PMC3909850_01
Hyperostotic esthesioneuroblastoma in 65-year-old male mimicking fibrous dysplasia.. A, B. Axial and coronal CT images show diffuse sclerotic expansile bones of anterior skull base and superior sinonasal cavity (arrows). Hyperostotic bones show homogeneous, ground glass appearance. C, D. Axial T2 and post-contrast T1 fat saturated MR images show enhancing rind of soft tissue mass (curved arrows) along hyperostotic bones (dashed arrows) which shows mild heterogeneous enhancement. Note formation of small cysts at tumor-brain interface (short arrows). Note formation of mucocele (long arrow).. E, F. Axial and coronal FDG-PET CT fused color images show intense FDG avidity in hyperostotic bones (blue arrows) indicating diffuse tumor infiltration. Uptake in thin rind of soft tissue mass could not be separately visualized. G, H. Histologic images (H&E stains with 200 x (G) and 400 x (H) magnification). (G) Shows predominantly reactive bone formation, and (H) demonstrates sheet of tumor cells (arrows) within reactive bone.
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CT (Fig. 1A, B) showed expansile, diffuse hyperostosis of the ethmoid bones, nasal septum, superomedial orbital walls and anterior frontal skull base. FDG-PET (Fig. 1E, F) showed a corresponding diffuse hypermetabolic uptake in the soft tissues and bones. Endoscopic biopsies of the mass and bone confirmed the diagnosis of ONB with osseous tumor infiltration (Fig. 1G, H).