PMC5225690_01
(a) Magnetic resonance imaging T1-weighted image sagittal view showing an isointense mass lesion in the sphenoid sinus, (b) the lesion is enhancing on contrast on gadolinium contrast sagittal view, and (c) coronal view. (d) Shows a microphotograph with clusters of histiocytoid cells with a convoluted, indented nucleus admixed with giant cells and mixed inflammatory cells (H and E, x400). Inset showing the tumor cells positive for CD1a immunostain (x400) suggestive of Langerhans cell histiocytosis
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F1
Immunohistochemistry (IHC) showed CD1a positive with MIB-1 labeling index of 10%-12% [Figure 1].
(a) Showed a T1-weighted sagittal view showing an isointense mass lesion located in the sphenoid sinus with (b) showing postgadolinium contrast enhancement of the lesion in T1-weighted sagittal images and (c) coronal images. (d) Microphotograph showing respiratory mucosa (*) with a submucosal cellular infiltrating neoplasm (#) which is infiltrating the bone ($) as well (H and E, x100). Inset shows the tumor composed of plasmacytoid cells (H and E, x200) suggestive of plasmacytoma
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F2
Histopathology showed cellular lesion with monomorphic small to medium cells in sheets, infiltrating bone which was strongly positive for lambda light chain and few cells for kappa chain, negative for cytokeratin, chromogranin, and pituitary hormones [Figure 2].
(a) Shows a T2-weighted sagittal magnetic resonance imaging with a hyperintense mass lesion located in the sphenoid sinus which is enlarged. (b) Shows the lesion in not enhancing on T1-weighted postgadolinium contrast compared to (c) axial T1-weighted image with a iso-hypointense mass located in the sphenoid sinus. (d) Microphotograph showing a myxoid neoplasm with diffusely scattered polyhedral cells having a vacuolated bubbly cytoplasm (Physaliphorous cells) in a highly myxoid stroma (H and E, x400) suggestive of chordoma
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F3
Histopathology showed a cellular neoplasm with prominent myxoid stroma, small epithelial-like dispersed cells with eosinophilic cytoplasm arranged in sheets, and trabeculae, interspersed with characteristic vacuolated physaliphorous cells [Figure 3].
(a) Shows a T2 weighted sagittal magnetic resonance imaging image with a heterogeneously iso-hyperintense mass located in the sphenoid sinus, (b) the lesion is enhancing heterogeneously on postgadolinium contrast sagittal magnetic resonance imaging and (c) axial magnetic resonance imaging. (d) Microphotograph showing the neoplasm composed of closely packed acinar clusters of uniform round to polyhedral neuroendocrine cells (H and E, x400) suggestive of pituitary adenoma
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F4
There was no bony defect seen in the sellar floor [Figure 4].
(a) Showing a T2-weighted sagittal view with a heterogeneously iso-hypointense mass lesion located in the sphenoid sinus. (b) Shows heterogonous enhancement of lesion after gadolinium administration, (c) lesion is isointense on plain T1-weighted images. (d) Microphotographs showing a cellular spindle cell tumor with interlacing fascicles; inset (1) showing the increased MIB-1 labeling and inset (2) showing positive staining for smooth muscle actin. Vimentin positive but negative for S100, desmin, creatine kinase, and CD99 suggestive of leiomyosarcoma
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F5
MIB-1 labeling was 8%-10% [Figure 5].
(a) Shows a T2-weighted sagittal magnetic resonance imaging with a hypointense mass lesion located inside the sphenoid sinus. (b) The lesion is not enhancing peripherally on postgadolinium T-weighted images (c) and in coronal images. (d) Microphotograph showing ulcerated mucosa with a colony of fungal hyphae morphologically resembling Aspergillus (H and E, x100) inset shows the fungal colony with slender septate and branching hyphae (H and E, x400)
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F6
There were no eosinophilic infiltrate or Charcot-Leyden crystals [Figure 6].
(a) Shows a T2-weighted sagittal magnetic resonance imaging with a hyperintense mass lesion in the sphenoid sinus with enlargement of sphenoid sinus. (b) The lesion is hyperintense on plain T1-weighted images and (c) not enhancing on postgadolinium injection axial and (d) coronal imagesab
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F7
Patient underwent transnasal resection of lesion [Figure 7].