Because the child's clinical status improved, removal of the nasal mass was postponed until he was 8 months old. Routine microscopy and electron microscopic studies demonstrated that the tumor was a fibrous histiocytoma.

Intranasal Neuroglial Heterotopia

THE DIFFERENTIAL diagnosis of intranasal masses in children includes a long list of infrequently encountered lesions once nasal polyp is excluded from consideration. The list includes cysts (sebaceous, dermoid, epidermoid, ethmoid, and those of the lacrimal duct apparatus) which are of ectodermal origin, as are nasal polyps. In addition, tumors of mesodermal origin such as hemangioma and lipoma may occur. Neurogenic tumors are occasionally found, ie, meningocele, encephalocele, neurofibroma, and nasal glioma. Finally, teratoma and abscesses should be included.1 Congenital intranasal neuroglial heterotopia, commonly referred to as nasal glioma, presented in a 5-year-old boy. The lesion, masquerading as a nasal polyp, is the subject of this report. Report of Case A 5-year-old white boy was referred to the Otolaryngology Service, US Army Hospital at Fort Campbell for evaluation of an intranasal mass obstructing the right nasal chamber. The mass had first been noted seven months earlier and had been