Paranasal Sinus Mass Research Articles

Metastatic nose and paranasal sinus masses – A case series

Metastases to the nose and paranasal sinuses are unusual. These tumors are commonly seen in the 4th to 6th decades of life. The clinical presentation may be analogous to that of primary sino-nasal tumors. They usually present with common nasal and ocular symptoms due to which diagnosis may be missed and delayed. Hence, high level of suspicion is necessary for patients with known malignancies presenting with inconsistent or repeated nasal and ocular symptoms. Otorhinolaryngologists should be familiar with these metastases to paranasal sinuses from unusual primary elsewhere in the body, to evaluate and manage these tumors. Retrospective data was collected from the hospital records from 2020-2023. A total 14 cases of sino-nasal malignancies were identified. On further analysis three cases were found to be having distant metastases from primary sites such as kidney, breast and lymph nodes. We are reporting three metastatic malignancies. Each was systematically evaluated, confirming their origin as metastases from other primary sites. They were then managed appropriately. Keywords: metastases; paranasal sinuses, renal cell carcinoma; breast carcinoma; non-Hodgkin’s lymphoma; sinus surgery

Pathology of Chronic Mycoplasma ovipneumoniae Carriers in a Declining Bighorn Sheep (Ovis canadensis) Population.

Bighorn sheep (Ovis canadensis) across North America commonly experience population-limiting epizootics of respiratory disease. Although many cases of bighorn sheep pneumonia are polymicrobial, Mycoplasma ovipneumoniae is most frequently associated with all-age mortality events followed by years of low recruitment. Chronic carriage of M. ovipneumoniae by adult females serves as a source of exposure of naïve juveniles; relatively few ewes may be responsible for maintenance of infection within a herd. Test-and-remove strategies focused on removal of adult females with evidence of persistent or intermittent shedding (hereafter chronic carriers) may reduce prevalence and mitigate mortality. Postmortem confirmation of pneumonia in chronic carriers has been inadequately reported and the pathology has not been thoroughly characterized, limiting our understanding of important processes shaping the epidemiology of pneumonia in bighorn sheep. Here we document postmortem findings and characterize the lesions of seven ewes removed from a declining bighorn sheep population in Wyoming, USA, following at least two antemortem detections of M. ovipneumoniae within a 14-mo period. We confirmed that 6/7 (85.7%) had variable degrees of chronic pneumonia. Mycoplasma ovipneumoniae was detected in the lung of 4/7 (57.1%) animals postmortem. Four (57.1%) had paranasal sinus masses, all of which were classified as inflammatory, hyperplastic lesions. Pasteurella multocida was detected in all seven (100%) animals, while Trueperella pyogenes was detected in 5/7 (71.4%). Our findings indicate that not all chronic carriers have pneumonia, nor do all have detectable M. ovipneumoniae in the lung. Further, paranasal sinus masses are a common but inconsistent finding, and whether sinus lesions predispose to persistence or result from chronic carriage remains unclear. Our findings indicate that disease is variable in chronic M. ovipneumoniae carriers, underscoring the need for further efforts to characterize pathologic processes and underlying mechanisms in this system to inform management.

A Case of Unilateral Proptosis Secondary to Prostatic Metastasis.

Prostate cancer metastases involving the orbit and/or paranasal sinuses represent a rare oncological presentation. Patients can have a myriad of symptoms such as proptosis, periorbital swelling, blurry vision, rhinorrhea, epistaxis, anosmia, or others depending on the structures involved. The differential diagnosis of paranasal sinus masses on imaging studies is broad and can include inflammatory, congenital, or neoplastic masses; leading to the requirement of biopsy for definitive diagnosis. Tissue sample is usually obtained via an endoscopic approach. The prognosis of such a presentation is not well described in the literature, but it is usually guarded due to the advanced stage of the disease and generally a poorly differentiated primary tumor. Treatments usually aim to reduce the burden of disease and debulk the tumor mass for palliative purposes. We present a case of a 71-year-old male presenting with unilateral proptosis and periorbital swelling secondary to prostatic metastasis.

Multi-parametric arterial spin labeling and diffusion-weighted imaging of paranasal sinuses masses.

To evaluate arterial spin labeling (ASL) and diffusion-weighted imaging (DWI) in discrimination of benign from malignant paranasal sinus (PNS) tumors. A prospective study was done upon 42 cases of PNS masses that underwent magnetic resonance ASL and DWI of the head. Tumor blood flow (TBF) and apparent diffusion coefficient (ADC) of the masses were calculated by two observers. The pathological diagnosis was malignant (n = 28) and benign (n = 14) cases. For both observers, the malignant PNS masses had significantly higher TBF (P < 0.001, 0.001) and lower ADC (P < 0.001, 0.001) than in benign masses. The ROC curve analysis of TBF, The threshed TBF was (121.45, 122.68mL/100g/min) used for differentiation between benign and malignant PNS masses, revealed sensitivity (92.9%, 89.3%), specificity (85.7%, 85.7%), accuracy (90.5%, 88.1%) and the AUC was 0.87 and 0.86 by both observers. the ROC curve analysis of ADC, The threshold ADC (1.215, 1.205 X10-3mm2/s) was used for differentiation between benign and malignant PNS masses, revealed sensitivity (96.4%, 89.3%), specificity (78.6%, 78.6%), accuracy of (90.5%, 85.7%) and the AUC was 0.93 and 0.92 by both observers. Combined analysis of TBF and ADC used for differentiation between benign and malignant PNS masses had revealed sensitivity (96.4%, 89.3%), specificity (92.9%, 85.7%) accuracy of (95.2%, 88.1%) and AUC. (0.995, 0.985) for both observers. Combined using of TBF and ADC have a role in differentiation malignant from benign PNS masses.

Late Metastatic Renal Cell Carcinoma Recurrence Presenting as a Maxillary Sinus Mass 12 Years after Nephrectomy: Case Report and Literature Review

Metastasis to the sinonasal cavity is rare. Late recurrence, such as metastasis developing 10 years or more after nephrectomy, is even more rare. We present a rare case of late metastatic renal cell carcinoma (RCC) in the maxillary sinus after nephrectomy and discuss reported sinonasal metastatic RCC cases. A 64-year-old man presented with left nasal obstruction for the previous one year. He had undergone right nephrectomy to treat RCC 12 years prior. Paranasal sinus computed tomography and magnetic resolution imaging revealed a 4.6-cm-diameter mass exhibiting delayed contrast enhancement that filled the left maxillary sinus and the nasal cavity. Histologically, clear cell RCC was diagnosed. We resected the maxillary sinus tumor to resolve the nasal obstruction for palliative symptom relief. There has been no evidence of recurrence to date, 3 years postoperatively. When a patient with a history of RCC presents with a hypervascular paranasal sinus mass, metastatic RCC should be considered, despite history of nephrectomy. It is important to make an appropriate treatment plan depending on extent of metastases and location of the metastatic tumor.

An unexpected finding in the frontal sinus: Cholesterol granuloma

There is a broad differential diagnosis for patients presenting with an expansile mass lesion in the frontal sinus on computed tomography. Due to the composition of granulation tissue, a cholesterol granuloma exhibits unique signal characteristics and should be considered when an expansive paranasal sinus mass with high signal intensity on both T1- and T2-weighted images is seen. A cholesterol granuloma is a benign tumor, and small lesions are mostly harmless. However, large cholesterol granuloma may cause severe morbidity and even mortality if unrecognized, by extension through the orbit and in the anterior cranial fossa, emphasizing the importance of early diagnosis and resection. We present the case of a young male with an expanding mass under the right eyebrow, proved to be a cholesterol granuloma on pathological examination. The differential diagnosis and the distinct radiological features of this rare entity are discussed.

Clinical analysis of orbital and periorbital abscess in 17 patients

Objective: To discuss the etiology, clinical features and treatment principles of the orbital and periorbital abscess. Methods: A retrospective case series of 17 cases with orbital and periorbital abscess between July 2010 and November 2015 were conducted. All patients(,) clinical data including medical history, etiology, abscess location, paranasal sinus involvement, eye involvement, microbiological test results, imaging features, treatment and prognosis were summarized and analyzed. Results: In all 17 patients, there were 10 males and 7 females with age from 3.0 to 71.0 years (the average age was 33.9 years).Eight patients(,) bacterial cultures of the pus and secretion were positive in all 17 patients. Orbital and periorbital abscess patients could manifest decreased vision, redness and swelling of eyelid, conjunctival congestion and edema, ocular motility disorders, displacement of eyeball, increased orbital pressure, abscess rupture etc. CT showed us the soft tissue mass, accompanied with sinusitis or paranasal sinus mass. MR performed with the long T(1) and T(2) signals. The signals of the abscess cavity were not uniform. For the etiology,11 cases were secondary to sinusitis, including 1 case of diabetes; 2 cases with orbital fractures.One case was secondary to orbital fracture repairment surgery. One case was secondary to the remnant of sequestrum and foreign bodys in the wound after repairment surgery. One case was injured by the hard object. One case was secondary to paranasal sinuses large B-cell lymphoma. One case had diabetic history and the blood sugar was controlled unstablly. For the treatment, 7 cases were treated by the drainage surgery which was performed via the sinus with endoscopic and abscess resection performed via the skin.Two cases were treatment by the abscess resection only.One case was treated by the drainage surgery performed via the sinus with endoscopic only. Six cases were treated by the drainage surgery performed via the skin. One case was only administered intravenous antibiotic. Sixteen cases acquired well prognosis without serious complications except 1 case which occurred central retinal artery and vein occlusion. Conclusions: The orbital and periorbital abscess is mainly a complication of paranasal sinus infection, or secondary to trauma, surgery, tumor, etc; Orbital and periorbital abscess always manifest inflammatory neoplastic clinical features, the key of the diagnosis is to make sure the etiology; Incision and drainage of the abscess is the main treatment method when necessary. We can do the surgery with other departments to avoid the occurrence of serious complications.(Chin J Ophthalmol, 2017, 53: 588-593).

Polypoidal masses in nasal cavity among patients in a tertiary level: a clinico-pathological spectrum

Introduction: Polypoidal mass in nose and paranasal sinuses are very common, that bulges or projects downwards from the normal nasal surface. The aim of the present study was to determine the incidence of nasal polypoidal mass and clinical and pathologic data of a group of consecutive cases. Materials and Methods: Clinico-pathological study of 92 consecutive cases of nasal polypoidal mass from single institution was performed for a period of 3 years. Clinical examination, routine investigations, Chest X ray PA were taken for all patients. Excised tissues were routinely processed for histopathologic examination. Results: Analysis of 92 polypoidal lesions in the nose and paranasal sinuses with clinical diagnosis of nasal polyps, revealed 52 cases were non-neoplastic and 40 were neoplastic; 34 (85%) were benign and 6 (15%) were malignant. True nasal polyps both inflammatory and allergic together comprised 49 cases of the 52 polypoidal lesions in the nasal cavity. Angiofibroma and capillary hemangioma were the most frequent benign tumour accounting for 30/34 (44%). The most common malignant tumour was squamous cell carcinoma 5/6 (83.3%). Conclusion: Majority of polypoidal mass in the nasal cavity were non-neoplastic, with histopathological examination being the easiest method for identification and distinguishing the type of sinonasalpolypoidal masses.

Clinico-epidemiological evaluation of patients with sinonasal masses attending a tertiary care hospital in Jharkhand: a three year retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal cavity may contain wide variety of masses within by which this organ differs from the rest of the body. Benign nasal and paranasal sinus masses are commonly encountered in clinical practice. The purpose of this study was to classify various types of sinonasal masses and characterize their clinico-epidemiological profile in a tertiary care hospital of Jharkhand. The objectives of the study was&lt;strong&gt; &lt;/strong&gt; to evaluate the clinico-epidemiological profile of nasal masses in patients attending ear, nose, throat and head and neck surgery (ENT &amp;amp; HNS) OPD of Rajendra Institute of Medical Sciences (RIMS), Ranchi from January 2013 to December 2015) and to classify the nasal masses according to their percentage of occurrence&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study was designed for evaluation of clinico-epidemiological data collected from admission register of ENT Dept. RIMS, Ranchi during the period of 2013 to 2015. Total sample size for this period was 240. Templates were generated in MS Excel sheets and analysis was done using SSPS software&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; With the three year data analysis of 240 patients, we came up with the result that nasal masses were more common in age group of &amp;lt;20 years (52%), occurred more in males (68.4%), most of the patients were tribals (72.9%), mostly from rural areas (60%), and maximum of them were diagnosed as antrochoanal polyps (37.9%). The most common presenting complain was nasal obstruction (85.8%), followed by nasal discharge (52.9%)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Antrochoanal polyp is the most common type of nasal masses presenting mostly in tribal males from rural areas of Jharkhand, presenting with nasal obstruction&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Lesions of nasal cavity, paranasal sinuses and nasopharynx: a clinicopathological study

Background: A variety of non-neoplastic and neoplastic lesions of nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in clinical practice. The aim of this study was to study clinical and histopathological profile of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx in a tertiary care hospital of Ranchi over the period of January 2011 to January 2012. Materials and Methods: This was a prospective study of 90 cases of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx over the period of 12 months. All tissues after fixation in 10% buffered formalin, processed and then stained with Hematoxylin & Eosin to study various histopathological patterns. Results: These 90 cases were broadly categorized in two categories, one category as nasal and paranasal sinus masses and the other as nasopharyngeal masses with 63 and 27 cases, respectively. These lesions were common in second and third decades of life with male predominance. Among nasal and paranasal sinus masses, there were 52 (82.2%) non-neoplastic and 11 (17.8%) neoplastic lesions. Inflammatory polyps (86.5%) were the most common among the non-neoplastic masses. Out of 27 nasopharyngeal masses, there were 23 (85.2%) non neoplastic and 4 (14.8%) neoplastic lesions. Majority of these i.e. 20 cases were of adenotonsillar hypertrophy. Conclusion: We concluded that complete clinical, radiological and histopathological correlation helps us to categorize these sinonasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis.

CT evaluation of malignant PNS mass and histopathological correlation

Background: Computed tomography (CT) is the gold standard for exact delineation of paranasal sinus(PNS) disease. There are many radiologically important diseases of paranasal sinuses. Objective: to evaluate the malignant PNS mass by computed tomographic image and the findings of this modality were compared with histopathological result.Methods: It was a cross sectional type of study and carried out with suspected PNS mass having patients during January 2009 to Octo­ber 2010.Results: The mean age of the patients was 35.95 ± 18.24 and common complaints of the patients were nasal obstruction (73.7%) and maximum 53.9% patients had PNS mass in maxillary sinuses. Out of 76 cases 21.1 % found malignant mass on CT and after histopathology 19. 7% had malignant mass. Out of all cases 14 were diagnosed as malig­nant PNS mass by CT scan and confirmed by histopathological evaluation and they were true positive. Two cases were diagnosed as malignant PNS mass by CT scan but not confirmed by histopathological findings and they were false positive. Of 60 cases, which were diagnosed by CT scan, one was confirmed as malignant and 59 were benign by histopa­thology. They were false negative and true negative respectively. Sensitivity of CT scan to diagnose malignant PNS mass was 93.3%, specificity 96.7%, positive predictive value 87.5%, negative predictive value 98.3% and accuracy 96.1 %. Conclusion: CT scan of the malignant para nasal sinus mass provides more information and better image quality and CT diagnosis correlate well with the findings of histopathology.

Sinonasal Neoplasia - Clinicopathological Profile And Importance of Computed Tomography.

Nasal cavity and Paranasal sinus malignancies are very rare, in which maxillary sinus is the commonest, followed by ethmoid, frontal and sphenoid sinus. Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) play a key role in diagnosis, staging and management of paranasal sinuses and nasal pathologies. Multiplanar imaging in CT helps better imaging of critical anatomical areas. Aim of our study was to study the incidence, clinical features, CT features and its importance in the management of sinonasal neoplasms. This prospective study was carried out in a tertiary care hospital of MP, India. Consecutive 40 histologically proven cases of sinonasal neoplasia who visited the Department of Otorhinolaryngology and Radiotherapy are included in our study. Demography and clinical features were recorded. Cases of nasal and paranasal sinus masses diagnosed on CT attending ENT and Radiotherapy OPD or admitted in the Radiotherapy ward forms the material of this study. This included patients of both sexes and all ages. Histopathological examination was asked to confirm the diagnosis made on CT. There were total 40 cases of sinonasal neoplasia among which 24 were benign. Almost all the benign cases were seen in the age group <40 y with mean age of 20 y and most of the malignant cases were seen in the age group above 40 y with mean age of 55 y. In our study we found male preponderance with male female ratio of 4:1 in both benign and malignant conditions. The commonest presenting symptoms of the patients with sinonasal masses in our study was nasal obstruction (75%) and nasal discharge (67.5%) followed by nasal mass (65%), epistaxis (62.5%) and headache (60%). Angiofibroma and papilloma were the commonest benign lesions. Commonest malignant lesion was squamous cell carcinoma. Of the malignant Sinonasal tumours studied in our series, maxillary sinus was involved in 13, ethmoid sinuses and nasal cavity in 10 cases each, and frontal sinuses in 2 cases. Contrast enhanced computed tomography with multiplanar reconstruction is an excellent modality for imaging sinonasal masses. CT can define the character of the sinonasal mass, thus differentiating benign from malignant. CT helps better imaging of critical anatomical areas and helpful in planning treatment procedures such as surgery and radiotherapy.

Sinonasal Schwannoma: A Case Report and Updated Review of the Literature

Sinonasal schwannomas are rare, benign and slow-growing peripheral nerve sheath tumors without age, race, or gender predilection. We present the unusual case of a 59-year-old female who pre-sented with right-sided retro-orbital pressure and rhinorrhea. Radiographic imaging revealed a mass centered in the right superior nasal cavity with extension through the cribriform plate into the right more than the left subfrontal region. Biopsy confirmed the diagnosis of a sinonasal schwannoma, which was resected via nasal endoscopic surgery and ethmoidectomy. These tumors, albeit rare, should be considered in the differential diagnosis for patients presenting with a para-nasal sinus mass to ensure inclusion of this benign lesion and avoid unnecessary aggressive in-tervention.

Role of CT (Computed Tomography) in the Evaluation of Fungal Diseases in Paranasal Sinus

A cross sectional study carried out with patients having suspected paranasal sinus (PNS) mass during January 2009 to October 2010 to evaluate the fungal diseases in PNS by computed tomographic(CT) image and comparison of the findings of this modality with histopathological result. Among the total 76 patients, the mean age of the patients was 35.95 ± 18.24 and common complaints of the patients were nasal obstruction (73.7%) and maximum 53.9% patients had PNS mass in maxillary sinuses. Out of all cases 10 were diagnosed as having fungal infection/mass by CT scan and confirmed by histopathological evaluation. Two cases were diagnosed as having fungal infection/mass by CT scan but not confirmed by histopathological findings. Of 64 cases of other than fungal infection/mass, which were diagnosed by CT scan, six were confirmed as having fungal infection/mass and 58 were other than having fungal infection/mass by histopathology. Sensitivity of CT scan to diagnose fungal infection/mass was 62.5%, specificity 96.7%, positive predictive value 83.3%, negative predictive value 90.6% and accuracy 89.5%. CT scan of the fungal diseases in paranasal sinus provides more information and better image quality and CT diagnosis correlate well with the findings of histopathology. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21002 J Bangladesh Coll Phys Surg 2013; 31: 189-193

Benign Sinonasal Masses: A Clinicopathological and Radiological Profile

Benign nasal and paranasal sinus masses are commonly encountered in clinical practice. Though benign, certain nasal polyps, fungal sinusitis, hemangiomas and fibro-osseous tumors can present with locally destructive features and deformities, mimicking malignancies at once. This study was carried out to recognize the great variety of benign nasal lesions and their frequency in our region. A retrospective chart analysis of cases presenting as mass in nose and paranasal sinus that underwent surgery over three years duration at our institute was done. A provisional diagnosis was made after clinical assessment and radiological investigations, but the final diagnosis was established after histopathological examination. A total 331 cases presented as masses in nose and paranasal sinus presented during the period. The clinicopathological examination aided by endoscopic and imaging studies revealed the non neoplastic benign masses in 293 and neoplastic masses in 38. Polyps were the commonest lesions constituting 70% cases followed by rhinosporidiosis in 10%. Fungal sinusitis, squamous papillomas, hemangiomas and inverted papillomas were found to be in order of 4.5%, 4%, 3.5% and 3% respectively. Rare cases like "rhinooto- cereberal" form of mucormycosis, angiomyoma, and psammomatoid ossifying fibroma were also observed in the study. Most of the nasal polyps/fungal sinusitis can be diagnosed clinically. However many a times Computer tomography (CT) scan and biopsy are necessary to differentiate them from each other and treatment plan. Certain benign tumors have high potential for malignant transformation while others can present with locally destructive features and deformities.

Role of CT in the Evaluation of Nasopharyngeal Angiofibroma in Para Nasal Sinus

Computed tomography (CT) is the gold standard for exact delineation of paranasal sinus(PNS) disease. There are many radiologically important diseases of paranasal sinuses. Objective of the study was to evaluate the role of computed tomographic image(CT) in the diagnosis of nasopharyngeal angiofibroma. A cross sectional study was carried out in the department of Radiology &amp; Imaging, Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka in collaboration with department of Otolaryngology and department of Pathology of BSMMU. This study was carried out with patients having suspected PNS mass and the duration of the study was from January 2009 to October 2010. Maximum 30.3% patients were belonged to 46 to 60 years age group and of them maximum 73.7% had complaints of nasal obstruction. Maximum 53.9% patients had PNS mass in maxillary sinuses and out of all cases 8 were diagnosed as having nasopharyngeal angiofibroma by CT scan and confirmed by histopathological evaluation. Two cases were diagnosed as having nasopharyngeal angiofibroma by CT scan but not confirmed by histopathological findings. By CT evaluation total 66 cases were diagnosed as having other than nasopharyngeal angiofibroma and confirmed by histopathology. Sensitivity of CT scan to diagnose nasopharyngeal angiofibroma was 100.0%, specificity 97.1 %, positive predictive value 80.0%, negative predictive value 100.0% and accuracy 97.4%. In conclusion, CT scan of the nasopharyngeal angiofibroma in para nasal sinus provides more information and better image quality and CT diagnosis correlate well with the findings of histopathology. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18801 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 27-30

Clinico-pathological Study of Space Occupying Lesions of Nasal Cavity, Paranasal Sinuses and Nasopharynx.

A variety of non-neoplastic and neoplastic lesions of nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in clinical practice. The aim of this study was to study clinical and histopathological profile of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx in a tertiary care hospital of Rajasthan over the period of January 2013 to January 2014. This was a prospective study of 147 cases (male 100, female 47; age group ranging from less than 1 y to 76 y) of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx over the period of 12 months (from January 2013 to January 2014). All tissues after fixation in 10% buffered formalin, processed and then stained with Hematoxylin & Eosin to study various histopathological patterns. These 147 cases were broadly categorized in two categories, one category as nasal and paranasal sinus masses and the other as nasopharyngeal masses with 91 and 56 cases, respectively. These lesions were common in second and third decades of life with male predominance. Among nasal and paranasal sinus masses, there were 67 (73.6%) non-neoplastic and 24 (26.4%) neoplastic lesions. Inflammatory polyps (89.5%) were the most common among the non-neoplastic masses; Inverted papilloma (45.46%) the most common among the benign neoplastic and squamous cell carcinoma (46.15%) was the commonest out of all malignant masses. Out of 56 nasopharyngeal masses, there were 53 (94.6%) non neoplastic and 3 (5.4%) neoplastic lesions. Majority of these i.e. 52 cases were of adenotonsillar hypertrophy. We concluded that complete clinical, radiological and histopathological correlation helps us to categorize these sinonasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, although Immunohistochemistry is the final diagnostic method in few cases.

Compressive Optic Neuropathy Caused by Orbital Non-Hodgkin's Lymphoma

Purpose. To present a unique case of Non-Hodgkin's-Lymphoma- (NHL) associated compressive optic neuropathy. Method. An 89-year-old male presenting with acute unilateral visual loss and headache. Results. Patient was initially diagnosed with occult giant cell arteritis; however after visual acuity deteriorated despite normal inflammatory markers, an urgent MRI scan revealed an extensive paranasal sinus mass compressing the optic nerve. Conclusion. Paranasal sinus malignancies occasionally present to the ophthalmologist with signs of optic nerve compression and must be included in the differential diagnosis of acute visual loss.

Progressive Vision Loss of a Deployed Soldier with Paranasal Sinus Mass

Objective: Understand the causes of progressive vision loss of a deployed soldier with paranasal sinus mass. Evaluate effectiveness of a multidisciplinary treatment team on the patient’s disease morbidity. Method: Case report of a soldier deployed to Iraq who developed allergic fungal sinusitis and presented with compressive optic neuritis. He was treated with high dose steroids and functional endoscopic sinus surgery with recurrent bilateral optic neuritis two weeks after surgery. Results: The patient was found to have allergic fungal sinusitis of a pneumatized clivus with a dehiscent optic nerve. He originally had excellent recovery of his vision after FESS. While recovering at home he had a subsequent relapse in both eyes 2 weeks later. Repeat imaging and exam in the operating room did not show a recurrence of the fungal debris. A multidisciplinary team involving ophthalmology, neurosurgery, and infectious disease subsequently found false positive Lyme titers with positive serology for syphilis in conjunction with his infectious optic neuritis. Conclusion: Vision loss from optic neuritis can be caused by sinusitis of the sphenoid such as with allergic fungal sinusitis, but other diagnoses and a multidisciplinary team must be pursued if initial treatment does not result in sustained or expected improvement.

Paranasal Sinus Masses of Rocky Mountain Bighorn Sheep (Ovis canadensis canadensis)

This article describes 10 cases of paranasal sinus masses in Rocky Mountain bighorn sheep (Ovis canadensis canadensis). Among 21 bighorns that were examined from 11 herds in Colorado, 10 individuals (48%) from 4 herds (36%) had masses arising from the paranasal sinuses. Affected animals included 9 of 17 females (53%) and 1 of 4 males (25%), ranging in age from approximately 2 years to greater than 10 years. Defining gross features of these masses included unilateral or bilateral diffuse thickening of the respiratory lining of the maxillary and/or frontal sinuses, with abundant seromucinous exudate in the affected sinus cavities. Defining histologic features of these masses included chronic inflammation and proliferation of mesenchymal and epithelial cells of the mucosa and submucosa. Epithelial changes included hyperplasia of mucosal epithelium, hyperplasia of submucosal glands and ducts, and neoplasia (adenocarcinoma). Mesenchymal changes included submucosal myxedema, submucosal fibroplasia/fibrosis, bone destruction, and neoplasia (myxomatous fibroma). Specific immunohistochemistry and polymerase chain reaction for Jaagsiekte sheep retrovirus and enzootic nasal tumor virus were performed with negative results.