PMC7301186_01
Contrast-enhanced CT sinuses (coronal section). Shows right-sided lesion within the nasal cavity associated with bony erosion and slight deviation of the upper aspect of the nasal septum to the left. There is associated complete soft tissue opacification of the frontal sinuses, ethmoidal sinuses, and maxillary sinus. Note the close relationship with the anterior ethmoid artery.
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An urgent contrast-enhanced CT scan of the sinuses was performed (Figure 2) which showed a mass lesion within the right nasal cavity causing local expansion and deviation of the nasal septum to the left and bowing of right medial orbital wall with opacification of the frontal, ethmoid, and maxillary sinuses and bony demineralisation of the adjacent skull base.
Contrast-enhanced MRI sinuses (coronal section, T2-weighted image). Demonstrates the demarcation between the mass and polypoid maxillary sinus, not appreciated on CT.
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Further evaluation with a contrast-enhanced MRI scan of the sinuses (Figure 3) demonstrated a lobulated right nasal cavity soft tissue mass involving the middle turbinate and uncinate process and extending superiorly making contact with the cribiform plate and olfactory recess but not extending intracranially.
Intraoperative endoscopic photograph displaying the soft tissue mass in the right nasal cavity obstructing the middle meatus.
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Appearances were concerning for an aggressive malignant lesion, subsequently leading to urgent diagnostic endoscopic resection (Figure 4).
(a) Haematoxylin and eosin stain x100 magnification: showing sheets of histiocytes with abundant eosinophilic cytoplasm intermingled with polymorphs. (b) Haematoxylin and eosin stain x100 magnification: showing multinucleate giant cells in the infiltrate (*). (c) CD68 stain x200 magnification: highlighting histiocytes (*). (d) S100 stain x200 magnification: a giant cell shows engulfed polymorphs in its cytoplasm (*).
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The histology (Figure 5) showed a polypoid lesion composed of a proliferation of large foamy histiocytic cells with associated lymphocytes, neutrophils, and eosinophils.
Noncontrast enhanced CT sinuses (coronal section). Postoperative scan demonstrates right ethmoidectomy, middle turbinectomy, and creation of middle meatal antrostomy. Well-aerated sinonasal spaces and no tumour recurrence.
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