PMC8602088_01
Endoscopic findings of localized sinonasal amyloidosis viewed from the right (A) and left (B) nasal cavities at the first visit to our hospital. The deviation of nasal septum to the right. The mucosa was smooth and pink, with nodular thickening, and bilateral narrowing of the common nasal meatus was observed. Plain computed tomography (CT) of the present case obtained at the previous hospital. Axial (C) and coronal (D) views of bone window CT of the head showed the deviation of the nasal septum to the right, thickening of the bilateral nasal mucosa, and deposition of microcalcified material in the submucosa of the nasal cavity, including the bilateral nasal septum, and middle and inferior turbinates. Magnetic resonance images of the present case obtained at the first visit to our hospital. Coronal views of plain T1-weighted (E) and T2-weighted imaging (F) of the head showed bilateral thickening of the nasal mucosa and numerous hypointense punctate signal areas in the submucosa of the entire nasal cavity.
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F1
On nasal endoscopy, the nasal septum was deviated to the right, the nasal mucosa was smooth and pink with nodular thickening, and the common nasal meatus was so narrow that the bilateral middle turbinates or posterior part of the nasal cavity were not visible (Figures 1A,B). Plain computed tomography (CT) revealed the deviation of the nasal septum to the right, thickening of the bilateral nasal mucosa, and deposition of microcalcified material in the submucosa of the nasal cavity, including the bilateral nasal septum, middle, and inferior turbinates (Figures 1C,D). Non-enhanced MRI showed bilateral thickening of the nasal mucosa and numerous hypointense punctate signal areas in the submucosa of the entire nasal cavity on both T1- and T2-weighted images (Figures 1E,F).
Histopathological features of localized amyloidosis of the nasal mucosa. (A) A histological examination revealed large deposits of amorphous eosinophilic with calcification (H&E staining, x20). (B) The calcification was stained black (von Kossa staining, x40). (C) Amyloid depositions with apple-green birefringence were found in the stroma when viewed with polarized light (Congo red staining, x20).
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F2
A histological examination revealed large deposits of amorphous eosinophilic substance with calcification (Figure 2A), which was stained black by von Kossa staining (Figure 2B), and the presence of amyloid on Congo-red staining with apple-green birefringence when viewed with polarized light (Figure 2C).
Intraoperative findings (A,B). The submucosal tissue with severe calcification ( ) was very hard and difficult to resect with the turbinate blade of a microdebrider (A). Hard submucosal tissue with calcification (Delta) was resected with an ultrasonic bone curette to preserve as much of the mucosal surface as possible (B). Comparison of preoperative (C) and postoperative (D) rhinomanometry results at 6 months. The nasal resistance in both nostrils was improved after surgery. Computed tomography at 6 months after surgery (E). Deviation of the nasal septum, mucosal thickening of the septum and bilateral inferior turbinates was improved and the bilateral common nasal meatuses were enlarged.
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F3
Since the submucosal tissue with severe calcification was very hard and difficult to resect with the turbinate blade of a microdebrider (Figure 3A), an ultrasonic bone curette (UBC) (Sonopet ) was also used to partially resect the submucosal tissue by shaving it off (Figure 3B). The objective evaluation of nasal obstruction using rhinomanometry also revealed the improvement of nasal resistance in both nostrils (Figures 3C,D). CT revealed the enlargement of the bilateral common nasal meatus (Figure 3E).