PMC4921178_01
A. 3D surface-rendered image from a CT showing nasolabial swelling over the topography of the right nasolacrimal duct. B. Illustration of the nasolacrimal duct corresponding to the area of swelling. Illustration courtesy of Mia S. Kelly, BA (copyright 2015).
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A 5-month-old male infant developed asymptomatic focal right nasolabial swelling over the right nasomaxillary crease that extended over the right cheek (Fig. 1).
Unenhanced CT (coronal and axial) images (A and B) reveal an expansile, lobulated, circumscribed, low-attenuation, soft-tissue mass centered over the right nasomaxillary groove and eroding into the left nasal cavity and inferomedial floor of the right orbit, without bony lysis.
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A CT scan revealed an expansile, low-attenuation, cystic-appearing mass eroding and protruding into the right nasal cavity and right inferior orbital wall, without bony lysis or intraorbital extension (Figs. 2A-B).
A. T1W unenhanced axial image shows homogeneous T1 hypointensity in a well-circumscribed, low-attenuation mass over the right nasolacrimal gland. B. Avid homogeneous enhancement is seen on the post-contrast, fat-saturated T1 view. C. Homogeneous T2 prolongation is seen throughout the lesion except for a punctate focus of low T2 signal posteriorly. D. FLAIR-weighted images show intermediate signal (lack of fluid suppression), which suggests that the lesion is either solid or that it is a cyst containing proteinaceous material. E. GRE axial images reveal several small oval susceptibility artifacts that could represent degraded blood products or mineralization. F. ADC map in axial plane shows high signal within the lesion, indicative of facilitated diffusion.
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T1-hypointense (Fig. 3A), heterogeneously enhancing lesion (3B) that was homogeneously T2-hyperintense (3C). There was incomplete fluid suppression on the T2 FLAIR images (Fig. 3D). Small susceptibility artifacts within the mass were noted on the gradient echo (GRE) sequence, possibly due to calcifications or microhemorrhage (Fig. 3E). Bright signal was present on the ADC map, compatible with facilitated diffusion (Fig. 3F).
Grossly, the biopsy and resection specimen consisted of pink, glistening, gelatinous soft tissue.
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The mass itself was gelatinous, gray, not vascular, and located medial to and distinct from the right nasolacrimal duct, which was preserved (Fig. 4).
A. Histologically, the tumor is composed of loose, myxoid tissue with numerous stellate and spindled fibroblasts. There was minimal cytoatypia, with small bland nuclei and no discernable mitotic activity. There was focal acute hemorrhage, but no necrosis was seen. B. The stroma was superficially infiltrated between bony spicules, eliciting reactive changes including osteoblastic rimming.
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Histological analysis revealed loose myxoid tissue interspersed with stellate and spindled fibroblasts, characteristic of a sinonasal myxoma, confirming myxoma (Fig. 5).