PMC10041614_01
Coronal images from MRI of the brain of a 51-year-old male patient presenting with pain and facial swelling of the right cheek. (A-D) The MRI was obtained using the trigeminal nerve (CN V) protocol with/without contrast. The T1-weighted magnetization-prepared 180  radio-frequency pulses and rapid gradient-echo (MP RAGE) sequence was obtained prior to biopsy. Coronal images from anterior (left, (A)) to posterior (right, (D)) demonstrate an enhanced infiltrative soft tissue mass (black arrows) centered in the right pterygopalatine fossa/retroantral fat extending into the right orbit/superior orbital fissure, right posterolateral nasopharynx and along the right maxillary branch of the trigeminal nerve and vidian nerves as well as the right masticator space. There is no definite intracranial extension. There is minimal involvement of the posterior right maxillary sinus.
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A magnetic resonance image (MRI) of the brain was obtained and revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along V2 and the vidian nerve, causing concern for potential malignancy (Figures 1 and 2).
Axial images from an MRI of the brain of a 51-year-old male patient presenting with pain and facial swelling of the right cheek. (A and B) The MRI was obtained using the trigeminal nerve (CN V) protocol with/without contrast. The T1-weighted magnetization-prepared 180  radio-frequency pulses and rapid gradient-echo (MP RAGE) sequence was obtained prior to biopsy. (A) Axial image showing enhanced soft tissue filling and expansion of the right pterygopalatine fossa extending into the right nasopharyngeal/parapharyngeal and masticator spaces (orange circle). (B) Secondary extension of the soft tissue mass along the lateral right orbital wall measuring 0.5 x 1.9 cm deep to the lateral rectus muscle (white lines).
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A magnetic resonance image (MRI) of the brain was obtained and revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along V2 and the vidian nerve, causing concern for potential malignancy (Figures 1 and 2).
Histological analysis of intraoperative biopsy tissues of a 51-year-old male patient presenting with pain and facial swelling of the right cheek. (A-E). (A) The tortuous profile of a large sphenopalatine artery branch shows varying degrees of luminal obliteration (asterisk), fibrointimal edema, and focal transmural inflammation (arrow). (B) A different artery shows architectural irregularities due to granulomatous inflammatory infiltrates (arrows). (C) Elastin stain demonstrates focal obliteration of the elastic layer (asterisk). (D) Acute neutrophil-rich vasculitis of smaller vessels. (E) Poorly formed granulomas with multinucleated giant cells, lymphocytes, and edema.
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Histological assessment demonstrated multiple arteries with partial to complete luminal obliteration associated with loosely formed non-necrotizing granulomas, consistent with granulomatous vasculitis (Figure 3).