PMC5461572_01
Pre operative CEMRI and CECT scan of the brain and paranasal sinuses showing dumbbell shaped mass in the left superior nasal cavity with extensions into the anterior cranial fossa and paranasal sinuses. The 'waist' of the dumbbell is at the cribriform plate. The mass shows intense heterogeneous post contrast enhancement. Peritumoral cysts are also noted at the tumor brain interface
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F1
The lesion involved bilateral ethmoidal and sphenoidal sinuses also [Figure 1].
Immediate post operative CECT scan of the brain and paranasal sinuses showing complete excision of the mass
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F2
Postoperative CECT scan of the brain and paranasal sinuses was suggestive of gross complete excision of the mass [Figure 2].
(a and b) Hematoxylin and eosin stained slides (x100) - showing olfactory neuroblastoma which is having a lobular pattern of primitive cells, no fibrillary matrix and showing squamous (single arrow) and glandular differentiation (double arrow) and inset (x200) having true rosettes (Flexner Wintersteiner rossette, double head arrow). (c-e) IHC (x400) (c) Strong synaptophysin positivity is seen in the tumor cells, (d) Cytokeratin 5/6 positivity is seen in the squamous cells and (e) Cytokeratin 7- focal positivity in the glands (thin arrow)
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F3
The final histopathological report was "mixed olfactory neuroblastoma-carcinoma (squamous and glandular differentiation) Hyams grade IV" [Figure 3].
Imaging two months after the first surgery showing full blown recurrence of esthesioneuroblastoma
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F4
CECT scan and CEMRI of the brain and paranasal sinuses were suggestive of a large recurrence of esthesioneuroblastoma with similar extensions as before [Figure 4].