PMC4275463_01
(A) Rigid 0  endoscopy of left nasal cavity shows a smooth, mucosa-covered mass splaying the posterior septum and filling the entire nasopharynx. (B) Endoscopic 30  view 24 months status after endoscopic resection shows a common nasal cavity after the tumor resection and septectomy, which is well mucosalized and without evidence of recurrence. Solid white arrow shows the base of the drilled-out basi-sphenoid in the midline. Broken white arrow shows the midline ethmoid skull base at attachment of nasal septum, and black arrows depict the most superior vertical attachments of the middle turbinate.
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F1
Nasal endoscopy revealed a large, smooth, mucosa-covered mass splaying the nasal septum posteriorly and filling the nasopharynx (Fig. 1A). After 24 months of follow-up, the patient has done well, without evidence of recurrence or development of bony pathology (Fig. 1B).
Intraoperative view using the computerized navigation system showing triplanar CT images correlating with tip of suction instrument in intraoperative endoscopic view. The triplanar CT images illustrate the extent of tumor on preoperative imaging, whereas endoscopic image in bottom right shows the sinonasal cavity in real-time with complete tumor resection. Note the splaying of the nasal septum and basi-sphenoid area with tumor abutting ethmoid skull base and extending across the sphenoid rostrum to the clivus on CT images.
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F2
A computed tomography (CT) and magnetic resonance imaging (MRI) were obtained and are depicted in Figs. 2 and 3 showing this expansile extracranial mass. After tumor resection, the skull base was drilled at the sites of attachment along the planum sphenoidale and ethmoid roof to the posterior frontal table (Fig. 2).
Tumor as visualized on MRI. (A) Axial fat-suppressed T2-weighted image demonstrates a heterogeneous mass expanding the posterior right nasal cavity and eroding into the sphenoid sinuses. The mass is predominantly isointense to cerebral gray matter with central areas of T2 hyperintensity (asterisk). (B) Axial fat-suppressed T1-weighted postcontrast image is likewise heterogeneous with central areas of nonenhancement (asterisk). The postcontrast MRI more clearly defines the posterior margins of the tumor (arrows) relative to trapped secretions in the sphenoid sinuses. No cavernous sinus invasion is present.
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F3
A computed tomography (CT) and magnetic resonance imaging (MRI) were obtained and are depicted in Figs. 2 and 3 showing this expansile extracranial mass.
(A) Low power view of sinonasal PMT showing variable cellularity and vascularity. (B) High-power view shows small, stellate cells in a myxoid matrix with a prominent vascular stroma and areas of hyalinization.
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F4
Pathological analysis of biopsy tissue showed a sheet-like distribution of monotonous, bland tumor cells in a background of vascular myxoid stroma, consistent with PMT (Fig. 4). Final histopathologic diagnosis confirmed negative margins and reconfirmed the diagnosis of PMT (Fig. 4).