PMC3953676_01
MRI of esthesioneuroblastoma/inverted papilloma collision tumor. Mass can be visualized in addition to inspissated secretions in the surrounding sinuses.
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F1
On MRI, the mass obstructed the right sphenoid sinus with inspissated secretions surrounding the mass (Figure 1).
Nasal endoscopy view of collision tumor.
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F2
Nasal endoscopy (Figure 2) with debulking and biopsy revealed a high-grade malignant neoplasm adjacent to a sinonasal papilloma with focal inverted growth pattern (Figure 3).
Hematoxylin and eosin stain - high power of sinonasal inverted papilloma with infiltration of epithelium by atypical cells (esthesioneuroblastoma).
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F3
Nasal endoscopy (Figure 2) with debulking and biopsy revealed a high-grade malignant neoplasm adjacent to a sinonasal papilloma with focal inverted growth pattern (Figure 3).
Immunohistochemistry of lesion for synaptophysin (characteristically stains positive in esthesioneuroblastoma).
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F4
Further immunohistochemical analysis showed the neoplastic cells to be focally positive for pan-keratin, neuron-specific enolase (NSE), synaptophysin (Figure 4), epithelial membrane antigen (EMA), and vimentin.
Immunohistochemistry of lesion for neurofilament stain (characteristically stains positive in esthesioneuroblastoma).
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F5
Additionally, rare immunoreactivity was noted in the subepithelial tumor cells for chromogranin, neurofilament (Figure 5), and GFAP.
(A-H) IMRT treatment plan with contoured target volume in axial, coronal, and sagittal view for the nasopharyngeal volume (A-D) and the neck volumes (E-H). (I-L) Cyberknife treatment plan with the target volume in axial, coronal, and sagittal views.
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F6
Figure 6 shows a composite of his radiation treatment plan.