PMC5009576_01
Axial (a) and sagittal (b) T1-weighted Gd-enhanced magnetic resonance imaging (MRI) on admission, showing a contrast-enhancing sinonasal mass with intracranial extension through the cribriform plate into the anterior cranial fossa. Postoperative axial (c) and sagittal (d) T1-weighted Gd-enhanced MRI demonstrating complete removal of the sinonasal and intracranial tumor
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F1
He was referred to our department after magnetic resonance imaging (MRI) showed an enormous mass occupying the nasal and paranasal cavities and extending into the bilateral frontal base [Figure 1a and b]. Total removal of the tumor was achieved surgically, using a transnasal approach in combination with a bilateral front basal craniotomy [Figure 1c and d].
Magnetic resonance imaging on second admission. The T2-weighted images (WI) (a) and Gd-enhanced T1-WI (b) sagittal images show multiple intradural lesions between C3 and Th4. Gd-enhanced axial T1-WI images reveal compression of the spinal cord along its right ventral aspect at C4/5 (c) and C5/6 (d)
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F2
C6, hyperreflexia of both legs, and urinary incontinence. CT and MRI revealed an intradural lesion compressing the spinal cord along its right ventral aspect at C5 through T2 [Figure 2a-d]; MRI of the head showed no evidence of tumor recurrence.
Photomicrographs of the spinal tumor. The hematoxylin and eosin-stained sections show tumor cells predominantly arranged in a densely growing pattern, scattered necrotic changes, nuclear fission, and Homer-Wright rosettes (a: x100, b: x200). These findings are consistent with Hyams grade 3 olfactory neuroblastoma and with the pathological findings of the first surgery
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F3
The tumor was histologically diagnosed as ONB, consistent with the first operation [Figure 3a and b].
Magnetic resonance imaging performed 1 week after the surgery. The T2-weighted images (WI) (a) and Gd-enhanced T1-WI (b) sagittal images demonstrate residual tumor. Gd-enhanced T1-WI axial images at the level of C4/5 (c) and C5/6 (d) show the decreased compression of the spinal cord
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F4
Residual tumor was seen on MRI performed 1 week after the surgery but the spinal cord was well decompressed [Figure 4a-d].