PMC6402053_01
Computed tomography of the first presentation. Bone window axial (A) and coronal (B) computed tomography shows total opacification with multiple density in left sphenoid sinus (asterisk) and left Onodi cell, osteolytic and hyperplastic lesion involving posterior and inferior wall of left sphenoid sinus (arrow).
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Sinus wall destruction was seen, involving posterior and inferior walls of the left sphenoid sinus, left-sided clivus, and left pterygoid plate (Figure 1), and we suspected chronic invasive fungus rhinosinusitis.
Histopathology of the lesions from the left sphenoid sinuses. Cyst-like spaces, lined by keratinizing benign squamous epithelium (A) (magnification: 100x); bone erosion, characterized by fragmented bony elements admixed with keratin materials, is also present (B) (magnification: 100x); and uniform regular-shaped hyphae, morphologically consistent with Aspergillus spp. (C) (magnification: 600x).
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Histopathology revealed cyst-like spaces, lined by keratinizing benign squamous epithelium compatible with sphenoid sinus cholesteatoma (Figure 2A). Bone erosion, characterized by fragmented bony elements admixed with keratin materials, were observed (Figure 2B). Fungal balls, consisting of uniform, regular-shaped hyphae, morphologically consistent with Aspergillus spp. (Figure 2C), were detected in the left sphenoid sinus without evidence of tissue invasion.
Computed tomography and histopathology of disease progression. Bone window axial (A) and bone window coronal (B) computed tomography shows progression of disease with multiple permeative bony destructions, involving bony sinus walls and central skull base (asterisk), involving left greater wing of the sphenoid bone, left medial pterygoid plate, clivus, medial border of left foramen ovale, left anterior part of foramen lacerum, medial part of left foramen spinosum, left petrous bone, and left carotid canal, encasing intrapetrous internal carotid artery and histopathology shows numerous inflammatory cells, mainly neutrophils admixed with keratin materials surrounding resorbed bony spicules, compatible with acute osteomyelitis (C) (magnification: 200x).
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It involved left greater wing of the sphenoid bone, left medial pterygoid plate, clivus, medial border of left foramen ovale, left anterior part of foramen lacerum, medial part of left foramen spinosum, left petrous bone, and left carotid canal, encasing intrapetrous internal carotid artery (Figure 3A and B). There were many neutrophilic infiltrates admixed with keratin, the features of which were compatible with acute osteomyelitis (Figure 3C).