A 70 year old man with previous history of nasal obstruction

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : ----------------
Academic Degree: ----------------
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Soudeh Jorjani

 

Patient's Information

Gender : Male
Age : 70

 

Case Section

Head & Neck Imaging

 

Clinical Summary

A 70 year old man with previous history of nasal obstruction and epistaxis presenting with seizure

 

 

Imaging Procedures and Findings

There is a soft tissue mass originating from nasopharynx with extension anteriorly to the nasal cavity and downward to the oropharynx. Left parapharyngeal and retropharyngeal fatty spaces are obliterated and carotid space is displaced posteriorly. Erosion of the left maxillary sinus wall with extension into it and pterygopalatine fossa is noted. Further extension to masticator space via pterygomaxillary fissure and then intracranial invasion through foramen oval is visible. There is also direct extension to the middle cranial fossa via distinct bone erosion of the sphenoid sinus. Hypo dense area around the intracranial extension is edema. Some necrotic lymph node in high jugular chain (zone 2) and posterior cervical space (zone 5) are noted.

 

Discussion

Squamous cell carcinoma of the sinonasal cavity arises most commonly from the maxillary sinus. Most are low-grade tumors that arise from the nasal septum near the mucocutaneous junction. The primary pathologic and therefore imaging feature of these lesions is propensity to destroy bone even in the presence of a relatively small demonstrable mass. Because squamous cell carcinoma and other carcinomas have a density similar to that of adjacent secretions within obstructed sinuses, a small region of bony abnormality and apparent destruction is important for the early imaging diagnosis of carcinoma, especially squamous cell carcinoma. IV contrast injection for CT scanning is rarely useful for differentiating tumor from inflammatory conditions or masses within the sinuses. The tumors themselves tend to enhance very little, whereas inflammatory mucosa may sometimes enhance brightly. However, the data suggest that enhanced (Gd-DTPA) MRl examinations may be most useful for differentiating neoplastic from inflammatory masses within the paranasal sinuses when this diagnosis is in doubt. These lesions also tend to spread along perineural sheaths and to leave normal skip areas between the primary lesion and a local metastatic site along a nerve. This is often the case when a tumor arising in the maxillary sinus gains access to the mandibular nerve and extends toward the skull base. At the time of radical antrectomy, the surgeon may be informed that the frozen sections showed no evidence of tumor. Some studies indicate that in many cases there has already been distant regional metastasis into the cavernous sinus at the time of surgery with an intervening normal segment of the trigeminal nerve. It has become the role of the imaging specialist, therefore, to evaluate the cavernous sinus and the more proximal portions of the trigeminal nerve in such patients to establish proper staging before radical and disfiguring surgery is undertaken.

 

Final Diagnosis

Squamous cell carcinoma of the nasopharynx

 

References

CT and MRI of the Whole body. John R. Haaga. Volume1

 

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