PMC7758204_01
Nasal endoscopic findings. Before chemoradiotherapy (A,B). A white tumor occupied right nasal cavity. X and * indicate the inferior nasal turbinate and nasal septum, respectively. After chemoradiotherapy (C,D). A white tumor was localized at the medial surface of right middle nasal turbinate (C). Right common nasal meatus was widely opened, and the olfactory cleft was clearly visualized (D).
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F1
Nasal endoscopy revealed a white tumor with a rugged margin that occupied the right nasal cavity (Figures 1A,B). In addition, only a bulge remained on the medial surface of the middle turbinate (Figure 1C). The mucous membranes of the nasal septum, the olfactory cleft, the superior and inferior turbinate, the middle meatus and the choana appeared to be normal (Figure 1D).
Computed tomography (CT) of the sinonasal region. Axial view (A,B,D,E). Coronal view (C,F). Enhanced CT scans obtained before chemoradiotherapy (A-C). On the right side, the nasal cavity and paranasal sinus were fully opacified. On the left side, the part of the sphenoid sinus were opacified. CT scans obtained after chemoradiotherapy (D-F). Opacification was only localized in the part of the right ethmoid sinus (E,F).
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F2
Sinonasal contrast computed tomography (CT) confirmed the presence of partially enhanced opacification in the right nasal cavity (Figures 2A-C). On day 94, CT showed that opacification of the right nasal cavity had completely disappeared (Figures 2D-F).
T2-weighted magnetic resonance imaging (MRI) of the sinonasal region. Axial view (A,C). Coronal view (B,D). Before chemoradiotherapy (A,B). Low signal area was observed mainly in the right nasal cavity, ethmoid and sphenoid sinuses. High signal intensity area was found in right maxillary and left sphenoid sinuses. After chemoradiotherapy (C,D). In right maxillary sinus, high signal intensity area was disappeared (C). High signal intensity area was observed within the ethmoid sinus (D).
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F3
T2-weighted magnetic resonance imaging (MRI) showed a right sinonasal mass with a low signal intensity, which mainly occupied the nasal cavity and part of the ethmoid sinus (Figures 3A,B). On day 95, T1- and T2-weighted MRI of the right ethmoid sinus confirmed a high signal intensity area (Figures 3C,D).
Positron emission tomography with 18F-fluorodeoxyglocose (FDG PET) of the sinonasal region. Axial view (A,B,D,E). Coronal view (C,F). Before chemoradiotherapy (A-C). Significant FDG uptake was found in right nasal cavity, ethmoid and sphenoid sinus. PET scans obtained after chemoradiotherapy (D-F). No significant FDG uptake was found in right nasal cavity or paranasal sinus (D-F).
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On the left side, the uppermost part of the nasal cavity showed a low signal intensity, and the anterior part of the sphenoid sinus showed a high signal intensity. 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed significant FDG uptake in the right nasal cavity and the ethmoid and sphenoid sinuses, indicating that the detected tumor was primitive, and extended to the surrounding two sinuses (Figures 4A-C). On day 99, no uptake of FDG in the right sinonasal area was shown by PET (Figures 4D-F).
Histopathological examination of biopsy specimen obtained before chemoradiotherapy (A-F) and the excised middle meatus after chemoradiotherapy (G,H). (A) Hematoxylin & eosin staining (H&E) x40. (B) H&E x100. (C) Cytokeratin 7 immunostaining x40. (D) Cytokeratin 20 immunostaining x40. (E) CDX2 immunostaining x40. (F) P16 immunostaining x40. (G,H) H&E x40 and x100, respectively.
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Histopathological examination of a hematoxylin and eosin (H&E)-stained biopsy specimen revealed a single layer of uniform columnar cells with an eosinophilic cytoplasm, with rare mitotic figures forming a tubular growth that infiltrated the underlying stroma (Figures 5A,B). Immunohistochemistry revealed that the tumor cells were immunoreactive with antibodies against cytokeratin 7 (CK7) and p16 and were not immunoreactive with antibodies against cytokeratin 20 (CK20), CDX2, or MUC2 (Figures 5C-F). Histopathological examination revealed that the lesion had been replaced by granulation tissue with lymphocytic infiltration and hemosiderin-laden macrophages, and no viable tumor cells remained (Figures 5G,H).