58y/o man with proptosis

 

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Hedieh Zamini

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Male
Age : 58

 

Clinical Summary

58 y/o man with proptosis and sinus pain.

 

Imaging Findings

Images demonstrate large destructive expansile soft tissue mass,isosignal on T1 and high signal on T2,filling right frontal sinus with extension into ethmoidal sinus and orbital cavity causing proptosis and orbital displacement . In post contrast sequences heterogenous enhancement is depicted

 

Differential Diagnosis

•sinonasal carcinoma : unfortunately imaging is unable to confidently distinguish between inverted papillomas, inverted papilloma with malignancy and pure malignancy
•antrochoanal polyp - only peripheral enhancement (if any)
•inflammatory polyp - only peripheral enhancement (if any)
•juvenile nasopharyngeal angiofibroma (JNA)
•olfactory neuroblastoma
•paranasal sinus mucocoele

 

Final Diagnosis

Inverted Papilloma

 

Discussion (Related Text)

An inverted papilloma is an uncommon sinonasal tumour with distinctive pathological and imaging features. Inverted papillomas account for approximately 0.5-4.0% of all nasal tumours and are most frequently seen in patients 40-60 years of age .There is a significant predilection for males (M:F of ~ 3-5:1) . Presentation can be similar to other sinonasal masses, with nasal obstruction, sinus pain, and epistaxis. Inverted papillomas most commonly occur on the lateral wall of the nasal cavity, most frequently related to middle turbinate and maxillary ostium, although they are seen elsewhere in the nasal passage. As the mass enlarges it results in bony remodelling and resorption and often extends into the maxillary antrum. Due to the location, impairment of normal drainage of the maxillary antrum is common, although mucocoele formation is rare CT features are largely non-specific, demonstrating a soft tissue density mass with some enhancement. The location of the mass is one of the few clues toward the correct diagnosis. Calcification is sometimes observed which is helpful, as is focal hyperostosis which tends to occur at the site of tumour origin . This is useful not only in suggesting the diagnosis, but also to aid surgical planning, as the location of tumour origin determines the extent of surgery required. As the mass enlarges bony resorption and destruction may be present, with similar pattern to that seen in patients with squamous cell carcinoma. MRI often demonstrates a distinctive appearance, referred to as convoluted cerebriform pattern seen on both T2 and contrast enhanced T1 weighted images. This represents alternating lines of high and low signal intensity, the appearance of which has been likened to, albeit loosely, cerebral cortical gyrations. This sign is seen in 50 - 100% of cases, and is uncommon in other sinonasal tumours .

 

References

inverted papilloma,Dr yuranga Weerakkody et al. 2008

 

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